Electrical stimulation mapping of language with stereo-EEG

Arya, Ravindra; Ervin, Brian; Dudley, Jonathan; Buroker, Jason; Rozhkov, Leonid; Scholle, Craig; Horn, Paul S.; Vannest, Jennifer; Byars, Anna W.; Leach, James; Mangano, Francesco T.; Greiner, Hansel M.; Holland, Katherine D.; Glauser, Tracy A.

doi:10.1016/j.yebeh.2019.06.038

Cited by 29 publications

(44 citation statements)

References 35 publications

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“…This finding is consistent with an earlier observation that AD's may be followed by seizures even in the cortex which does not produce spontaneous seizures (Blume et al, 2004). To compare, the incidence of iatrogenic seizures has varied from 13% to 30% in patients undergoing high-frequency SEEG ESM (Arya et al, 2019(Arya et al, , 2020.…”

Section: Esm-induced Seizuressupporting

confidence: 88%

“…However, the incidence of AD's with SEEG ESM has been sparsely reported. Our experience suggests it is probably similar to that with SDE ESM and occurs with 32%-43% of stimulations (Arya et al, 2019(Arya et al, , 2020.…”

Section: After-dischargessupporting

confidence: 71%

“…The preliminary experience with SEEG ESM suggests a different age-relationship between functional and AD thresholds (Figure 3). In 10 patients undergoing language ESM with SEEG, speech/language response thresholds were below AD thresholds throughout the age range (5-21 years; Arya et al, 2019). Similarly, in 15 patients aged 6-21 years, sensorimotor thresholds remained below the AD thresholds (Arya et al, 2020).…”

Section: Relationship Between Ad and Functional Thresholdsmentioning

confidence: 92%

“…With SEEG, the stimulation settings are fairly similar to those used with SDE, with two important differences. First, although the maximum current used with SDE ESM has varied from 10 to 20 mA, it has been lower (3-8 mA) with SEEG ESM (Trebuchon and Chauvel, 2016;Britton, 2018;Arya et al, 2019Arya et al, , 2020Cuisenier et al, 2020). The use of lower maximum current with SEEG ESM is based on calculations extrapolated from the estimates of safe current strengths for SDE ESM, and the desire to maintain similar charge density with SEEG and SDE ESM (Shannon, 1992;Britton, 2018).…”

Section: Stimulation Settingsmentioning

confidence: 99%

“…However, we found that 1 Hz stimulation was able to reproduce habitual seizures or auras in 4/6 patients. On the other hand, although 50 Hz stimulation resulted in seizures in 5/15 patients, habitual semiology was observed in only 2/5 patients (Arya et al, 2019(Arya et al, , 2020. Therefore, at our center, we prefer 50 Hz stimulation for functional mapping, and 1 Hz stimulation to attempt to reproduce habitual seizures ( Table 2).…”

Section: Stimulation Settingsmentioning

confidence: 99%

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Electrical Stimulation Mapping of Brain Function: A Comparison of Subdural Electrodes and Stereo-EEG

Grande

Ihnen

Arya

2020

Front. Hum. Neurosci.

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Despite technological and interpretative advances, the non-invasive modalities used for pre-surgical evaluation of patients with drug-resistant epilepsy (DRE), fail to generate a concordant anatomo-electroclinical hypothesis for the location of the seizure onset zone in many patients. This requires chronic monitoring with intracranial electroencephalography (EEG), which facilitates better localization of the seizure onset zone, and allows evaluation of the functional significance of cortical regions-of-interest by electrical stimulation mapping (ESM). There are two principal modalities for intracranial EEG, namely subdural electrodes and stereotactic depth electrodes (stereo-EEG). Although ESM is considered the gold standard for functional mapping with subdural electrodes, there have been concerns about its utility with stereo-EEG. This is mainly because subdural electrodes allow contiguous sampling of the dorsolateral convexity of cerebral hemispheres, and permit delineation of the extent of eloquent functional areas on the cortical surface. Stereo-EEG, while having relatively sparse sampling on the cortical surface, offers the ability to access the depth of sulci, mesial and basal surfaces of cerebral hemispheres, and deep structures such as the insula, which are largely inaccessible to subdural electrodes. As stereo-EEG is increasingly the preferred modality for intracranial monitoring, we find it opportune to summarize the literature for ESM with stereo-EEG in this narrative review. Emerging evidence shows that ESM for defining functional neuroanatomy is feasible with stereo-EEG, but probably requires a different approach for interpretation and clinical decision making compared to ESM with subdural electrodes. We have also compared ESM with stereo-EEG and subdural electrodes, for current thresholds required to evoke desired functional responses vs. unwanted after-discharges. In this regard, there is preliminary evidence that ESM with stereo-EEG may be safer than ESM with subdural grids. Finally, we have highlighted important unanswered clinical and scientific questions for ESM with stereo-EEG in the hope to encourage future research and collaborative efforts.

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Section: Esm-induced Seizuressupporting

confidence: 88%

Section: After-dischargessupporting

confidence: 71%

Section: Relationship Between Ad and Functional Thresholdsmentioning

confidence: 92%

Section: Stimulation Settingsmentioning

confidence: 99%

Section: Stimulation Settingsmentioning

confidence: 99%

See 3 more Smart Citations

Electrical Stimulation Mapping of Brain Function: A Comparison of Subdural Electrodes and Stereo-EEG

Grande

Ihnen

Arya

2020

Front. Hum. Neurosci.

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An international survey of SEEG cortical stimulation practices

et al. 2023

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ObjectiveCortical stimulation is an important component of stereoelectroencephalography (SEEG). Despite this, there is currently no standardized approach and significant heterogeneity in the literature regarding cortical stimulation practices. Via an international survey of SEEG clinicians, we sought to examine the spectrum of cortical stimulation practices to reveal areas of consensus and variability.MethodsA 68‐item questionnaire was developed to understand cortical stimulation practices including neurostimulation parameters, interpretation of epileptogenicity, functional and cognitive assessment and subsequent surgical decisions. Multiple recruitment pathways were pursued, with the questionnaire distributed directly to 183 clinicians.ResultsResponses were received from 56 clinicians across 17 countries with experience ranging from 2 to 60 years (M = 10.73, SD = 9.44). Neurostimulation parameters varied considerably, with maximum current ranging from 3 to 10 mA (M = 5.33, SD = 2.29) for 1 Hz and from 2 to 15 mA (M = 6.54, SD = 3.68) for 50 Hz stimulation. Charge density ranged from 8 to 200 μC/cm2, with up to 43% of responders utilizing charge densities higher than recommended upper safety limits, i.e. 55 μC/cm2. North American responders reported statistically significant higher maximum current (P < 0.001) for 1 Hz stimulation and lower pulse width for 1 and 50 Hz stimulation (P = 0.008, P < 0.001, respectively) compared to European responders. All clinicians evaluated language, speech, and motor function during cortical stimulation; in contrast, 42% assessed visuospatial or visual function, 29% memory, and 13% executive function. Striking differences were reported in approaches to assessment, classification of positive sites, and surgical decisions guided by cortical stimulation. Patterns of consistency were observed for interpretation of the localizing capacity of stimulated electroclinical seizures and auras, with habitual electroclinical seizures induced by 1 Hz stimulation considered the most localizing.SignificanceSEEG cortical stimulation practices differed vastly across clinicians internationally, highlighting the need for consensus‐based clinical guidelines. In particular, an internationally standardized approach to assessment, classification, and functional prognostication will provide a common clinical and research framework for optimizing outcomes for people with drug‐resistant epilepsy.

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