Advancements in Stereotactic Epilepsy Surgery: Stereo-EEG, Laser Interstitial Thermotherapy, and Responsive Neurostimulation

Lang, Michael J; Chitale, Ameet Md; Sharan, Ashwini; Wu, Chengyuan Md

doi:10.29046/jhnj.011.2.005

Cited by 4 publications

(4 citation statements)

References 16 publications

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“…SEEG technology was introduced over half a century ago (Bancaud and Talairach, 1965, 1973). Because of the smaller surgical trauma (burr holes instead of a full craniotomy (Sperling and Connor, 1989; Lang and Chitale, 2016)), and because of recent advances in surgical robotics (Cardinale et al, 2016), SEEG has become increasingly prevalent in clinical practice (Munari et al, 1994; Ayoubian et al, 2010; Cossu et al, 2005; Guenot et al, 2001; Lachaux et al, 2003; Proserpio et al, 2011; Ryvlin and Picard, 2017). In addition to potential clinical benefits, SEEG also opens a unique window into brain function, because it can sample the temporal evolution of neural activity at many locations throughout the brain (Jerbi et al, 2009; Koessler et al, 2010; Lachaux et al, 2006; Lakatos et al, 2007; Perrone-Bertolotti et al, 2012; Vidal et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Optimal referencing for stereo-electroencephalographic (SEEG) recordings

et al. 2018

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Stereo-electroencephalography (SEEG) is an intracranial recording technique in which depth electrodes are inserted in the brain as part of presurgical assessments for invasive brain surgery. SEEG recordings can tap into neural signals across the entire brain and thereby sample both cortical and subcortical sites. However, even though signal referencing is important for proper assessment of SEEG signals, no previous study has comprehensively evaluated the optimal referencing method for SEEG. In our study, we recorded SEEG data from 15 human subjects during a motor task, referencing them against the average of two white matter contacts (monopolar reference). We then subjected these signals to 5 different re-referencing approaches: common average reference (CAR), gray-white matter reference (GWR), electrode shaft reference (ESR), bipolar reference, and Laplacian reference. The results from three different signal quality metrics suggest the use of the Laplacian re-reference for study of local population-level activity and low-frequency oscillatory activity.

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Section: Introductionmentioning

confidence: 99%

Optimal referencing for stereo-electroencephalographic (SEEG) recordings

et al. 2018

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“…These arrays record primarily from the cortical surface, poorly resolving deeper brain structures that can generate seizures, such as the cingulate gyrus and insula. Stereotaxic electroencephalography (SEEG) utilizes arrays of stereotaxically placed, penetrating depth electrodes to map seizures throughout the cortex, offering a less invasive alternative to ECoG that can record from deeper structures (Lang et al 2016;Podkorytova et al 2016). Although the resolution of SEEG electrodes is higher than for ECoG, with typical interelectrode spacing of 3.5 mm (Narizzano et al 2017), both recording methods can miss important epileptic activity occurring in the cortex on a submillimeter scale (Schevon et al 2010;Stead et al 2010;Viventi et al 2011).…”

Section: Introductionmentioning

confidence: 99%

Spatiotemporal evolution of focal epileptiform activity from surface and laminar field recordings in cat neocortex

Bink

Sedigh-Sarvestani

Fernández-Lamo

et al. 2018

Journal of Neurophysiology

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New devices that use targeted electrical stimulation to treat refractory localization-related epilepsy have shown great promise, although it is not well known which targets most effectively prevent the initiation and spread of seizures. To better understand how the brain transitions from healthy to seizing on a local scale, we induced focal epileptiform activity in the visual cortex of five anesthetized cats with local application of the GABA blocker picrotoxin while simultaneously recording local field potentials on a high-resolution electrocorticography array and laminar depth probes. Epileptiform activity appeared in the form of isolated events, revealing a consistent temporal pattern of ictogenesis across animals with interictal events consistently preceding the appearance of seizures. Based on the number of spikes per event, there was a natural separation between seizures and shorter interictal events. Two distinct spatial regions were seen: an epileptic focus that grew in size as activity progressed, and an inhibitory surround that exhibited a distinct relationship with the focus both on the surface and in the depth of the cortex. Epileptiform activity in the cortical laminae was seen concomitant with activity on the surface. Focus spikes appeared earlier on electrodes deeper in the cortex, suggesting that deep cortical layers may be integral to recruiting healthy tissue into the epileptic network and could be a promising target for interventional devices. Our study may inform more effective therapies to prevent seizure generation and spread in localization-related epilepsies. NEW & NOTEWORTHY We induced local epileptiform activity and recorded continuous, high-resolution local field potentials from the surface and depth of the visual cortex in anesthetized cats. Our results reveal a consistent pattern of ictogenesis, characterize the spatial spread of the epileptic focus and its relationship with the inhibitory surround, and show that focus activity within events appears earliest in deeper cortical layers. These findings have potential implications for the monitoring and treatment of refractory epilepsy.

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“…[32] Targets of sEEG are determined by the EZ hypothesis, localization by scalp EEG, abnormalities on magnetoencephalography (MEG), interictal positron emission tomography, and ictal single-photon emission computed tomography. [6,19,24,31]…”

Section: Seegmentioning

confidence: 99%

“…[32] Approximately 50% of these patients are seizure-free at 1 year follow-up. [3,18,24,38] Although temporal lobectomy results in a higher rate of seizure freedom (60–80%), sparing the lateral temporal lobe structures may correlate with better neuropsychological outcomes, such as reduced naming and verbal/working memory deficits. [3,18,24,38] Therefore, some support laser ablation as first-line therapy for dominant mesial temporal lobe epilepsy.…”

Section: Laser Ablationmentioning

confidence: 99%

An update on pediatric surgical epilepsy: Part II

Gadgil

Muir

LoPresti

et al. 2019

Surgical Neurology International

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Background: Recent advances may allow surgical options for pediatric patients with refractory epilepsy not previously deemed surgical candidates. This review outlines major technological developments in the field of pediatric surgical epilepsy. Methods: The literature was comprehensively reviewed and summarized pertaining to stereotactic electroencephalography (sEEG), laser ablation, focused ultrasound (FUS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) in pediatric epilepsy patients. Results: sEEG allows improved seizure localization in patients with widespread, bilateral, or deep-seated epileptic foci. Laser ablation may be used for destruction of deep-seated epileptic foci close to eloquent structures; FUS has a similar potential application. RNS is a palliative option for patients with eloquent, multiple, or broad epileptogenic foci. DBS is another palliative approach in children unsuitable for respective surgery. Conclusion: The landscape of pediatric epilepsy is changing due to improved diagnostic and treatment options for patients with refractory seizures. These interventions may improve seizure outcomes and decrease surgical morbidity, though further research is needed to define the appropriate role for each modality.

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Advancements in Stereotactic Epilepsy Surgery: Stereo-EEG, Laser Interstitial Thermotherapy, and Responsive Neurostimulation

Cited by 4 publications

References 16 publications

Optimal referencing for stereo-electroencephalographic (SEEG) recordings

Optimal referencing for stereo-electroencephalographic (SEEG) recordings

Spatiotemporal evolution of focal epileptiform activity from surface and laminar field recordings in cat neocortex

An update on pediatric surgical epilepsy: Part II

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