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Fan CH, Tsai HC, Tsai YS, Wang HC, Lin YC, Chiang PH, Wu N, Chou MH, Ho YJ, Lin ZH, Yeh CK. Selective Activation of Cells by Piezoelectric Molybdenum Disulfide Nanosheets with Focused Ultrasound. ACS Nano 2023; 17:9140-9154. [PMID: 37163347 DOI: 10.1021/acsnano.2c12438] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
An accurate method for neural stimulation within the brain could be very useful for treating brain circuit dysfunctions and neurological disorders. With the aim of developing such a method, this study investigated the use of piezoelectric molybdenum disulfide nanosheets (MoS2 NS) to remotely convert ultrasound energy into localized electrical stimulation in vitro and in vivo. The application of ultrasound to cells surrounding MoS2 NS required only a single pulse of 2 MHz ultrasound (400 kPa, 1,000,000 cycles, and 500 ms pulse duration) to elicit significant responses in 37.9 ± 7.4% of cells in terms of fluxes of calcium ions without detectable cellular damage. The proportion of responsive cells was mainly influenced by the acoustic pressure, number of ultrasound cycles, and concentration of MoS2 NS. Tests using appropriate blockers revealed that voltage-gated membrane channels were activated. In vivo data suggested that, with ultrasound stimulation, neurons closest to the MoS2 NS were 3-fold more likely to present c-Fos expression than cells far from the NS. The successful activation of neurons surrounding MoS2 NS suggests that this represents a method with high spatial precision for selectively modulating one or several targeted brain circuits.
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Affiliation(s)
- Ching-Hsiang Fan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City 701401, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan City 701401, Taiwan
| | - Hong-Chieh Tsai
- Division of Neurosurgery, Linkou Chang Gung Memorial Hospital, Taoyuan City 333423, Taiwan
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yi-Sheng Tsai
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu City 300044, Taiwan
| | - Hsien-Chu Wang
- Department of Medical Science, Institute of Molecular Medicine, National Tsing Hua University, Hsinchu City 300044, Taiwan
| | - Yu-Chun Lin
- Department of Medical Science, Institute of Molecular Medicine, National Tsing Hua University, Hsinchu City 300044, Taiwan
| | - Po-Han Chiang
- Institute of Biomedical Engineering, National Yang Ming Chiao Tung University, Hsinchu City 30010, Taiwan
| | - Nan Wu
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu City 300044, Taiwan
| | - Min-Hwa Chou
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu City 300044, Taiwan
| | - Yi-Ju Ho
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu City 30010, Taiwan
| | - Zong-Hong Lin
- Department of Biomedical Engineering, National Taiwan University, Taipei City 10617, Taiwan
| | - Chih-Kuang Yeh
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu City 300044, Taiwan
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Cole ER, Grogan DP, Laxpati NG, Fernandez AM, Skelton HM, Isbaine F, Gutekunst CA, Gross RE. Evidence supporting deep brain stimulation of the medial septum in the treatment of temporal lobe epilepsy. Epilepsia 2022; 63:2192-2213. [PMID: 35698897 DOI: 10.1111/epi.17326] [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: 12/09/2021] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/28/2022]
Abstract
Electrical brain stimulation has become an essential treatment option for more than one third of epilepsy patients who are resistant to pharmacological therapy and are not candidates for surgical resection. However, currently approved stimulation paradigms achieve only moderate success, on average providing approximately 75% reduction in seizure frequency and extended periods of seizure freedom in nearly 20% of patients. Outcomes from electrical stimulation may be improved through the identification of novel anatomical targets, particularly those with significant anatomical and functional connectivity to the epileptogenic zone. Multiple studies have investigated the medial septal nucleus (i.e., medial septum) as such a target for the treatment of mesial temporal lobe epilepsy. The medial septum is a small midline nucleus that provides a critical functional role in modulating the hippocampal theta rhythm, a 4-7-Hz electrophysiological oscillation mechanistically associated with memory and higher order cognition in both rodents and humans. Elevated theta oscillations are thought to represent a seizure-resistant network activity state, suggesting that electrical neuromodulation of the medial septum and restoration of theta-rhythmic physiology may not only reduce seizure frequency, but also restore cognitive comorbidities associated with mesial temporal lobe epilepsy. Here, we review the anatomical and physiological function of the septohippocampal network, evidence for seizure-resistant effects of the theta rhythm, and the results of stimulation experiments across both rodent and human studies, to argue that deep brain stimulation of the medial septum holds potential to provide an effective neuromodulation treatment for mesial temporal lobe epilepsy. We conclude by discussing the considerations necessary for further evaluating this treatment paradigm with a clinical trial.
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Affiliation(s)
- Eric R Cole
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | | | - Nealen G Laxpati
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alejandra M Fernandez
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Henry M Skelton
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Faical Isbaine
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Claire-Anne Gutekunst
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert E Gross
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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Riestenberg RA, Sherman AE, Clark AJS, Shahlaie K, Zwienenberg M, Alden T, Bandt SK. Patient-Specific Characteristics Associated with Favorable Response to Vagus Nerve Stimulation. World Neurosurg 2022; 161:e608-e624. [PMID: 35202878 DOI: 10.1016/j.wneu.2022.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The expansion in treatments for medically refractory epilepsy heightens the importance of identifying patients who are likely to benefit from vagus nerve stimulation (VNS). Here, we identify predictors with a positive VNS response. METHODS We present a retrospective analysis of 158 patients with medically refractory epilepsy. Patients were categorized as VNS responders or nonresponders. Baseline characteristics and time to VNS response were recorded. Univariate and multivariate Cox regression were used to identify predictors of response. Recursive partitioning analysis was used to identify likely VNS responders. RESULTS Eighty-nine (56.3%) patients achieved ≥50% seizure frequency reduction. Left-hand dominance (hazard ratio [HR] 1.703, P = 0.038), age at epilepsy onset ≥15 years (HR 2.029, P = 0.005), duration of epilepsy ≥8 years (HR 1.968, P = 0.007) and age at implantation ≥35 years (HR 1.809, P = 0.020), and baseline seizure frequency <5/month (HR 1.569, P = 0.044) were significant univariate predictors of VNS response. Following multivariate Cox regression, left-hand dominance, age at epilepsy onset ≥15 years, and duration of epilepsy ≥8 years remained significant. With recursive partitioning analysis, patients with either age at epilepsy onset ≥15 years, left-hand dominance, or baseline seizure frequency <5/month were stratified into Group A and had a 73.9% responder rate; the remaining patients stratified into Group B had a 43.8% responder rate. CONCLUSIONS Patients with age at epilepsy onset ≥15 years, left-hand dominance, or baseline seizure frequency <5/month are ideal candidates for VNS.
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Affiliation(s)
- Robert A Riestenberg
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA.
| | - Alain E Sherman
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Austin J S Clark
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
| | - Marike Zwienenberg
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
| | - Tord Alden
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - S Kathleen Bandt
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Takeuchi Y, Harangozó M, Pedraza L, Földi T, Kozák G, Li Q, Berényi A. Closed-loop stimulation of the medial septum terminates epileptic seizures. Brain 2021; 144:885-908. [PMID: 33501929 DOI: 10.1093/brain/awaa450] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/29/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
Temporal lobe epilepsy with distributed hippocampal seizure foci is often intractable and its secondary generalization might lead to sudden death. Early termination through spatially extensive hippocampal intervention is not feasible directly, because of the large size and irregular shape of the hippocampus. In contrast, the medial septum is a promising target to govern hippocampal oscillations through its divergent connections to both hippocampi. Combining this 'proxy intervention' concept and precisely timed stimulation, we report here that closed-loop medial septum electrical stimulation can quickly terminate intrahippocampal seizures and suppress secondary generalization in a rat kindling model. Precise stimulus timing governed by internal seizure rhythms was essential. Cell type-specific stimulation revealed that the precisely timed activation of medial septum GABAergic neurons underlaid the effects. Our concept of time-targeted proxy stimulation for intervening pathological oscillations can be extrapolated to other neurological and psychiatric disorders, and has potential for clinical translation.
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Affiliation(s)
- Yuichi Takeuchi
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary.,Department of Neuropharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, 467-8603, Japan.,Neurocybernetics Excellence Center, University of Szeged, Szeged 6720, Hungary
| | - Márk Harangozó
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary
| | - Lizeth Pedraza
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged 6720, Hungary
| | - Tamás Földi
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged 6720, Hungary
| | - Gábor Kozák
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary
| | - Qun Li
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged 6720, Hungary
| | - Antal Berényi
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged 6720, Hungary.,HCEMM-USZ Magnetotherapeutics Research Group, University of Szeged, Szeged 6720, Hungary.,Neuroscience Institute, New York University, New York, NY 10016, USA
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Auzmendi J, Akyuz E, Lazarowski A. The role of P-glycoprotein (P-gp) and inwardly rectifying potassium (Kir) channels in sudden unexpected death in epilepsy (SUDEP). Epilepsy Behav 2021; 121:106590. [PMID: 31706919 DOI: 10.1016/j.yebeh.2019.106590] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the major cause of death that affects patients with epilepsy. The risk of SUDEP increases according to the frequency and severity of uncontrolled seizures; therefore, SUDEP risk is higher in patients with refractory epilepsy (RE), in whom most antiepileptic drugs (AEDs) are ineffective for both seizure control and SUDEP prevention. Consequently, RE and SUDEP share a multidrug resistance (MDR) phenotype, which is mainly associated with brain overexpression of ABC-transporters such as P-glycoprotein (P-gp). The activity of P-gp can also contribute to membrane depolarization and affect the normal function of neurons and cardiomyocytes. Other molecular regulators of membrane potential are the inwardly rectifying potassium channels (Kir), whose genetic variants have been related to both epilepsy and heart dysfunctions. Although it has been suggested that dysfunctions of the cardiac, respiratory, and brainstem arousal systems are the causes of SUDEP, the molecular basis for explaining its dysfunctions remain unknown. In rats, repetitive seizures or status epilepticus induced high expression of P-gp and loss Kir expression in the brain and heart, and promoted membrane depolarization, malignant bradycardia, and the high rate of mortality. Here we reviewed clinical and experimental evidences suggesting that abnormal expression of depolarizing/repolarizing factors as P-gp and Kir could favor persistent depolarization of membranes without any rapid functional recovery capacity. This condition induced by convulsive stress could be the molecular mechanism leading to acquired severe bradycardia, as an ineffective heart response generating the appropriate scenario for SUDEP development. This article is part of the Special Issue "NEWroscience 2018".
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Affiliation(s)
- Jerónimo Auzmendi
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina; INFIBIOC, Departamento de Bioquímica Clínica, Facultad de Farmacia y Bioquímica (FFyB), Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Enes Akyuz
- Yozgat Bozok University, Medical Faculty, Department of Biophysics, Erdoğan Akdağ Yerleşkesi, 66100 Yozgat, Turkey
| | - Alberto Lazarowski
- INFIBIOC, Departamento de Bioquímica Clínica, Facultad de Farmacia y Bioquímica (FFyB), Universidad de Buenos Aires (UBA), Buenos Aires, Argentina.
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Kurada AV, Srinivasan T, Hammond S, Ulate-Campos A, Bidwell J. Seizure detection devices for use in antiseizure medication clinical trials: A systematic review. Seizure 2019; 66:61-69. [PMID: 30802844 DOI: 10.1016/j.seizure.2019.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/28/2019] [Accepted: 02/12/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This study characterizes the current capabilities of seizure detection device (SDD) technology and evaluates the fitness of these devices for use in anti-seizure medication (ASM) clinical trials. METHODS Through a systematic literature review, 36 wireless SDDs featured in published device validation studies were identified. Each device's seizure detection capabilities that addressed ASM clinical trial primary endpoint measurement needs were cataloged. RESULTS The two most common types of seizures targeted by ASMs in clinical trials are generalized tonic-clonic (GTC) seizures and focal with impaired awareness (FIA) seizures. The Brain Sentinel SPEAC achieved the highest performance for the detection of GTC seizures (F1-score = 0.95). A non-commercial wireless EEG device achieved the highest performance for the detection of FIA seizures (F1-score = 0.88). DISCUSSION A preliminary assessment of device capabilities for measuring selected ASM clinical trial secondary endpoints was performed. The need to address key limitations in validation studies is highlighted in order to support future assessments of SDD fitness for ASM clinical trial use. In tandem, a stepwise framework to streamline device testing is put forth. These suggestions provide a starting point for establishing SDD reporting requirements before device integration into ASM clinical trials.
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Affiliation(s)
- Abhinav V Kurada
- Department of Biomedical Engineering, Columbia University School of Engineering and Applied Science, New York, NY, USA.
| | - Tarun Srinivasan
- Department of Biochemistry, Columbia University, New York, NY, USA
| | - Sarah Hammond
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Adriana Ulate-Campos
- Department of Neurology, National Children's Hospital "Dr. Carlos Saenz Herrera", San José, Costa Rica
| | - Jonathan Bidwell
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; School of Interactive Computing, Georgia Institute of Technology, 85 Fifth Street NW, Atlanta, GA, USA
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