1,067 research outputs found

    Advanced Invasive Neurophysiological Methods to Aid Decision Making in Paediatric Epilepsy Surgery

    Get PDF
    For patients with drug-resistant focal epilepsy, surgery is the most effective treatment to attain seizure freedom. Intracranial electroencephalogram investigations succeed in defining the seizure onset zone (SOZ) where non-invasive methods fail to identify a single seizure generator. However, resection of the SOZ does not always lead to a surgical benefit and, in addition, eloquent functions like language might be compromised. The aim of this thesis was to use advanced invasive neurophysiological methods to improve pre-surgical planning in two ways. The first aim was to improve delineation of the pathological tissue, the SOZ using novel quantitative neurophysiological biomarkers: high gamma activity (80–150Hz) phase-locked to low frequency iEEG discharges (phase-locked high gamma, PLHG) and high frequency oscillations called fast ripples (FR, 250–500Hz). Resection of contacts containing these markers were recently reported to lead to an improved seizure outcome. The current work shows the first replication of the PLHG metric in a small adult pilot study and a larger paediatric cohort. Furthermore, I tested whether surgical removal of PLHG- and/or FR-generating brain areas resulted in better outcome compared to the current clinical SOZ delineation. The second aim of this work was to aid delineation of eloquent language cortex. Invasive event-related potentials (iERP) and spectral changes in the beta and gamma frequency bands were used to determine cortical dynamics during speech perception and production across widespread brain regions. Furthermore, the relationship between these cortical dynamics and the relationship to electrical stimulation responses was explored. For delineation of pathological tissue, the combination of FRs and SOZ proved to be a promising biomarker. Localising language cortex showed the highest level of activity around the perisylvian brain regions with a significantly higher occurrence rate of iERPs compared to spectral changes. Concerning electrical stimulation mapping beta and high gamma frequency bands represented the most promising markers

    Epilepsy

    Get PDF
    With the vision of including authors from different parts of the world, different educational backgrounds, and offering open-access to their published work, InTech proudly presents the latest edited book in epilepsy research, Epilepsy: Histological, electroencephalographic, and psychological aspects. Here are twelve interesting and inspiring chapters dealing with basic molecular and cellular mechanisms underlying epileptic seizures, electroencephalographic findings, and neuropsychological, psychological, and psychiatric aspects of epileptic seizures, but non-epileptic as well

    Focal Augmentation of Somatostatin Interneuron Function and Subsequent Circuit Effects in Developmentally Malformed, Epileptogenic Cortex

    Get PDF
    Drug-resistant epilepsy (DRE) is a common clinical sequela of developmental cortical malformations such as polymicrogyria. Unfortunately, much remains unknown about the aberrant GABA-mediated circuit alterations that underlie DRE\u27s onset and persistence in this context. To address this knowledge gap, we utilized the transcranial freeze lesion model in optogenetic mice lines (Somatostatin (SST)-Cre or Parvalbumin (PV)-Cre x floxed channelrhodopsin-2) to dissect features of the SST, PV, and pyramidal neuron microcircuit that are potentially associated with DRE. Investigations took place within developmental microgyria’s known pathological substrate, the adjoined and epileptogenic paramicrogyral region (PMR). As well, microcircuit relationships within the previously unexplored range of normal-appearing cortex beyond PMR’s terminus were also interrogated. We previously demonstrated SST interneuron output enhancement onto postsynaptic layer V pyramidal neurons of PMR. Dissertation studies elaborated on this SST-interneuron mediated effect through the utilization of ex vivo slice electrophysiology in conjunction with selective optical activation of either SST or PV interneurons. An ostensible mechanism was identified in the form of a novel structural schematic for SST interneurons of PMR whereby they exhibit wider reaching, within-layer arborization of axons within this pathological substrate. Also, within PMR, SST interneuron output was not enhanced onto postsynaptic layer V PV interneurons, indicating targeting specificity of the SST to pyramidal neuron effect. Moving beyond PMR, past its terminus, SST interneuron output onto layer V pyramidal cells was found to be equivalent to controls, indicating effect focality. Finally, a novel disinhibitory relationship was demonstrated beyond PMR’s terminus, wherein PV interneurons exhibited output enhancement onto postsynaptic layer V SST interneurons. This indicates a putative in vivo mechanism for the PMR-focality of the SST to pyramidal neuron output enhancement scheme. These novel discoveries will provide the field with more context as to the role SST and PV interneurons potentially play in the emergence and/or modulation of drug-resistant epilepsy in and outside the terminus of PMR

    Epilepsy

    Get PDF
    Epilepsy is the most common neurological disorder globally, affecting approximately 50 million people of all ages. It is one of the oldest diseases described in literature from remote ancient civilizations 2000-3000 years ago. Despite its long history and wide spread, epilepsy is still surrounded by myth and prejudice, which can only be overcome with great difficulty. The term epilepsy is derived from the Greek verb epilambanein, which by itself means to be seized and to be overwhelmed by surprise or attack. Therefore, epilepsy is a condition of getting over, seized, or attacked. The twelve very interesting chapters of this book cover various aspects of epileptology from the history and milestones of epilepsy as a disease entity, to the most recent advances in understanding and diagnosing epilepsy

    Biomarkers to Localize Seizure from Electrocorticography to Neurons Level

    Get PDF

    The negative BOLD response as a marker of the seizure onset zone

    Get PDF
    Epilepsy is a neurological disease affecting 70 million people worldwide. For most individuals, these seizures can be controlled using medications, however nearly 1 in 3 people may need surgery to achieve seizure freedom. For this surgery to be successful, the brain region generating the seizures, which contains the critical seizure onset zone (SOZ), must be accurately identified and removed. Unfortunately, the surgical success rate is low likely due to imprecise determination of the SOZ. As a novel approach to SOZ identification, the collection of intracranial electroencephalography and functional magnetic resonance imaging (iEEG-fMRI) has been proposed as a novel method of identifying the SOZ. However, iEEG-fMRI faces the methodological challenge of artifact introduced from MR scanning which completely obscures the physiological EEG signal. Therefore, the first step towards bringing iEEG-fMRI into the clinical realm is to improve methods for extracting the physiological EEG signal from the iEEG-fMRI data. To this end, the first study in this thesis validated a set of methods aimed at removing fMRI artifact from iEEG, culminating in the creation of the first automatic iEEG pre-processing pipeline. The next step towards clinical utility for iEEG-fMRI is improving our interpretation of iEEG-fMRI results. Traditionally, only positive IED related fMRI activation maps were considered in relation to SOZ localization, and the negative response was ignored. It has been suggested that both positive and negative activation maps should be considered, and the maximal cluster of these two maps, regardless of polarity, should be used to localize the SOZ. In the second study, the concept was tested using iEEG-fMRI and it was found that the use of the maximal negative cluster had limited utility for SOZ localization. The results of this thesis provide a new method for preparing EEG data from iEEG-fMRI experiments and it shows that the bulk of maximal negative fMRI clusters have limited reliability for clinical applications

    Mining Biomarkers Of Epilepsy From Large-Scale Intracranial Electroencephalography

    Get PDF
    Epilepsy is a chronic neurological disorder characterized by seizures. Affecting over 50 million people worldwide, the quality of life of a patient with uncontrolled epilepsy is degraded by medical, social, cognitive, and psychological dysfunction. Fortunately, two-thirds of these patients can achieve adequate seizure control through medications. Unfortunately, one-third cannot. Improving treatment for this patient population depends upon improving our understanding of the underlying epileptic network. Clinical therapies modulate this network to some degree of success, including surgery to remove the seizure onset zone or neuromodulation to alter the brain\u27s dynamics. High resolution intracranial EEG (iEEG) is often employed to study the dynamics of cortical networks, from interictal patterns to more complex quantitative features. These interictal patterns include epileptiform biomarkers whose detection and mapping, along with seizures and neuroimaging, form the mainstay of data for clinical decision making around drug therapy, surgery, and devices. They are also increasingly important to assess the effects of epileptic physiology on brain functions like behavior and cognition, which are not well characterized. In this work, we investigate the significance and trends of epileptiform biomarkers in animal and human models of epilepsy. We develop reliable methods to quantify interictal patterns, applying state of the art techniques from machine learning, signal processing, and EEG analysis. We then validate these tools in three major applications: 1. We study the effect of interictal spikes on human cognition, 2. We assess trends of interictal epileptiform bursts and their relationship to seizures in prolonged recordings from canines and rats, and 3. We assess the stability of long-term iEEG spanning several years. These findings have two main impacts: (1) they inform the interpretation of interictal iEEG patterns and elucidate the timescale of post-implantation changes. These findings have important implications for research and clinical care, particularly implantable devices and evaluating patients for epilepsy surgery. (2) They provide an analytical framework to enable others to mine large-scale iEEG datasets. In this way we hope to make a lasting contribution to accelerate collaborative research not only in epilepsy, but also in the study of animal and human electrophysiology in acute and chronic conditions
    • …
    corecore