Slow waves of neuronal activity are a fundamental component of sleep that are proposed to have homeostatic and restorative functions. Despite this, their interaction with pathology is unclear and there is only indirect evidence of their presence during wakefulness. Using intracortical recordings from the temporal lobe of 25 patients with epilepsy, we demonstrate the existence of local wake slow waves (LoWS) with key features of sleep slow waves, including the down-state of neuronal firing. LoWS were distinct from slow waves recorded in people without epilepsy and showed evidence of adaptation during periods of increased normal (cognitive task) and abnormal (interictal epileptiform discharges, IEDs) activity. Importantly, we also provide evidence that LoWS reduce increases in network excitability during IEDs but are associated with poorer memory. We therefore propose an “epilepsy homeostasis hypothesis”: that slow waves are activated in epilepsy to reduce aberrant activity at the price of transient cognitive impairment.
There has been a significant rise in robotic trajectory guidance devices that have been utilised for stereotactic neurosurgical procedures. These devices have significant costs and associated learning curves. Previous studies reporting devices usage have not undertaken prospective parallel-group comparisons before their introduction, so the comparative differences are unknown.We study the difference in stereoelectroencephalography electrode implantation time between a robotic trajectory guidance device (iSYS1) and manual frameless implantation (PAD) in patients with drug-refractory focal epilepsy through a single-blinded randomised control parallel-group investigation of SEEG electrode implantation, concordant with CONSORT statement.Thirty-two patients (18 male) completed the trial. The iSYS1 returned significantly shorter median operative time for intracranial bolt insertion, 6.36 min (95%CI 5.72-7.07) versus 9.06 min (95%CI 8.16- 10.06), ratio of median estimate (iSYS1/PAD) 0.70 (95%CI 0.61-0.81), p=0.0001. The PAD group had a better median target point accuracy 1.58 mm (95%CI 1.38- 1.82) versus 1.16 mm (95%CI 1.01- 1.33)), p=0.004. The mean electrode implantation angle error was 2.13o for the iSYS1 group and 1.71o for the PAD groups (p=0.023). There was no statistically significant difference for any other outcome.Health policy and hospital commissioners should consider these differences in the context of the opportunity cost of introducing robotic devices.Trial registration: ISRCTN17209025 (https://doi.org/10.1186/ISRCTN17209025)
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