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Krishnan B, Tousseyn S, Taylor K, Wu G, Serletis D, Najm I, Bulacio J, Alexopoulos AV. Measurable transitions during seizures in intracranial EEG: A stereoelectroencephalography and SPECT study. Clin Neurophysiol 2024; 161:80-92. [PMID: 38452427 DOI: 10.1016/j.clinph.2024.02.022] [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: 08/10/2023] [Revised: 02/05/2024] [Accepted: 02/17/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Ictal Single Photon Emission Computed Tomography (SPECT) and stereo-electroencephalography (SEEG) are diagnostic techniques used for the management of patients with drug-resistant focal epilepsies. While hyperperfusion patterns in ictal SPECT studies reveal seizure onset and propagation pathways, the role of ictal hypoperfusion remains poorly understood. The goal of this study was to systematically characterize the spatio-temporal information flow dynamics between differently perfused brain regions using stereo-EEG recordings. METHODS We identified seizure-free patients after resective epilepsy surgery who had prior ictal SPECT and SEEG investigations. We estimated directional connectivity between the epileptogenic-zone (EZ), non-resected areas of hyperperfusion, hypoperfusion, and baseline perfusion during the interictal, preictal, ictal, and postictal periods. RESULTS Compared to the background, we noted significant information flow (1) during the preictal period from the EZ to the baseline and hyperperfused regions, (2) during the ictal onset from the EZ to all three regions, and (3) during the period of seizure evolution from the area of hypoperfusion to all three regions. CONCLUSIONS Hypoperfused brain regions were found to indirectly interact with the EZ during the ictal period. SIGNIFICANCE Our unique study, combining intracranial electrophysiology and perfusion imaging, presents compelling evidence of dynamic changes in directional connectivity between brain regions during the transition from interictal to ictal states.
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Affiliation(s)
- Balu Krishnan
- Neurological Institute, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA.
| | - Simon Tousseyn
- Academic Center for Epileptology, Kempenhaeghe and Maastricht UMC+, Heeze, The Netherlands; School for Mental Health and Neuroscience (MHeNs), University Maastricht (UM), Maastricht, The Netherlands
| | - Kenneth Taylor
- Neurological Institute, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Guiyun Wu
- Neurological Institute, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Demitre Serletis
- Neurological Institute, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Imad Najm
- Neurological Institute, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Juan Bulacio
- Neurological Institute, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
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Monney J, Dallaire SE, Stoutah L, Fanda L, Mégevand P. Voxeloc: A time-saving graphical user interface for localizing and visualizing stereo-EEG electrodes. J Neurosci Methods 2024; 407:110154. [PMID: 38697518 DOI: 10.1016/j.jneumeth.2024.110154] [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: 10/16/2023] [Revised: 03/26/2024] [Accepted: 04/27/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Thanks to its unrivalled spatial and temporal resolutions and signal-to-noise ratio, intracranial EEG (iEEG) is becoming a valuable tool in neuroscience research. To attribute functional properties to cortical tissue, it is paramount to be able to determine precisely the localization of each electrode with respect to a patient's brain anatomy. Several software packages or pipelines offer the possibility to localize manually or semi-automatically iEEG electrodes. However, their reliability and ease of use may leave to be desired. NEW METHOD Voxeloc (voxel electrode locator) is a Matlab-based graphical user interface to localize and visualize stereo-EEG electrodes. Voxeloc adopts a semi-automated approach to determine the coordinates of each electrode contact, the user only needing to indicate the deep-most contact of each electrode shaft and another point more proximally. RESULTS With a deliberately streamlined functionality and intuitive graphical user interface, the main advantages of Voxeloc are ease of use and inter-user reliability. Additionally, oblique slices along the shaft of each electrode can be generated to facilitate the precise localization of each contact. Voxeloc is open-source software and is compatible with the open iEEG-BIDS (Brain Imaging Data Structure) format. COMPARISON WITH EXISTING METHODS Localizing full patients' iEEG implants was faster using Voxeloc than two comparable software packages, and the inter-user agreement was better. CONCLUSIONS Voxeloc offers an easy-to-use and reliable tool to localize and visualize stereo-EEG electrodes. This will contribute to democratizing neuroscience research using iEEG.
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Affiliation(s)
- Jonathan Monney
- Clinical Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Basic Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Shannon E Dallaire
- Clinical Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Basic Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Dalhousie University, Halifax, Canada
| | - Lydia Stoutah
- Clinical Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Basic Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Université Paris-Saclay, Paris, France
| | - Lora Fanda
- Clinical Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Basic Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pierre Mégevand
- Clinical Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Basic Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Neurology division, Geneva University Hospitals, Geneva, Switzerland.
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Arévalo-Astrada MA, Suller-Marti A, McLachlan RS, Paredes-Aragón E, Jones ML, Parrent AG, Mirsattari SM, Lau JC, Steven DA, Burneo JG. Involvement of the posterior cingulate gyrus in temporal lobe epilepsy: A study using stereo-EEG. Epilepsy Res 2023; 198:107237. [PMID: 37890266 DOI: 10.1016/j.eplepsyres.2023.107237] [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: 03/20/2023] [Revised: 08/22/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To analyze the involvement of the posterior cingulate gyrus (PCG) during mesial temporal lobe seizures (MTLS). METHODS We retrospectively reviewed the stereo-EEG (SEEG) recordings of patients with MTLS performed in our institution from February 2013 to December 2020. Only patients who had electrode implantation in the PCG were included. Patients with lesions that could potentially alter the seizure spread pathways were excluded. We assessed the propagation patterns of MTLS with respect to the different structures sampled. RESULTS Nine of 97 patients who had at least one seizure originating in the mesial temporal region met the inclusion criteria. A total of 174 seizures were analyzed. The PCG was the first site of propagation in most of the cases (8/9 patients and 77.5% of seizures, and 7/8 patients and 65.6% of seizures after excluding an outlier patient). The fastest propagation times were towards the contralateral mesial temporal region and ipsilateral PCG. Seven patients underwent standard anterior temporal lobectomy and, of these, all but one were Engel 1 at last follow up. CONCLUSION We found the PCG to be the first propagation site of MTLS in this group of patients. These results outline the relevance of the PCG in SEEG planning strategies. Further investigations are needed to corroborate whether fast propagation to the PCG predicts a good surgical outcome.
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Affiliation(s)
- Miguel A Arévalo-Astrada
- Division of Neurology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Box 511, Ottawa, Ontario K1H 8L6, Canada
| | - Ana Suller-Marti
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada; Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada
| | - Richard S McLachlan
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada
| | - Elma Paredes-Aragón
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada
| | - Michelle-Lee Jones
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada
| | - Andrew G Parrent
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada
| | - Seyed M Mirsattari
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada
| | - Jonathan C Lau
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada
| | - David A Steven
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada
| | - Jorge G Burneo
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada; Neuro-Epidemiology Unit, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada.
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Li Z, Zhang H, Niu S, Xing Y. Localizing epileptogenic zones with high-frequency oscillations and directed connectivity. Seizure 2023; 111:9-16. [PMID: 37487273 DOI: 10.1016/j.seizure.2023.07.013] [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: 03/27/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/26/2023] Open
Abstract
PURPOSE Precise localization of the epileptogenic zone (EZ) is essential for epilepsy surgery. Existing methods often fail to detect slow onset patterns or similar neural activities presented in the recorded signals. To address this issue, we propose a new measure to quantify epileptogenicity, i.e., the connectivity high-frequency epileptogenicity index (cHFEI). METHODS The cHFEI method combines directed connectivity and high-frequency oscillations (HFOs) to measure the epileptogenicity of regions involved in a brain network. By applying this method to stereoelectroencephalography (SEEG) recordings of 49 seizures in 20 patients, we calculated the accuracy, sensitivity, and precision with a visually identified epileptogenic zone as a reference. The performance was evaluated by the confusion matrix and the area under the receiver operating characteristic (ROC) curve. RESULTS Epileptic network estimation based on cHFEI successfully distinguished brain regions involved in seizure onset from the propagation network. Moreover, cHFEI outperformed other existing detection methods in the estimation of EZs in all patients, with an average area under the ROC curve of 0.88 and an accuracy of 0.85. CONCLUSIONS cHFEI can characterize EZ in a robust manner despite various seizure onset patterns and has potential application in epilepsy therapy.
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Affiliation(s)
- Zhaohui Li
- School of Information Science and Engineering, Yanshan University, Qinhuangdao 066004, China; Hebei Key Laboratory of information transmission and signal processing, Yanshan University, Qinhuangdao 066004, China.
| | - Hao Zhang
- School of Information Science and Engineering, Yanshan University, Qinhuangdao 066004, China
| | - Shipeng Niu
- School of Information Science and Engineering, Yanshan University, Qinhuangdao 066004, China
| | - Yanyu Xing
- School of Information Science and Engineering, Yanshan University, Qinhuangdao 066004, China
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Smith KM, Starnes DK, Brinkmann BH, So E, Cox BC, Marsh WR, Van Gompel JJ, Wirrell E, Britton JW, Burkholder DB, Wong-Kisiel LC. Stereo-EEG localization of midline onset seizures on scalp EEG. Epilepsy Res 2023; 193:107162. [PMID: 37172404 DOI: 10.1016/j.eplepsyres.2023.107162] [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: 02/13/2023] [Revised: 04/06/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE The objective of this study was to describe the sEEG-defined seizure onset zone (SOZ), seizure semiology, presurgical evaluations, surgical intervention and outcome in patients with midline onset noninvasive phase I monitoring. METHODS A single center sEEG database was reviewed to identify patients with seizures onset predominantly involving midline electrodes (FZ, CZ, PZ, OZ) on scalp EEG. Data abstracted included clinical factors, seizure semiology graded into lobar segmentation, imaging and electrographic findings, sEEG plan, interventions, and outcome. RESULTS Twelve patients were identified (8 males, median age of sEEG 28 years) out of 100 cases of sEEG performed from January 2015-September 2019. "Frontal lobe" seizure semiology was the most common. sEEG-defined SOZ were frontal (5), diffuse (1), multifocal (1), frontal and insular (1), frontal and cingulate (1), insular (1), cingulate (1), and mesial temporal (1). CZ and/or FZ scalp EEG changes were present for all patients with SOZ involving the frontal, cingulate, and insular regions. PZ/OZ scalp involvement was present in one patient with mesial temporal SOZ. Four patients underwent a definitive resective or ablative surgery, and the remaining patients underwent a palliative intervention. Of those with follow-up information available, 8/11 had seizure reduction by ≥ 50%, including 4 with an Engel I outcome. No clinical factors were associated with outcome. CONCLUSIONS SOZ for midline onset seizures from noninvasive phase I monitoring was most commonly in the frontal, cingulate, and insular regions. A complex cortical network between these regions may explain overlap in semiology and scalp EEG findings. While the number rendered seizure-free was limited, a significant proportion experienced a reasonably favorable outcome justifying use of sEEG to identify surgical options in these patients.
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Affiliation(s)
- Kelsey M Smith
- Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55906, United States.
| | - Donnie K Starnes
- Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55906, United States
| | - Benjamin H Brinkmann
- Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55906, United States
| | - Elson So
- Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55906, United States
| | - Benjamin C Cox
- Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55906, United States
| | - W Richard Marsh
- Department of Neurosurgery, Mayo Clinic, 200 1st St. SW, Rochester, MN 55906, United States
| | - Jamie J Van Gompel
- Department of Neurosurgery, Mayo Clinic, 200 1st St. SW, Rochester, MN 55906, United States
| | - Elaine Wirrell
- Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55906, United States
| | - Jeffrey W Britton
- Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55906, United States
| | - David B Burkholder
- Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55906, United States
| | - Lily C Wong-Kisiel
- Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55906, United States
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Ferri L, Mai R, di Vito L, Menghi V, Martinoni M, D'Orio P, Licchetta L, Muccioli L, Stipa C, Tinuper P, Bisulli F. A case of clinical worsening after stereo-electroencephalographic-guided radiofrequency thermocoagulation in a patient with polymicrogyria. Epilepsy Behav Rep 2022; 21:100579. [PMID: 36620478 PMCID: PMC9813673 DOI: 10.1016/j.ebr.2022.100579] [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: 10/07/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
Radiofrequency thermocoagulation (RF-TC) is a wide-used procedure for drug-resistant epilepsy. The technique is considered safe with an overall risk of 1.1% of permanent complications, mainly focal neurological deficits. We report the case of a patient with drug-resistant epilepsy who complained of immediate seizure worsening and an unexpected event seven months following RF-TC. A 35-year-old male with drug-resistant epilepsy from the age of 18 years underwent stereoelectroencephalography (SEEG) implantation for a right peri-silvian polymicrogyria. He was excluded from surgery due to extent of the epileptogenic zone and the risk of visual field deficits. RF-TC was attempted to ablate the most epileptogenic zone identified by SEEG. After RF-TC, the patient reported an increase in seizure severity/frequency and experienced episodes of postictal psychosis. Off-label cannabidiol treatment led to improved seizure control and resolution of postictal psychosis. Patients with polymicrogyria (PwP) may present with a disruption of normal anatomy and the co-existence between epileptogenic zone and eloquent cortex within the malformation. RF-TC should be considered in PwP when they are excluded from surgery for prognostic and palliative purposes. However, given the complex interplay between pathological and electrophysiological networks in these patients, the remote possibility of clinical exacerbation after RF-TC should also be taken into account.
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Affiliation(s)
- Lorenzo Ferri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Roberto Mai
- Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Lidia di Vito
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Veronica Menghi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy,Neurology Unit, Rimini “Infermi” Hospital-AUSL Romagna, Rimini, Italy
| | - Matteo Martinoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | | | - Laura Licchetta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Lorenzo Muccioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Carlotta Stipa
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Paolo Tinuper
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesca Bisulli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy,Corresponding author at: Department of Biomedical and Neuromotor Sciences, University of Bologna, Bellaria Hospital, Via Altura 3, Bologna 40139, Italy.
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Sheth SA, Bijanki KR, Metzger B, Allawala A, Pirtle V, Adkinson JA, Myers J, Mathura RK, Oswalt D, Tsolaki E, Xiao J, Noecker A, Strutt AM, Cohn JF, McIntyre CC, Mathew SJ, Borton D, Goodman W, Pouratian N. Deep Brain Stimulation for Depression Informed by Intracranial Recordings. Biol Psychiatry 2022; 92:246-251. [PMID: 35063186 PMCID: PMC9124238 DOI: 10.1016/j.biopsych.2021.11.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [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: 08/16/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/02/2022]
Abstract
The success of deep brain stimulation (DBS) for treating Parkinson's disease has led to its application to several other disorders, including treatment-resistant depression. Results with DBS for treatment-resistant depression have been heterogeneous, with inconsistencies largely driven by incomplete understanding of the brain networks regulating mood, especially on an individual basis. We report results from the first subject treated with DBS for treatment-resistant depression using an approach that incorporates intracranial recordings to personalize understanding of network behavior and its response to stimulation. These recordings enabled calculation of individually optimized DBS stimulation parameters using a novel inverse solution approach. In the ensuing double-blind, randomized phase incorporating these bespoke parameter sets, DBS led to remission of symptoms and dramatic improvement in quality of life. Results from this initial case demonstrate the feasibility of this personalized platform, which may be used to improve surgical neuromodulation for a vast array of neurologic and psychiatric disorders.
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Affiliation(s)
- Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston TX, 77030 USA,Corresponding Author: Sameer A. Sheth, MD, PhD, 7200 Cambridge Street, Suite 9B, Houston, TX 77030, 310-922-2596,
| | - Kelly R. Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston TX, 77030 USA
| | - Brian Metzger
- Department of Neurosurgery, Baylor College of Medicine, Houston TX, 77030 USA
| | - Anusha Allawala
- Department of Engineering, Brown University, Providence, RI, 02912 USA
| | - Victoria Pirtle
- Department of Neurosurgery, Baylor College of Medicine, Houston TX, 77030 USA
| | - Josh A. Adkinson
- Department of Neurosurgery, Baylor College of Medicine, Houston TX, 77030 USA
| | - John Myers
- Department of Neurosurgery, Baylor College of Medicine, Houston TX, 77030 USA
| | - Raissa K. Mathura
- Department of Neurosurgery, Baylor College of Medicine, Houston TX, 77030 USA
| | - Denise Oswalt
- Department of Neurosurgery, Baylor College of Medicine, Houston TX, 77030 USA
| | - Evangelia Tsolaki
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, 90095 USA
| | - Jiayang Xiao
- Department of Neurosurgery, Baylor College of Medicine, Houston TX, 77030 USA
| | - Angela Noecker
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106 USA
| | - Adriana M. Strutt
- Department of Neurology, Baylor College of Medicine, Houston TX, 77030 USA
| | - Jeffrey F. Cohn
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, 19104 USA
| | - Cameron C. McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106 USA
| | - Sanjay J. Mathew
- Department of Psychiatry, Baylor College of Medicine, Houston TX, 77030 USA
| | - David Borton
- Department of Engineering, Brown University, Providence, RI, 02912 USA
| | - Wayne Goodman
- Department of Psychiatry, Baylor College of Medicine, Houston TX, 77030 USA
| | - Nader Pouratian
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, 90095 USA
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Park JT, Vaca GFB. Stereo-EEG in Tuberous Sclerosis Complex. Pediatr Neurol Briefs 2020; 34:6. [PMID: 32174749 PMCID: PMC7051857 DOI: 10.15844/pedneurbriefs-34-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A collaborative research team lead by an investigator from the Lyon Neuroscience Research Center and Lyon University Hospital and Lyon 1 University studied epileptogenicity of tuber and its surrounding cortex using stereoelectroencephalography (SEEG) in patients diagnosed with tuberous sclerosis complex (TSC) (genetic or clinical).
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Affiliation(s)
- Jun T Park
- Department of Neurology, Epilepsy Center, University Hospitals of Cleveland Medical Center, Cleveland, OH.,Department of Pediatrics, Division of Neurology & Epilepsy, Rainbow Babies & Children's Hospital, Cleveland, OH
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Dionisio S, Mayoglou L, Cho SM, Prime D, Flanigan PM, Lega B, Mosher J, Leahy R, Gonzalez-Martinez J, Nair D. Connectivity of the human insula: A cortico-cortical evoked potential (CCEP) study. Cortex 2019; 120:419-442. [PMID: 31442863 DOI: 10.1016/j.cortex.2019.05.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 03/13/2019] [Revised: 05/02/2019] [Accepted: 05/22/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The human insula is increasingly being implicated as a multimodal functional network hub involved in a large variety of complex functions. Due to its inconspicuous location and highly vascular anatomy, it has historically been difficult to study. Cortico-cortical evoked potentials (CCEPs), utilize low frequency stimulation to map cerebral networks. They were used to study connections of the human insula. METHODS CCEP data was acquired from each sub-region of the dominant and non-dominant insula in 30 patients who underwent stereo-EEG. Connectivity strength to the various cortical regions was obtained via a measure of root mean square (RMS), calculated from each gyrus of the insula and ranked into weighted means. RESULTS The results of all cumulative CCEP responses for each individual gyrus were represented by circro plots. Forty-nine individual CCEP pairs were stimulated across all the gyri from the right and left insula. In brief, the left insula contributed more greatly to language areas. Sensory function, pain, saliency processing and vestibular function were more heavily implicated from the right insula. Connections to the primary auditory cortex arose from both insula regions. Both posterior insula regions showed significant contralateral connectivity. Ipsilateral mesial temporal connections were seen from both insula regions. In visual function, we further report the novel finding of a direct connection between the right posterior insula and left visual cortex. SIGNIFICANCE The insula is a major multi-modal network hub with the cerebral cortex having major roles in language, sensation, auditory, visual, limbic and vestibular functions as well as saliency processing. In temporal lobe epilepsy surgery failure, the insula may be implicated as an extra temporal cause, due to the strong mesial temporal connectivity findings.
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Affiliation(s)
- Sasha Dionisio
- Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA; Epilepsy Centre, Mater Centre for Neurosciences, Brisbane, Australia.
| | - Lazarus Mayoglou
- Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA; Epilepsy Center, UPMC Hamot, Erie, PA, USA
| | - Sung-Min Cho
- Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - David Prime
- Epilepsy Centre, Mater Centre for Neurosciences, Brisbane, Australia; Griffith School of Electrical Engineering, Nathan Campus, QLD, Australia
| | - Patrick M Flanigan
- Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - Bradley Lega
- Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA; Neurological Surgery, University of Texas-Southwestern, Dallas, TX, USA
| | - John Mosher
- Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - Richard Leahy
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, USA
| | | | - Dileep Nair
- Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
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Issa Roach AT, Pizarro D, Deshpande HD, Pati S, Szaflarski JP, Riley KO, Muhlhofer W, Houston T. Ictogenesis during sEEG evaluation after acute intracranial hemorrhage. Epilepsy Behav Case Rep 2019; 11:115-119. [PMID: 30963027 PMCID: PMC6434162 DOI: 10.1016/j.ebcr.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/12/2019] [Accepted: 02/26/2019] [Indexed: 11/09/2022]
Abstract
We present a unique case of a patient with drug-resistant focal epilepsy undergoing stereoelectroencephalography (sEEG) who developed an acute posttraumatic intracranial hemorrhage during monitoring, first detected by changes on sEEG. Our case demonstrates the evolution of electrographic changes at the time of initial hemorrhage to the development of ictal activity. We conducted spectral analysis of the sEEG data to illustrate the transition from an interictal to ictal state. Initially, delta power increased in the region of acute hemorrhage, followed by sustained regional reduction in frequency variability. Our findings provide further information on the development of epileptiform activity in acute hemorrhage. sEEG shows new epileptiform activity in acute hemorrhage despite lack of clinical signs. In acute hemorrhage, there is initially an increase in delta power. There is loss of frequency variability in involved channels in acute hemorrhage.
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Affiliation(s)
- Alexandra T Issa Roach
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Diana Pizarro
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Hrishikesh D Deshpande
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Sandipan Pati
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Kristen O Riley
- Department of Neurosurgery, University of Alabama at Birmingham, AL, United States of America
| | - Wolfgang Muhlhofer
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Thomas Houston
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
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11
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Pelliccia V, Villani F, Gozzo F, Gnatkovsky V, Cardinale F, Tassi L. Musicogenic epilepsy: A Stereo-electroencephalography study. Cortex 2019; 120:582-587. [PMID: 30837152 DOI: 10.1016/j.cortex.2019.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/02/2018] [Accepted: 02/05/2019] [Indexed: 11/30/2022]
Abstract
Musicogenic epilepsy is rare focal epilepsy in which seizures are triggered by music. Both spontaneous and reflexes seizures may occur. To date there are limited data about this epilepsy, particularly about its etiopathogenesis. We report the clinical, neurophysiological and imaging data about musicogenic epilepsy in a patient who underwent Stereo-electroencephalography (SEEG) study. A 27 year-old right-handed woman suffering from drug-resistant epilepsy since the age of 17 years, was evaluated for surgery. She had weekly seizures characterized by an unpleasant ascending gastric sensation, tachycardia, occasionally late oro-alimentary automatisms, déjà-vu and vomiting. Only during longer seizures a partial loss of awareness was reported. Interestingly, familiar songs triggered seizures. Rarely, she had spontaneous seizures with the same features. The ictal EEG onset appeared to be right temporal, but there was seizure propagation to suprasylvian areas. Brain MRI was negative. A SEEG implantation was performed to study the right temporo-perisylvian regions. SEEG data clearly indicated the antero-mesial temporal regions as origin of the seizures, without any spread to other close or distant cortical areas. Right temporal antero-mesial resection was performed 24 months ago and the patient is seizure-free since surgery. Neuropathology was uninformative. SEEG data highlighted the hypothesis regarding a temporo-mesial emotional-mnesic network triggered by particular music with an affective component for the patient. The primary auditory cortex and lateral mid-posterior temporal and extratemporal cortices were not involved. Different triggers as mentally singing and hearing the music can induce seizure as well as electrical stimulation in the mesial temporal structures.
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Affiliation(s)
| | - Flavio Villani
- Epilepsy Unit, Fondazione IRCCS, Istituto Neurologico C. Besta, Milano, Italy
| | - Francesca Gozzo
- C. Munari Epilepsy Surgery Centre, Ospedale Niguarda, Milano, Italy
| | - Vadym Gnatkovsky
- Epilepsy Unit, Fondazione IRCCS, Istituto Neurologico C. Besta, Milano, Italy
| | | | - Laura Tassi
- C. Munari Epilepsy Surgery Centre, Ospedale Niguarda, Milano, Italy.
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12
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Cvetkovska E, Martins WA, Gonzalez-Martinez J, Taylor K, Li J, Grinenko O, Mosher J, Leahy R, Chauvel P, Nair D. Heterotopia or overlaying cortex: What about in-between? Epilepsy Behav Case Rep 2018; 11:4-9. [PMID: 30456171 PMCID: PMC6232626 DOI: 10.1016/j.ebcr.2018.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/12/2018] [Accepted: 09/19/2018] [Indexed: 11/28/2022]
Abstract
We describe a patient with unilateral periventricular nodular heterotopia (PNH) and drug-resistant epilepsy, whose SEEG revealed that seizures were arising from the PNH, with the almost simultaneous involvement of heterotopic neurons ("micronodules") scattered within the white matter, and subsequently the overlying cortex. Laser ablation of heterotopic nodules and the adjacent white matter rendered the patient seizure free. This case elucidates that "micronodules" scattered in white matter between heterotopic nodules and overlying cortex might be another contributor in complex epileptogenicity of heterotopia. Detecting patient-specific targets in the epileptic network of heterotopia creates the possibility to disrupt the pathological circuit by minimally invasive procedures.
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Affiliation(s)
- Emilija Cvetkovska
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA,University Clinic of Neurology, Medical Faculty, Ss. Cyril and Methodius University, Vodnjanska str. 17, MK-1000, Skopje, Macedonia,Corresponding author at: University Clinic of Neurology, Medical Faculty, Ss. Cyril and Methodius University, Vodnjanska str. 17, MK-1000, Skopje, Macedonia.
| | - William Alves Martins
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA,Service of Neurology, Hospital São Lucas, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Jorge Gonzalez-Martinez
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA,Department of Neurosurgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Ken Taylor
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Jian Li
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, USA
| | - Olesya Grinenko
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - John Mosher
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA,Department of Neurology, University of Texas, Huston, TX, USA
| | - Richard Leahy
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, USA
| | - Patrick Chauvel
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Dileep Nair
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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13
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Young JJ, Friedman JS, Oxley TJ, Palmese C, Panov F, Ghatan S, Fifi JT, Marcuse LV. Intracarotid amobarbital disrupts synchronous and nested oscillatory activity ipsilateral to injection. Epilepsy Behav Case Rep 2018; 10:25-8. [PMID: 30013931 DOI: 10.1016/j.ebcr.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/05/2018] [Accepted: 04/10/2018] [Indexed: 11/21/2022]
Abstract
The mechanism of amobarbital action during the intracarotid amobarbital procedure is poorly understood. We report a patient case who underwent IAP while implanted with bilateral stereo-EEG. We analyzed the spectral power, phase amplitude coupling, and cluster-phase group synchrony during the procedure. Delta and gamma power increased bilaterally. By contrast, phase amplitude coupling increased only ipsilateral to the injection. Similarly, 4–30 Hz cluster-phase group synchrony declines and gamma cluster-phase group synchrony increases only ipsilateral to the injection. These results suggest that a possible additional mechanism for amobarbital action in the IAP is by altering the precise timing of oscillatory activity. Intracranial activity shows bilateral increases in delta and gamma activity during the IAP. Phase amplitude coupling increases in the 2–3 Hz (phase) and 30–70 Hz (amplitude) band only ipsilateral to the injection. 4–30 Hz synchrony declines and gamma synchrony increases only ipsilateral to the injection. Amobarbital may alter the temporal organization of activity, rather than inactivation of the injected hemisphere.
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14
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Tuyisenge V, Trebaul L, Bhattacharjee M, Chanteloup-Forêt B, Saubat-Guigui C, Mîndruţă I, Rheims S, Maillard L, Kahane P, Taussig D, David O. Automatic bad channel detection in intracranial electroencephalographic recordings using ensemble machine learning. Clin Neurophysiol 2017; 129:548-554. [PMID: 29353183 PMCID: PMC5819872 DOI: 10.1016/j.clinph.2017.12.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/02/2017] [Accepted: 12/01/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Intracranial electroencephalographic (iEEG) recordings contain "bad channels", which show non-neuronal signals. Here, we developed a new method that automatically detects iEEG bad channels using machine learning of seven signal features. METHODS The features quantified signals' variance, spatial-temporal correlation and nonlinear properties. Because the number of bad channels is usually much lower than the number of good channels, we implemented an ensemble bagging classifier known to be optimal in terms of stability and predictive accuracy for datasets with imbalanced class distributions. This method was applied on stereo-electroencephalographic (SEEG) signals recording during low frequency stimulations performed in 206 patients from 5 clinical centers. RESULTS We found that the classification accuracy was extremely good: It increased with the number of subjects used to train the classifier and reached a plateau at 99.77% for 110 subjects. The classification performance was thus not impacted by the multicentric nature of data. CONCLUSIONS The proposed method to automatically detect bad channels demonstrated convincing results and can be envisaged to be used on larger datasets for automatic quality control of iEEG data. SIGNIFICANCE This is the first method proposed to classify bad channels in iEEG and should allow to improve the data selection when reviewing iEEG signals.
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Affiliation(s)
- Viateur Tuyisenge
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France; Inserm, U1216, F-38000 Grenoble, France
| | - Lena Trebaul
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France; Inserm, U1216, F-38000 Grenoble, France
| | - Manik Bhattacharjee
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France; Inserm, U1216, F-38000 Grenoble, France
| | - Blandine Chanteloup-Forêt
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France; Inserm, U1216, F-38000 Grenoble, France
| | - Carole Saubat-Guigui
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France; Inserm, U1216, F-38000 Grenoble, France
| | - Ioana Mîndruţă
- Neurology Department, University Emergency Hospital, Bucharest, Romania; Neurology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Lyon, France; Epilepsy Institute (IDEE), Lyon, France
| | - Louis Maillard
- Research Center for Automatic Control (CRAN), University of Lorraine, CNRS, UMR 7039, Vandoeuvre, France; Department of Neurology, Central University Hospital, CHU de Nancy, Nancy, France; Medical Faculty, University of Lorraine, Nancy, France
| | - Philippe Kahane
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France; Inserm, U1216, F-38000 Grenoble, France; Laboratory of Neurophysiopathology of Epilepsy, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Delphine Taussig
- Department of Pediatric Neurosurgery, Fondation Rothschild, F-75940 Paris, France
| | - Olivier David
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France; Inserm, U1216, F-38000 Grenoble, France.
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15
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Abdallah C, Maillard LG, Rikir E, Jonas J, Thiriaux A, Gavaret M, Bartolomei F, Colnat-Coulbois S, Vignal JP, Koessler L. Localizing value of electrical source imaging: Frontal lobe, malformations of cortical development and negative MRI related epilepsies are the best candidates. Neuroimage Clin 2017; 16:319-329. [PMID: 28856095 PMCID: PMC5565782 DOI: 10.1016/j.nicl.2017.08.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 07/24/2017] [Accepted: 08/07/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to prospectively assess the anatomical concordance of electric source localizations of interictal discharges with the epileptogenic zone (EZ) estimated by stereo-electroencephalography (SEEG) according to different subgroups: the type of epilepsy, the presence of a structural MRI lesion, the aetiology and the depth of the EZ. METHODS In a prospective multicentric observational study, we enrolled 85 consecutive patients undergoing pre-surgical SEEG investigation for focal drug-resistant epilepsy. Electric source imaging (ESI) was performed before SEEG. Source localizations were obtained from dipolar and distributed source methods. Anatomical concordance between ESI and EZ was defined according to 36 predefined sublobar regions. ESI was interpreted blinded to- and subsequently compared with SEEG estimated EZ. RESULTS 74 patients were finally analyzed. 38 patients had temporal and 36 extra-temporal lobe epilepsy. MRI was positive in 52. 41 patients had malformation of cortical development (MCD), 33 had another or an unknown aetiology. EZ was medial in 27, lateral in 13, and medio-lateral in 34. In the overall cohort, ESI completely or partly localized the EZ in 85%: full concordance in 13 cases and partial concordance in 50 cases. The rate of ESI full concordance with EZ was significantly higher in (i) frontal lobe epilepsy (46%; p = 0.05), (ii) cases of negative MRI (36%; p = 0.01) and (iii) MCD (27%; p = 0.03). The rate of ESI full concordance with EZ was not statistically different according to the depth of the EZ. SIGNIFICANCE We prospectively demonstrated that ESI more accurately estimated the EZ in subgroups of patients who are often the most difficult cases in epilepsy surgery: frontal lobe epilepsy, negative MRI and the presence of MCD.
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Affiliation(s)
- Chifaou Abdallah
- Neurology Department, University Hospital of Nancy, Nancy, France
| | - Louis G Maillard
- Neurology Department, University Hospital of Nancy, Nancy, France.,CRAN, UMR 7039, Lorraine University, Vandœuvre-les-Nancy Cedex, France.,CNRS, CRAN, UMR 7039, Vandœuvre-les-Nancy Cedex, France.,Medical Faculty, Lorraine University, Nancy, France
| | - Estelle Rikir
- Neurology Department, University Hospital of Sart-Tilman, Liege, Belgium.,Medical Faculty, Liege University, Liege, Belgium
| | - Jacques Jonas
- Neurology Department, University Hospital of Nancy, Nancy, France.,CRAN, UMR 7039, Lorraine University, Vandœuvre-les-Nancy Cedex, France.,CNRS, CRAN, UMR 7039, Vandœuvre-les-Nancy Cedex, France
| | - Anne Thiriaux
- Neurology department, University Hospital of Reims, Reims, France
| | - Martine Gavaret
- Clinical Neurophysiology Department, AP-HM, University Hospital la Timone, Marseille, France.,INSERM UMR 1106, Institut de Neurosciences des Systemes, Marseille, France.,Medical Faculty, Aix-Marseille University, Marseille, France
| | - Fabrice Bartolomei
- Clinical Neurophysiology Department, AP-HM, University Hospital la Timone, Marseille, France.,INSERM UMR 1106, Institut de Neurosciences des Systemes, Marseille, France.,Medical Faculty, Aix-Marseille University, Marseille, France
| | - Sophie Colnat-Coulbois
- Medical Faculty, Lorraine University, Nancy, France.,Neurosurgery Department, University Hospital of Nancy, Nancy, France
| | - Jean-Pierre Vignal
- Neurology Department, University Hospital of Nancy, Nancy, France.,CRAN, UMR 7039, Lorraine University, Vandœuvre-les-Nancy Cedex, France.,CNRS, CRAN, UMR 7039, Vandœuvre-les-Nancy Cedex, France
| | - Laurent Koessler
- Neurology Department, University Hospital of Nancy, Nancy, France.,CRAN, UMR 7039, Lorraine University, Vandœuvre-les-Nancy Cedex, France.,CNRS, CRAN, UMR 7039, Vandœuvre-les-Nancy Cedex, France
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16
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Pastori C, Francione S, Pelle F, de Curtis M, Gnatkovsky V. Fluency tasks generate beta-gamma activity in language-related cortical areas of patients during stereo-EEG monitoring. Brain Lang 2016; 163:50-56. [PMID: 27684988 DOI: 10.1016/j.bandl.2016.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 06/06/2023]
Abstract
A quantitative method was developed to map cortical areas responsive to cognitive tasks during intracerebral stereo-EEG recording sessions in drug-resistant patients candidate for epilepsy surgery. Frequency power changes were evaluated with a computer-assisted analysis in 7 patients during phonemic fluency tasks. All patients were right-handed and were explored with depth electrodes in the dominant frontal lobe. We demonstrate that fluency tasks enhance beta-gamma frequencies and reduce background activities in language network regions of the dominant hemisphere. Non-reproducible changes were observed in other explored brain areas during cognitive tests execution.
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Affiliation(s)
- Chiara Pastori
- Unit of Epileptology and Experimental Neurophysiology, Fondazione Istituto Neurologico Carlo Besta, Milano, Italy
| | - Stefano Francione
- Claudio Munari Epilepsy Surgery Center, Ospedale Niguarda, Milano, Italy
| | - Federica Pelle
- Claudio Munari Epilepsy Surgery Center, Ospedale Niguarda, Milano, Italy
| | - Marco de Curtis
- Unit of Epileptology and Experimental Neurophysiology, Fondazione Istituto Neurologico Carlo Besta, Milano, Italy
| | - Vadym Gnatkovsky
- Unit of Epileptology and Experimental Neurophysiology, Fondazione Istituto Neurologico Carlo Besta, Milano, Italy.
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17
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Pietrafusa N, de Palma L, De Benedictis A, Trivisano M, Marras CE, Vigevano F, Specchio N. Ictal vomiting as a sign of temporal lobe epilepsy confirmed by stereo-EEG and surgical outcome. Epilepsy Behav 2015; 53:112-6. [PMID: 26558713 DOI: 10.1016/j.yebeh.2015.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 11/30/2022]
Abstract
Vomiting is uncommon in patients with epilepsy and has been reported in both idiopathic and symptomatic epilepsies. It is presumed to originate in the anterior part of the temporal lobe or insula. To date, 44 cases of nonidiopathic focal epilepsy and seizures associated with ictal vomiting have been reported. Of the 44 cases, eight were studied using invasive exploration (3 stereo-EEG/5 subdural grids). Here, we report a 4-year-and-7-month-old patient with a history of febrile convulsion in the second year of life and who developed episodes of vomiting and complex partial seizures at 3 years of age. Scalp EEG showed no electrical modification during vomiting while the complex partial seizure displayed a clear right temporal origin. Brain MR showed hippocampal volume reduction with mild diffuse blurring of the temporal lobe. Stereoelectroencephalography study confirmed the mesiotemporal origin of the seizures and showed that the episodes of vomiting were strictly related to an ictal discharge originating in the mesial temporal structures without insular diffusion. The patient is now seizure-free (18 months) after removal of the right anterior and mesial temporal structures. In all the reported patients, seizures seemed to start in mesial temporal structures. The grid subgroup is more homogeneous, and the most prominent characteristic (4/5) is the involvement of both mesial and lateral temporal structures at the time of vomiting. In the S-EEG group, there is evidence of involvement of either the anterior temporal structures alone (2/3) or both insular cortices (1/3). Our case confirms that vomiting could occur when the ictal discharge is limited to the anterior temporal structure without insular involvement. Regarding the pathophysiology of vomiting, the role of subcortical structures such as the dorsal vagal complex and the central pattern generators (CPG) located in the reticular area is well established. Vomiting as an epileptic phenomenon seems to be related to the involvement of temporal structures, mainly mesial structures (amygdala) and with an uncertain role of the insula. An intriguing hypothesis is that the ictal discharge in mesial structures determines seizure manifestation that could be explained not only by tonic activation of the cortex, but also by 'release' (reduction of inhibition?) of the CPG responsible for involuntary motor behaviors.
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Affiliation(s)
- Nicola Pietrafusa
- Division of Neurology, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Luca de Palma
- Division of Neurology, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Marina Trivisano
- Division of Neurology, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Federico Vigevano
- Division of Neurology, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Nicola Specchio
- Division of Neurology, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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18
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Gnatkovsky V, de Curtis M, Pastori C, Cardinale F, Lo Russo G, Mai R, Nobili L, Sartori I, Tassi L, Francione S. Biomarkers of epileptogenic zone defined by quantified stereo-EEG analysis. Epilepsia 2014; 55:296-305. [PMID: 24417731 DOI: 10.1111/epi.12507] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 12/24/2022]
Abstract
OBJECTIVE In one third of patients with a diagnosis of pharmacoresistant focal epilepsy who are candidates for therapeutic surgery, cerebral areas responsible for seizure generation can be defined exclusively with invasive intracranial recordings. A correct presurgical identification of the epileptogenic zone (EZ) with intracranial electrodes has a direct impact on postsurgical outcome. We aimed at identifying biomarkers of the EZ based on computer-assisted inspection of intracranial electroencephalography (EEG). METHODS Computer-driven intracranial EEG analysis in the domains of time, frequency, and space was retrospectively applied to a population of 10 patients with focal epilepsy to detect EZ electrophysiologic markers. Next, a prospective study was performed on 14 surgery candidate patients. The stereo-EEG computer-assisted analysis of EZ boundaries performed blind from patients data was compared to that defined with the traditional visual inspection completed by neurophysiologists. RESULTS In the retrospective study, the EZ was characterized by the combined detection of three biomarkers observed at seizure onset: (1) fast activity at 80-120 Hz associated with (2) very slow transient polarizing shift and (3) voltage depression (flattening). Correlations between these indexes were calculated for each seizure. In the prospective study, the quantified analysis based on the three biomarkers confirmed a complete overlap between leads within the EZ identified by expert clinicians. In 2 of 14 patients the proposed biomarkers partially identified the EZ. SIGNIFICANCE Our findings demonstrate and validate with a prospective unbiased study the use of three neurophysiologic intracranial EEG parameters as excellent biomarkers of ictogenesis and as reliable indicators of EZ boundaries.
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Affiliation(s)
- Vadym Gnatkovsky
- Unit of Experimental Neurophysiology and Epileptology, Foundation of the Carlo Besta Neurological Institute, Milan, Italy
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