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Bearden DJ, Ehrenberg A, Selawski R, Ono KE, Drane DL, Pedersen NP, Cernokova I, Marcus DJ, Luongo-Zink C, Chern JJ, Oliver CB, Ganote J, Al-Ramadhani R, Bhalla S, Gedela S, Zhang G, Kheder A. Four-Way Wada: SEEG-based mapping with electrical stimulation, high frequency activity, and phase amplitude coupling to complement traditional Wada and functional MRI prior to epilepsy surgery. Epilepsy Res 2023; 192:107129. [PMID: 36958107 PMCID: PMC11008564 DOI: 10.1016/j.eplepsyres.2023.107129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/29/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023]
Abstract
Presurgical evaluation of refractory epilepsy involves functional investigations to minimize postoperative deficit. Assessing language and memory is conventionally undertaken using Wada and fMRI, and occasionally supplemented by data from invasive intracranial electroencephalography, such as electrical stimulation, corticortical evoked potentials, mapping of high frequency activity and phase amplitude coupling. We describe the comparative and complementary role of these methods to inform surgical decision-making and functional prognostication. We used Wada paradigm to standardize testing across all modalities. Postoperative neuropsychological testing confirmed deficit predicted based on these methods.
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Affiliation(s)
- D J Bearden
- Children's Healthcare of Atlanta, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - R Selawski
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - K E Ono
- Children's Healthcare of Atlanta, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - D L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - N P Pedersen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - D J Marcus
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - C Luongo-Zink
- Children's Healthcare of Atlanta, Atlanta, GA, USA; William James College, Newton, MA, USA
| | - J J Chern
- Department of Neurosurgery, Children's Healthcare of Atlanta, USA
| | - C B Oliver
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - J Ganote
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - R Al-Ramadhani
- University of Pittsburgh Medical Center Children's Hospital, Pittsburgh, PA 15224, USA
| | - S Bhalla
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - S Gedela
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - G Zhang
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - A Kheder
- Children's Healthcare of Atlanta, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
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2
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Smith KM, Alden EC, Simpson HD, Brinkmann BH, Gregg NM, Miller KJ, Lundstrom BN. Multimodal approach leads to seizure-freedom in a case of highly refractory drug-resistant focal epilepsy. Epilepsy Behav Rep 2022; 20:100570. [PMID: 36411878 PMCID: PMC9674497 DOI: 10.1016/j.ebr.2022.100570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/23/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Drug-resistant, nonlesional, extratemporal lobe focal epilepsy can be difficult to treat and may require a high degree of multidisciplinary teamwork to localize the seizure onset zone for resective surgery. Here, we describe a patient with longstanding drug-resistant, nonlesional, extratemporal focal epilepsy with a high seizure burden who became seizure-free after prolonged evaluation and eventual left frontal cortical resection. Prior evaluations included magnetoencephalography, invasive video-EEG monitoring, and implantation of a responsive neurostimulation (RNS) device for ongoing intracranial stimulation. Highly sophisticated techniques were utilized including stereotactic localization of prior evaluations to guide repeat stereo-EEG (SEEG), electrical stimulation mapping, SEEG-guided radiofrequency ablation, and awake resection with language and motor mapping using a cognitive testing platform . Incorporating a wide array of data from multiple centers and evaluation time periods was necessary to optimize seizure control and minimize the risk of neurological deficits from surgery.
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Affiliation(s)
- Kelsey M. Smith
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
- Corresponding author.
| | - Eva C. Alden
- Department of Psychology and Psychiatry, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
| | - Hugh D. Simpson
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Benjamin H. Brinkmann
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
| | - Nicholas M. Gregg
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
| | - Kai J. Miller
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
| | - Brian N. Lundstrom
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
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Sivaraju A, Spencer DD, Hirsch LJ. Intrastimulation discharges during electrical stimulation mapping May help identify seizure onset network. Brain Stimul 2021; 14:652-654. [PMID: 33826933 DOI: 10.1016/j.brs.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/03/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- Adithya Sivaraju
- Comprehensive Epilepsy Center, Department of Neurology, Yale University, New Haven, CT, USA.
| | - Dennis D Spencer
- Comprehensive Epilepsy Center, Department of Neurosurgery, Yale University, New Haven, CT, USA
| | - Lawrence J Hirsch
- Comprehensive Epilepsy Center, Department of Neurology, Yale University, New Haven, CT, USA
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Sabsevitz DS, Middlebrooks EH, Tatum W, Grewal SS, Wharen R, Ritaccio AL. Examining the function of the visual word form area with stereo EEG electrical stimulation: A case report of pure alexia. Cortex 2020; 129:112-118. [PMID: 32442776 DOI: 10.1016/j.cortex.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 01/30/2020] [Revised: 03/10/2020] [Accepted: 04/08/2020] [Indexed: 11/24/2022]
Abstract
Functional imaging studies have implicated an area in the left lateral fusiform gyrus, known as the visual word form area (VWFA), in pre-lexical orthographic processing. There are very few studies that have examined the functional specificity of this area in patients with discrete lesions limited to this region. Here we describe a rare opportunity to examine the functional specificity of the VWFA in a patient with stereo EEG (sEEG) electrodes implanted for localization of seizures prior to epilepsy surgery. sEEG offers the opportunity to create a transient and highly localized electrophysiological lesion to examine brain behavior correlates during functional mapping. In this case, word reading and writing as well as a variety of non-orthographic language functions (e.g., picture and face naming, auditory naming, and non-word repetition), were tested during electrical stimulation at a series of different electrode contact sites in the ventral temporal region. Pure alexia resulted from stimulation of the lateral fusiform gyrus at coordinates nearly identical to those published for the VWFA in the functional imaging literature.
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Affiliation(s)
- David S Sabsevitz
- Department of Psychology and Psychiatry, Mayo Clinic, Jacksonville, FL, USA; Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Erik H Middlebrooks
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA; Department of Neuroradiology, Mayo Clinic, Jacksonville, FL, USA
| | - William Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Sanjeet S Grewal
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Robert Wharen
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Anthony L Ritaccio
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA; Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
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Katlowitz KA, Oya H, Howard MA, Greenlee JDW, Long MA. Paradoxical vocal changes in a trained singer by focally cooling the right superior temporal gyrus. Cortex 2017; 89:111-119. [PMID: 28282570 PMCID: PMC5421518 DOI: 10.1016/j.cortex.2017.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/26/2016] [Accepted: 01/30/2017] [Indexed: 11/24/2022]
Abstract
The production and perception of music is preferentially mediated by cortical areas within the right hemisphere, but little is known about how these brain regions individually contribute to this process. In an experienced singer undergoing awake craniotomy, we demonstrated that direct electrical stimulation to a portion of the right posterior superior temporal gyrus (pSTG) selectively interrupted singing but not speaking. We then focally cooled this region to modulate its activity during vocalization. In contrast to similar manipulations in left hemisphere speech production regions, pSTG cooling did not elicit any changes in vocal timing or quality. However, this manipulation led to an increase in the pitch of speaking with no such change in singing. Further analysis revealed that all vocalizations exhibited a cooling-induced increase in the frequency of the first formant, raising the possibility that potential pitch offsets may have been actively avoided during singing. Our results suggest that the right pSTG plays a key role in vocal sensorimotor processing whose impact is dependent on the type of vocalization produced.
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Affiliation(s)
- Kalman A Katlowitz
- NYU Neuroscience Institute, New York University Langone Medical Center, New York, NY, USA; Department of Otolaryngology, New York University Langone Medical Center, New York, NY, USA; Center for Neural Science, New York University, New York, NY, USA
| | - Hiroyuki Oya
- Human Brain Research Lab, Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Matthew A Howard
- Human Brain Research Lab, Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Jeremy D W Greenlee
- Human Brain Research Lab, Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Michael A Long
- NYU Neuroscience Institute, New York University Langone Medical Center, New York, NY, USA; Department of Otolaryngology, New York University Langone Medical Center, New York, NY, USA; Center for Neural Science, New York University, New York, NY, USA.
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Casciato S, Ritaccio AL. Ezio Sciamanna: The Italian contribution to the origin of cortical stimulation mapping in humans. Epilepsy Behav 2016; 62:186-8. [PMID: 27490906 DOI: 10.1016/j.yebeh.2016.07.003] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022]
Abstract
Influenced by Ferrier's 1873 publication documenting his initial experience with cortical stimulation mapping (CSM) across several species, 19th-century experiments applying electric current to exposed human brain soon followed. Bartholow is commonly credited with the first report of CSM in a conscious human in 1874. What is not well established is that prominent Italian neurologist, Ezio Sciamanna, localized sensorimotor function in a human demonstration of CSM shortly thereafter in 1882. Sciamanna was in the vanguard of functional localization of brain function through direct stimulation of human gray matter. Unlike Bartholow, who has been canonized in the annals of CSM, Sciamanna has remained relatively obscure, despite the fact that his case may represent a better example of true subdural CSM than his better known contemporary.
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Affiliation(s)
- Sara Casciato
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Viale dell'Università 30, 00185 Rome, Italy
| | - Anthony L Ritaccio
- Department of Neurology, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA.
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Ritaccio A, Brunner P, Gunduz A, Hermes D, Hirsch LJ, Jacobs J, Kamada K, Kastner S, Knight RT, Lesser RP, Miller K, Sejnowski T, Worrell G, Schalk G. Proceedings of the Fifth International Workshop on Advances in Electrocorticography. Epilepsy Behav 2014; 41:183-92. [PMID: 25461213 PMCID: PMC4268064 DOI: 10.1016/j.yebeh.2014.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 09/03/2014] [Accepted: 09/05/2014] [Indexed: 11/30/2022]
Abstract
The Fifth International Workshop on Advances in Electrocorticography convened in San Diego, CA, on November 7-8, 2013. Advancements in methodology, implementation, and commercialization across both research and in the interval year since the last workshop were the focus of the gathering. Electrocorticography (ECoG) is now firmly established as a preferred signal source for advanced research in functional, cognitive, and neuroprosthetic domains. Published output in ECoG fields has increased tenfold in the past decade. These proceedings attempt to summarize the state of the art.
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Affiliation(s)
| | - Peter Brunner
- Albany Medical College, Albany, NY, USA,Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Gerwin Schalk
- Albany Medical College, Albany, NY, USA,Wadsworth Center, New York State Department of Health, Albany, NY, USA
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Hamberger MJ, Williams AC, Schevon CA. Extraoperative neurostimulation mapping: results from an international survey of epilepsy surgery programs. Epilepsia 2014; 55:933-9. [PMID: 24816083 DOI: 10.1111/epi.12644] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Extraoperative electrical stimulation mapping (ESM) to identify functional cortex is performed prior to neurosurgical resection at epilepsy surgery programs worldwide. However, the procedure remains unstandardized, with no established clinical guidelines. We sought to determine the current range in ESM practice parameters across established epilepsy surgery centers. METHODS We developed and distributed a 31-question survey to 220 epilepsy centers worldwide regarding current practice parameters of ESM. Questions addressed preoperative assessment, technical stimulation parameters, language testing protocols, criteria for identification of positive or negative functional sites, management of mapping complications, and postoperative functional outcome. RESULTS Survey responses were obtained from 56 centers. These revealed marked practice variability in virtually all aspects of the ESM procedure. These aspects included critical procedure components such as electrical stimulation settings, the types of language functions tested, the operational definition of a language error, size of surgical resection margin, cortical locations mapped for language, testing in the presence of afterdischarges, and medical management of mapping complications. Forty-one percent of centers reported at least one persistent adverse language outcome despite preserving all eloquent sites defined by their stimulation mapping procedure. SIGNIFICANCE The striking variations in practice across centers are likely to influence mapping results, which directly affect the boundaries of cortical resection and, consequently, might worsen either seizure or functional outcomes. Clearly, adverse functional outcomes occur despite mapping procedures that were perceived to be adequate. Investigation of critical technical and procedural aspects of stimulation mapping is warranted, with the ultimate goal of establishing empirically based practice guidelines to improve the safety and efficacy of ESM and resective epilepsy surgery. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
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Affiliation(s)
- Marla J Hamberger
- Department of Neurology, Columbia University Medical Center, New York, New York, U.S.A
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