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Talavera B, Chaitanya G, Hupp N, Pati S, Hampson JP, Luo X, Hampson J, Vakilna YS, Rani MRS, Noor R, Mosher JC, Tandon N, Lhatoo SD, Lacuey N. Stimulation-induced respiratory enhancement in corticothalamic regions. Epilepsia 2023; 64:1925-1938. [PMID: 37119434 DOI: 10.1111/epi.17635] [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: 01/23/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE We aimed to identify corticothalamic areas and electrical stimulation paradigms that optimally enhance breathing. METHODS Twenty-nine patients with medically intractable epilepsy were prospectively recruited in an epilepsy monitoring unit while undergoing stereoelectroencephalographic evaluation. Direct electrical stimulation in cortical and thalamic regions was carried out using low (<1 Hz) and high (≥10 Hz) frequencies, and low (<5 mA) and high (≥5 mA) current intensities, with pulse width of .1 ms. Electrocardiography, arterial oxygen saturation (SpO2 ), end-tidal carbon dioxide (ETCO2 ), oronasal airflow, and abdominal and thoracic plethysmography were monitored continuously during stimulations. Airflow signal was used to estimate breathing rate, tidal volume, and minute ventilation (MV) changes during stimulation, compared to baseline. RESULTS Electrical stimulation increased MV in the amygdala, anterior cingulate, anterior insula, temporal pole, and thalamus, with an average increase in MV of 20.8% ± 28.9% (range = 0.2%-165.6%) in 19 patients. MV changes were associated with SpO2 and ETCO2 changes (p < .001). Effects on respiration were parameter and site dependent. Within amygdala, low-frequency stimulation of the medial region produced 78.49% greater MV change (p < .001) compared to high-frequency stimulation. Longer stimulation produced greater MV changes (an increase of 4.47% in MV for every additional 10 s, p = .04). SIGNIFICANCE Stimulation of amygdala, anterior cingulate gyrus, anterior insula, temporal pole, and thalamus, using certain stimulation paradigms, enhances respiration. Among tested paradigms, low-frequency, low-intensity, long-duration stimulation of the medial amygdala is the most effective breathing enhancement stimulation strategy. Such approaches may pave the way for the future development of neuromodulatory techniques that aid rescue from seizure-related apnea, potentially as a targeted sudden unexpected death in epilepsy prevention method.
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Affiliation(s)
- Blanca Talavera
- Texas Institute of Restorative Neurotechnologies, University of Texas Health Science Center, Houston, Texas, USA
| | - Ganne Chaitanya
- Texas Institute of Restorative Neurotechnologies, University of Texas Health Science Center, Houston, Texas, USA
| | - Norma Hupp
- Texas Institute of Restorative Neurotechnologies, University of Texas Health Science Center, Houston, Texas, USA
| | - Sandipan Pati
- Texas Institute of Restorative Neurotechnologies, University of Texas Health Science Center, Houston, Texas, USA
| | - Johnson P Hampson
- Texas Institute of Restorative Neurotechnologies, University of Texas Health Science Center, Houston, Texas, USA
| | - Xi Luo
- Texas Institute of Restorative Neurotechnologies, University of Texas Health Science Center, Houston, Texas, USA
- Department of Biostatistics and Data Science, University of Texas Health Science Center, School of Public Health, Houston, Texas, USA
| | - Jaison Hampson
- Texas Institute of Restorative Neurotechnologies, University of Texas Health Science Center, Houston, Texas, USA
| | - Yash S Vakilna
- Texas Institute of Restorative Neurotechnologies, University of Texas Health Science Center, Houston, Texas, USA
| | - M R Sandhya Rani
- Texas Institute of Restorative Neurotechnologies, University of Texas Health Science Center, Houston, Texas, USA
| | - Rabeha Noor
- Epilepsy Monitoring Unit, Memorial Hermann Houston Medical Center, Houston, Texas, USA
| | - John C Mosher
- Texas Institute of Restorative Neurotechnologies, University of Texas Health Science Center, Houston, Texas, USA
| | - Nitin Tandon
- Texas Institute of Restorative Neurotechnologies, University of Texas Health Science Center, Houston, Texas, USA
- Department of Neurosurgery, University of Texas Health Science Center, School of Public Health, Houston, Texas, USA
| | - Samden D Lhatoo
- Texas Institute of Restorative Neurotechnologies, University of Texas Health Science Center, Houston, Texas, USA
| | - Nuria Lacuey
- Texas Institute of Restorative Neurotechnologies, University of Texas Health Science Center, Houston, Texas, USA
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Bucurenciu I, Staack AM, Gharabaghi A, Steinhoff BJ. High-frequency electrical stimulation of the anterior thalamic nuclei increases vigilance in epilepsy patients during relaxed and drowsy wakefulness. Epilepsia 2020; 61:1174-1182. [PMID: 32385944 DOI: 10.1111/epi.16514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE High-frequency deep brain stimulation (DBS) of anterior thalamic nuclei (ANT) reduces the frequency and intensity of focal and focal to bilateral tonic-clonic epileptic seizures. We investigated the impact of high-frequency ANT-DBS on vigilance in epilepsy patients during relaxed and drowsy wakefulness, to better understand the effects and the mechanisms of action of this intervention in humans. METHODS Four patients with different structural epileptic pathologies were included in this retrospective case-cohort study. Short- and long-term electroencephalography (EEG) was used to determine states of relaxed or drowsy wakefulness and the vigilance changes during stimulation-on and stimulation-off intervals. RESULTS In relaxed, wakeful patients with eyes closed, the eyelid artifact rate increased acutely and reproducibly during stimulation-on intervals, suggesting an enhanced vigilance. This effect was accompanied by a slight acceleration of the alpha rhythm. In drowsy patients with eyes closed, stimulation generated acutely and reproducibly alpha rhythms, similar to the paradoxical alpha activation during eyes opening. The occurrence of the alpha rhythms reflected an increase in the vigilance of the drowsy subjects during ANT-DBS. SIGNIFICANCE This is the first demonstration that ANT-DBS increases the vigilance of wakeful epilepsy patients. Our results deliver circumstantial evidence that high-frequency ANT-DBS activates thalamocortical connections that promote wakefulness.
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Affiliation(s)
| | | | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard-Karls University Hospital, Tübingen, Germany
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