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1.
Medicine (Baltimore) ; 99(4): e18877, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977892

RESUMO

RATIONALE: Posterior reversible encephalopathy syndrome (PRES), a rare neurologic disorder, manifests as headache, altered mental status, seizures, visual disturbances, and other focal neurologic signs with typically reversible clinical symptoms and image changes. Although the underlying mechanism remains unknown, a current theory indicates cerebral autoregulation failure as the primary cause. We report a case of PRES with stroke in an adult with intrauterine fetal death (IUFD). PATIENT CONCERNS: A 35-year-old Asian woman with twin pregnancy underwent cesarean section at 32 weeks of gestation because of IUFD. She presented with focal seizures and visual field defect 2 days after undergoing cesarean section. Her blood pressure and kidney, liver, and coagulation functions were normal without proteinuria. DIAGNOSIS: PRES was diagnosed based on a series of brain magnetic resonance imaging findings. Ischemic infarction in the right frontal lobe eventually developed to encephalomalacia. INTERVENTIONS: The patient received levetiracetam and valproate for seizure management. OUTCOMES: Five days after the onset, seizures were under control. All neurologic deficits completely improved after 21 days of admission. LESSONS: PRES can occur in women with IUFD without preeclampsia or eclampsia symptoms. Although most cases result in vasogenic edema of the brain and exhibit good prognosis, PRES can cause cytotoxic edema and permanently damage the brain.


Assuntos
Morte Fetal/etiologia , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Complicações na Gravidez/diagnóstico , Acidente Vascular Cerebral/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Cesárea , Eletrocorticografia , Feminino , Humanos , Síndrome da Leucoencefalopatia Posterior/complicações , Gravidez , Gravidez de Gêmeos , Convulsões/etiologia
3.
PLoS Comput Biol ; 15(11): e1007316, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31730613

RESUMO

Predicting future brain signal is highly sought-after, yet difficult to achieve. To predict the future phase of cortical activity at localized ECoG and MEG recording sites, we exploit its predominant, large-scale, spatiotemporal dynamics. The dynamics are extracted from the brain signal through Fourier analysis and principal components analysis (PCA) only, and cast in a data model that predicts future signal at each site and frequency of interest. The dominant eigenvectors of the PCA that map the large-scale patterns of past cortical phase to future ones take the form of smoothly propagating waves over the entire measurement array. In ECoG data from 3 subjects and MEG data from 20 subjects collected during a self-initiated motor task, mean phase prediction errors were as low as 0.5 radians at local sites, surpassing state-of-the-art methods of within-time-series or event-related models. Prediction accuracy was highest in delta to beta bands, depending on the subject, was more accurate during episodes of high global power, but was not strongly dependent on the time-course of the task. Prediction results did not require past data from the to-be-predicted site. Rather, best accuracy depended on the availability in the model of long wavelength information. The utility of large-scale, low spatial frequency traveling waves in predicting future phase activity at local sites allows estimation of the error introduced by failing to account for irreducible trajectories in the activity dynamics.


Assuntos
Mapeamento Encefálico/métodos , Previsões/métodos , Adulto , Encéfalo/fisiologia , Córtex Cerebral/fisiologia , Eletrocorticografia/métodos , Eletroencefalografia/métodos , Feminino , Humanos , Masculino , Análise de Componente Principal/métodos , Adulto Jovem
4.
N Engl J Med ; 381(17): 1632-1643, 2019 10 24.
Artigo em Inglês | MEDLINE | ID: mdl-31566309

RESUMO

BACKGROUND: Patients with metastatic colorectal cancer with the BRAF V600E mutation have a poor prognosis, with a median overall survival of 4 to 6 months after failure of initial therapy. Inhibition of BRAF alone has limited activity because of pathway reactivation through epidermal growth factor receptor signaling. METHODS: In this open-label, phase 3 trial, we enrolled 665 patients with BRAF V600E-mutated metastatic colorectal cancer who had had disease progression after one or two previous regimens. Patients were randomly assigned in a 1:1:1 ratio to receive encorafenib, binimetinib, and cetuximab (triplet-therapy group); encorafenib and cetuximab (doublet-therapy group); or the investigators' choice of either cetuximab and irinotecan or cetuximab and FOLFIRI (folinic acid, fluorouracil, and irinotecan) (control group). The primary end points were overall survival and objective response rate in the triplet-therapy group as compared with the control group. A secondary end point was overall survival in the doublet-therapy group as compared with the control group. We report here the results of a prespecified interim analysis. RESULTS: The median overall survival was 9.0 months in the triplet-therapy group and 5.4 months in the control group (hazard ratio for death, 0.52; 95% confidence interval [CI], 0.39 to 0.70; P<0.001). The confirmed response rate was 26% (95% CI, 18 to 35) in the triplet-therapy group and 2% (95% CI, 0 to 7) in the control group (P<0.001). The median overall survival in the doublet-therapy group was 8.4 months (hazard ratio for death vs. control, 0.60; 95% CI, 0.45 to 0.79; P<0.001). Adverse events of grade 3 or higher occurred in 58% of patients in the triplet-therapy group, in 50% in the doublet-therapy group, and in 61% in the control group. CONCLUSIONS: A combination of encorafenib, cetuximab, and binimetinib resulted in significantly longer overall survival and a higher response rate than standard therapy in patients with metastatic colorectal cancer with the BRAF V600E mutation. (Funded by Array BioPharma and others; BEACON CRC ClinicalTrials.gov number, NCT02928224; EudraCT number, 2015-005805-35.).


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Benzimidazóis/administração & dosagem , Carbamatos/administração & dosagem , Cetuximab/administração & dosagem , Neoplasias Colorretais/tratamento farmacológico , Mutação , Proteínas Proto-Oncogênicas B-raf/genética , Sulfonamidas/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Colorretais/genética , Neoplasias Colorretais/mortalidade , Progressão da Doença , Eletrocorticografia , Feminino , Humanos , Análise de Intenção de Tratamento , Irinotecano/uso terapêutico , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida
5.
Nat Commun ; 10(1): 4699, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619680

RESUMO

Regaining the function of an impaired limb is highly desirable in paralyzed individuals. One possible avenue to achieve this goal is to bridge the interrupted pathway between preserved neural structures and muscles using a brain-computer interface. Here, we demonstrate that monkeys with subcortical stroke were able to learn to use an artificial cortico-muscular connection (ACMC), which transforms cortical activity into electrical stimulation to the hand muscles, to regain volitional control of a paralysed hand. The ACMC induced an adaptive change of cortical activities throughout an extensive cortical area. In a targeted manner, modulating high-gamma activity became localized around an arbitrarily-selected cortical site controlling stimulation to the muscles. This adaptive change could be reset and localized rapidly to a new cortical site. Thus, the ACMC imparts new function for muscle control to connected cortical sites and triggers cortical adaptation to regain impaired motor function after stroke.


Assuntos
Adaptação Fisiológica/fisiologia , Interfaces Cérebro-Computador , Estimulação Elétrica , Córtex Motor/fisiopatologia , Músculo Esquelético/fisiologia , Córtex Somatossensorial/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Animais , Braço , Córtex Cerebral/fisiologia , Córtex Cerebral/fisiopatologia , Eletrocorticografia , Mãos , Macaca mulatta , Córtex Motor/fisiologia , Vias Neurais/fisiopatologia , Paralisia , Córtex Somatossensorial/fisiologia , Reabilitação do Acidente Vascular Cerebral , Punho
6.
Elife ; 82019 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-31596233

RESUMO

This study uses electrocorticography in humans to assess how alpha- and beta-band rhythms modulate excitability of the sensorimotor cortex during psychophysically-controlled movement imagery. Both rhythms displayed effector-specific modulations, tracked spectral markers of action potentials in the local neuronal population, and showed spatially systematic phase relationships (traveling waves). Yet, alpha- and beta-band rhythms differed in their anatomical and functional properties, were weakly correlated, and traveled along opposite directions across the sensorimotor cortex. Increased alpha-band power in the somatosensory cortex ipsilateral to the selected arm was associated with spatially-unspecific inhibition. Decreased beta-band power over contralateral motor cortex was associated with a focal shift from relative inhibition to excitation. These observations indicate the relevance of both inhibition and disinhibition mechanisms for precise spatiotemporal coordination of movement-related neuronal populations, and illustrate how those mechanisms are implemented through the substantially different neurophysiological properties of sensorimotor alpha- and beta-band rhythms.


Assuntos
Ritmo alfa , Ritmo beta , Movimento , Córtex Sensório-Motor/fisiologia , Adolescente , Adulto , Animais , Braço , Eletrocorticografia , Feminino , Humanos , Masculino , Adulto Jovem
7.
PLoS Comput Biol ; 15(9): e1007091, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31525179

RESUMO

A fundamental challenge in neuroscience is to understand what structure in the world is represented in spatially distributed patterns of neural activity from multiple single-trial measurements. This is often accomplished by learning a simple, linear transformations between neural features and features of the sensory stimuli or motor task. While successful in some early sensory processing areas, linear mappings are unlikely to be ideal tools for elucidating nonlinear, hierarchical representations of higher-order brain areas during complex tasks, such as the production of speech by humans. Here, we apply deep networks to predict produced speech syllables from a dataset of high gamma cortical surface electric potentials recorded from human sensorimotor cortex. We find that deep networks had higher decoding prediction accuracy compared to baseline models. Having established that deep networks extract more task relevant information from neural data sets relative to linear models (i.e., higher predictive accuracy), we next sought to demonstrate their utility as a data analysis tool for neuroscience. We first show that deep network's confusions revealed hierarchical latent structure in the neural data, which recapitulated the underlying articulatory nature of speech motor control. We next broadened the frequency features beyond high-gamma and identified a novel high-gamma-to-beta coupling during speech production. Finally, we used deep networks to compare task-relevant information in different neural frequency bands, and found that the high-gamma band contains the vast majority of information relevant for the speech prediction task, with little-to-no additional contribution from lower-frequency amplitudes. Together, these results demonstrate the utility of deep networks as a data analysis tool for basic and applied neuroscience.


Assuntos
Biologia Computacional/métodos , Aprendizado Profundo , Córtex Sensório-Motor/fisiologia , Fala/fisiologia , Eletrocorticografia , Humanos , Processamento de Sinais Assistido por Computador
8.
Nat Commun ; 10(1): 3671, 2019 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-31413319

RESUMO

Being able to produce sounds that capture attention and elicit rapid reactions is the prime goal of communication. One strategy, exploited by alarm signals, consists in emitting fast but perceptible amplitude modulations in the roughness range (30-150 Hz). Here, we investigate the perceptual and neural mechanisms underlying aversion to such temporally salient sounds. By measuring subjective aversion to repetitive acoustic transients, we identify a nonlinear pattern of aversion restricted to the roughness range. Using human intracranial recordings, we show that rough sounds do not merely affect local auditory processes but instead synchronise large-scale, supramodal, salience-related networks in a steady-state, sustained manner. Rough sounds synchronise activity throughout superior temporal regions, subcortical and cortical limbic areas, and the frontal cortex, a network classically involved in aversion processing. This pattern correlates with subjective aversion in all these regions, consistent with the hypothesis that roughness enhances auditory aversion through spreading of neural synchronisation.


Assuntos
Atenção , Córtex Auditivo/fisiologia , Percepção Auditiva/fisiologia , Som , Estimulação Acústica , Acústica , Adolescente , Adulto , Vias Auditivas/fisiologia , Epilepsia Resistente a Medicamentos/cirurgia , Eletrocorticografia , Epilepsias Parciais/cirurgia , Feminino , Humanos , Masculino , Fatores de Tempo , Adulto Jovem
9.
World Neurosurg ; 132: e599-e603, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31442661

RESUMO

OBJECTIVE: Patients with medically intractable epilepsy often undergo sequential surgeries and are therefore exposed to an elevated risk for infection, resulting in unanticipated returns to the operating room. The goal of our study was to determine whether use of an osteoplastic bone flap technique would reduce the infection rate in these patients. METHODS: A single-institution, retrospective chart review of patients with medically intractable epilepsy for grid placement was performed. Univariate analyses and linear regression were used to assess primary outcomes, including infection and hematomas requiring surgical evacuation. Secondary outcomes included duration of treatment and other, unanticipated surgeries. RESULTS: A total of 199 patients were identified, 56 (28%) with osteoplastic flaps. Standard free flaps were associated with an increased rate of infection at the craniotomy site (n = 24, 17%, vs. 0, 0%, P = 0.003), whereas osteoplastic flaps were associated with more returns to operating room for hematoma evacuation (n = 5, 9% vs. 3.2%, P = 0.024). Overall, the rate of return to operating room for unanticipated surgeries was similar, but infectious complications prolonged the duration of treatment (median: 17 days vs. 2 days, χ2 = 13.97, P < 0.001). CONCLUSIONS: Osteoplastic bone flaps markedly decreased the risk of craniotomy infections compared with free flaps in patients undergoing sequential surgeries. This decrease is offset, however, by an increase in intracranial hematoma requiring return to the operating room. Infection appeared to be a more significant complication as it was associated with increased duration of treatment. The osteoplastic technique is especially appealing in those patients likely to undergo multiple surgeries in short succession.


Assuntos
Craniotomia/efeitos adversos , Craniotomia/métodos , Epilepsia Resistente a Medicamentos/cirurgia , Eletrocorticografia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Feminino , Hematoma/etiologia , Hematoma/prevenção & controle , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Reoperação/efeitos adversos , Estudos Retrospectivos , Convulsões/cirurgia , Retalhos Cirúrgicos , Infecção dos Ferimentos/etiologia , Infecção dos Ferimentos/prevenção & controle
10.
Nat Commun ; 10(1): 3096, 2019 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-31363096

RESUMO

Natural communication often occurs in dialogue, differentially engaging auditory and sensorimotor brain regions during listening and speaking. However, previous attempts to decode speech directly from the human brain typically consider listening or speaking tasks in isolation. Here, human participants listened to questions and responded aloud with answers while we used high-density electrocorticography (ECoG) recordings to detect when they heard or said an utterance and to then decode the utterance's identity. Because certain answers were only plausible responses to certain questions, we could dynamically update the prior probabilities of each answer using the decoded question likelihoods as context. We decode produced and perceived utterances with accuracy rates as high as 61% and 76%, respectively (chance is 7% and 20%). Contextual integration of decoded question likelihoods significantly improves answer decoding. These results demonstrate real-time decoding of speech in an interactive, conversational setting, which has important implications for patients who are unable to communicate.


Assuntos
Mapeamento Encefálico/métodos , Córtex Cerebral/fisiologia , Fala/fisiologia , Interfaces Cérebro-Computador , Eletrocorticografia/instrumentação , Eletrocorticografia/métodos , Eletrodos Implantados , Epilepsia/diagnóstico , Epilepsia/fisiopatologia , Feminino , Humanos , Fatores de Tempo
11.
Epileptic Disord ; 21(4): 347-352, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31366450

RESUMO

Small encephaloceles of the anterior temporal pole have been increasingly recognised as an underlying epileptogenic substrate in patients with medically refractory epilepsy. The current report aims to expand on the current knowledge by emphasising that seizure semiology in such patients can vary significantly. Patients were selected from an epilepsy surgery database between 2012 and 2017. Of the 143 patients who underwent epilepsy surgery, six patients had a temporal encephalocele. Four of these patients had stereo-EEG implantation. Of the four patients studied, each had a seizure semiology discordant with an ictal focus in the temporal lobe. Intracranial EEG assessment demonstrated, irrespective of this semiology, seizures originated from the anterior temporal pole. Seizures were observed to rapidly propagate to the orbitofrontal cortex, insula, temporo-occipital junction, and posterior language regions. Engagement of the mesial temporal structures could occur early or late, however, a good surgical outcome was achieved following a focused lesionectomy in either situation. The major finding was that seizures arising from anterior temporal encephaloceles can have an extra-temporal semiology. The varied clinical semiology and the rapid propagation to seemingly distant cortical regions could be explained by the connectivity of the anterior temporal lobe.


Assuntos
Eletroencefalografia , Encefalocele/fisiopatologia , Epilepsia/fisiopatologia , Convulsões/fisiopatologia , Epilepsia Resistente a Medicamentos/fisiopatologia , Eletrocorticografia/métodos , Eletroencefalografia/métodos , Epilepsia/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino
12.
Handb Clin Neurol ; 161: 45-71, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31307620

RESUMO

Identification and localization of the "epileptogenic process" in the brain of patients with drug-resistant epilepsy for surgical cure is the goal of presurgical investigations. Intracranial recordings are required when conflicting data between seizure clinical semiology and EEG prevent precise localization within one hemisphere or lateralization, when a visible lesion on MRI seems unrelated to the electroclinical data, or in MRI-negative cases. Two methods are currently used. The objective of the subdural grid electrocorticography with or without depth electrodes (SDG/DE) is the best possible identification of the area of onset of spontaneous seizures and localization of the eloquent cortex. The objective of stereoelectroencephalography (SEEG) is to define the epileptogenic zone (configured as a network) and its relation to an unmasked lesion. Two-dimensional (SDG) and three-dimensional (SEEG) brain sampling dictate different strategies for noninvasive presurgical phase I goals as well as for data analysis. SEEG must resolve several potential localization hypotheses in a manner that cannot be achieved with SDG. SDG operates through brain surface coverage, unlike SEEG, which samples networks. SDG estimates the extent of cortical resection through a lobar or sublobar localization of ictal onset and constraints from functional mapping. SEEG defines a tailored resection according to the results of anatomo-electro-clinical correlations in stereotaxic space that will guide the ablation of the epileptogenic zone. SEEG is currently expanding faster than SDG. The prerequisites (especially in the preimplantation hypothetical strategy) and technical tools (especially stimulation and functional mapping) in the two methods are very different. This chapter presents a comparative review of the rationale, indications, electrode implantation strategies, interpretation, and surgical decision making of these two approaches of presurgical evaluation for epilepsy surgery.


Assuntos
Mapeamento Encefálico/métodos , Epilepsia Resistente a Medicamentos , Eletrocorticografia/métodos , Eletroencefalografia/métodos , Cuidados Pré-Operatórios/métodos , Epilepsia Resistente a Medicamentos/fisiopatologia , Epilepsia Resistente a Medicamentos/cirurgia , Eletrodos Implantados , Humanos
13.
EBioMedicine ; 45: 422-431, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31300348

RESUMO

BACKGROUND: The inability to reliably assess seizure risk is a major burden for epilepsy patients and prevents developing better treatments. Recent advances have paved the way for increasingly accurate seizure preictal state detection algorithms, primarily using electrocorticography (ECoG). To develop seizure forecasting for broad clinical and ambulatory use, however, less complex and invasive modalities are needed. Algorithms using scalp electroencephalography (EEG) and electrocardiography (EKG) have also achieved better than chance performance. But it remains unknown how much preictal information is in ECoG versus modalities amenable to everyday use - such as EKG and single channel EEG - and how to optimally extract that preictal information for seizure prediction. METHODS: We apply deep learning - a powerful method to extract information from complex data - on a large epilepsy data set containing multi-day, simultaneous recordings of EKG, ECoG, and EEG, using a variety of feature sets. We use the relative performance of our algorithms to compare the preictal information contained in each modality. RESULTS: We find that single-channel EKG contains a comparable amount of preictal information as scalp EEG with up to 21 channels and that preictal information is best extracted not with standard heart rate measures, but from the power spectral density. We report that preictal information is not preferentially contained in EEG or ECoG channels within the seizure onset zone. CONCLUSION: Collectively, these insights may help to devise future prospective, minimally invasive long-term epilepsy monitoring trials with single-channel EKG as a particularly promising modality.


Assuntos
Aprendizado Profundo/estatística & dados numéricos , Eletrocorticografia/métodos , Epilepsia/diagnóstico , Convulsões/diagnóstico , Eletrocardiografia/estatística & dados numéricos , Eletrocorticografia/estatística & dados numéricos , Eletroencefalografia/estatística & dados numéricos , Epilepsia/fisiopatologia , Epilepsia/terapia , Feminino , Humanos , Masculino , Medicina de Precisão/métodos , Medicina de Precisão/estatística & dados numéricos , Convulsões/fisiopatologia , Convulsões/terapia
14.
Biol Psychol ; 146: 107733, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31352031

RESUMO

Although people with high interdependent self-construal (SC) are often assumed to be competent in emotion suppression, direct evidence is missing. We tested whether interdependent SC would predict the ability to down-regulate emotional arousal. Americans of both East Asian and European descent were shown a series of pictures. They were instructed to suppress or attend to their emotions. Their electroencephalogram was recorded and analyzed. The late positive potential (LPP) evoked by unpleasant (vs. neutral) pictures (a marker of emotional arousal) was reduced in the suppress (vs. attend) condition. This effect of emotion suppression was more pronounced for those high in interdependent SC than for those low in it. Curiously, the resulting valence x condition x interdependent SC interaction was robust among those of Asian descent, but not those of European descent. The 4-way interaction involving culture was statistically significant. Our work suggests that the purported link between interdependent SC and emotion suppression may be culture-bound.


Assuntos
Americanos Asiáticos/psicologia , Emoções , Autoimagem , Adolescente , Nível de Alerta , Cultura , Eletrocorticografia , Eletroencefalografia , Grupo com Ancestrais do Continente Europeu , Potenciais Evocados/fisiologia , Feminino , Humanos , Individualidade , Masculino , Estimulação Luminosa , Estados Unidos , Adulto Jovem
15.
Handb Clin Neurol ; 160: 313-327, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277857

RESUMO

Brain mapping is often critical to the success of epilepsy and brain tumor surgeries. Mapping the cerebral cortex can be performed either extraoperatively or intraoperatively. When considering the optimal venue for a particular patient, a number of important considerations need to be considered including: the intended goals for the mapping, patient factors, anesthetic effects, stimulation parameters, cortical functions of interest, as well as the mapping modalities being considered. In this chapter, we will cover electrocorticography, cortical somatosensory evoked potentials, and the various neurophysiologic techniques used to map sensorimotor and cognitive functions, including language. One of the main uses of electrocorticography in epilepsy surgery is to map the cortical regions associated with epileptiform activity. This information is used to plan resection boundaries. Electrocorticography can also be used to monitor for afterdischarges (ADs) during direct cortical stimulation as well as for mapping high-frequency activity during various cognitive tasks. Cortical somatosensory evoked potentials can identify the central sulcus by mapping the dipolar activation of the primary somatosensory cortex that results from stimulation of the large fiber somatosensory pathway by peripheral nerve stimulation. Motor, sensory, and language cortex can also be identified by direct electrical cortical stimulation.


Assuntos
Mapeamento Encefálico/métodos , Eletrocorticografia/métodos , Monitorização Intraoperatória/métodos , Córtex Somatossensorial/fisiologia , Eletroencefalografia/métodos , Humanos , Monitorização Intraoperatória/instrumentação
16.
Int J Neurosci ; 129(11): 1045-1052, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31215295

RESUMO

Objective: It is challenging for neurosurgeons to perform surgeries on patients without detectable structural lesions. Therefore, this retrospective study aimed to explore the outcome of stereo-electroencephalography (SEEG) in suspicious areas guided by magnetoencephalography (MEG)-magnetic resonance imaging (MRI) reconstruction in MRI-negative epilepsy patients. Methods: This study included 47 patients with negative-MRI epilepsy. Seizure outcome at 24 months was assessed using a modified Engel's classification. Accordingly, class I and II were considered favorable outcomes, whereas classes III and IV were unfavorable. Furthermore, patients were classified into a consistent group if the results of MEG and SEEG indicated the same area of the brain. The relationship between surgical outcome and the concordance of MEG and SEEG was analyzed. Results: A complete seizure-free condition was achieved in 22 (47%) patients. Sex, handedness, age and duration of illness were not significantly associated with seizure-free outcome (p = .187 [Pearson chi-squared test]). The number of patients with favorable outcome (Engle I and II) was as high as 68% at the time of follow-up. Furthermore, more seizure-free patients were found in the SEEG and MEG consistent group. Conclusions: SEEG is a valuable tool in the pre-evaluation for resective epilepsy surgery, particularly in negative-MRI epilepsy patients; MEG greatly facilitates localization for SEEG electrode implantation. However, none of these tools are absolutely sensitive and reliable; therefore, collecting as much information as possible is necessary to achieve satisfactory results in epilepsy surgery.


Assuntos
Eletrocorticografia/métodos , Epilepsia/diagnóstico , Epilepsia/cirurgia , Magnetoencefalografia/métodos , Procedimentos Neurocirúrgicos/métodos , Adolescente , Adulto , Criança , Eletrocorticografia/normas , Epilepsia/fisiopatologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
17.
Seizure ; 70: 12-19, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31234050

RESUMO

PURPOSE: Resective epilepsy surgery based on an invasive EEG-monitors performed with subdural grids (SDG) or depth electrodes (stereo-electroencephalography, SEEG) is considered to be the best option towards achieving seizure-free state in drug-resistant epilepsy. The authors present a meta-analysis, due to the lack of such a study focusing on surgical outcomes originating from SDG- or SEEG-monitors. METHOD: English-language studies published until May 2018, highlighting surgical outcomes were reviewed. Outcome measures including total number of SDG- or SEEG-monitors and resective surgeries; consecutively followed surgical cases; surgical outcomes classified by Engel in overall, temporal/extratemporal and lesional/nonlesional subgroups were analyzed. RESULTS: 19 articles containing 1025 SDG-interventions and 16 publications comprising 974 SEEG-monitors were researched. The rate of resective surgery deriving from SDG-monitoring hovered at 88.8% (95%CI:83.3-92.6%) (I2 = 77.0%;p < 0.001); in SEEG-group, 79.0% (95%CI:70.4-85.7%) (I2 = 72.5%;p < 0.001) was measured. After SDG-interventions, percentage of post-resective follow-up escalated to 96.0% (95%CI:92.0-98.1%) (I2 = 49.1%;p = 0.010), and in SEEG-group, it reached 94.9% (95%CI:89.3-97.6%) (I2 = 80.2%;p < 0.001). In SDG-group, ratio of seizure-free outcomes reached 55.9% (95%CI:50.9-60.8%) (I2 = 54.47%;p = 0.002). Using SEEG-monitor, seizure-freedom occurred in 64.7% (95%CI:59.2-69.8%) (I2 = 11.9%;p = 0.32). Assessing lesional cases, likelihood of Engel I outcome was found in 57.3% (95%CI:48.7%-65.6%) (I2 = 69.9%;p < 0.001), using SDG; while in SEEG-group, it was 71.6% (95%CI:61.6%-79.9%) (I2 = 24.5%;p = 0.225). In temporal subgroup, ratio of seizure-freedom was found to be 56.7% (95%CI:51.5%-61.9%) (I2 = 3.2%;p = 0.412) in SDG-group; whereas, SEEG-group reached 73.9% (95%CI:64.4%-81.6%); (I2 = 0.00%;p = 0.45). Significant differences between seizure-free outcomes were found in overall (p = 0.02), lesional (p = 0.031), and also, temporal (p = 0.002) comparisons. CONCLUSIONS: SEEG-interventions were associated, at least, non-inferiorly, with seizure-freedom compared with SDG-monitors in temporal, lesional and overall subgroups.


Assuntos
Epilepsia Resistente a Medicamentos/cirurgia , Eletrocorticografia , Eletrodos Implantados , Monitorização Neurofisiológica , Procedimentos Neurocirúrgicos , Epilepsia Resistente a Medicamentos/diagnóstico , Eletrocorticografia/instrumentação , Humanos , Monitorização Neurofisiológica/instrumentação , Convulsões/diagnóstico , Convulsões/cirurgia , Resultado do Tratamento
18.
Epileptic Disord ; 21(3): 252-264, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31225808

RESUMO

Temporal lobe epilepsy with amygdala enlargement (TLE-AE) has been considered a subtype of TLE. We evaluated the epileptogenic zone in patients with TLE-AE, who underwent intracranial video-EEG (ivEEG) and/or intraoperative electrocorticography (ioECoG) as well as epilepsy surgery. Eleven patients with TLE-AE were enrolled and investigated based on seizure profile, volumetric MRI, the Wechsler Memory Scale-Revised (WMS-R), the location of seizure onset zone (SOZ) and irritative zone (IZ) based on ivEEG (n=8), the location of interictal epileptiform discharges (IEDs) based on ioECoG (11), surgical procedure, and seizure outcome. The mean age at seizure onset was 34.9 years (range: 23-57). The mean duration of seizures was 5.0 years (range: 1-10). The number of AEDs was 2.3 (range: 1-5). The mean seizure frequency was nine per month (range: 1-30/month). All patients presented with focal impaired awareness seizures with (n=9) and without (2) secondary generalized convulsions. Volumetric MRI analysis showed unilateral enlarged amygdala with statistical significance (p<0.01). None of the patients' hippocampi had any abnormality based on MRI. Pre-operative mean verbal, visual, and delayed recall scores based on the WMS-R were over 100. The SOZ and IZ were identified in both the amygdala and hippocampus in seven patients and in only the amygdala in one patient based on ivEEG. IEDs were identified in the hippocampus in six patients and in both the amygdala and hippocampus in four patients based on ioECoG. All 11 patients underwent anterior temporal lobectomy, including amygdala resection, with multiple hippocampal transections (dominant hemisphere: seven patients) and resection (non-dominant hemisphere: three patients). Nine (81.8%) of 11 patients achieved seizure freedom with a mean follow-up of 26 months (range: 12-47). Post-operative WMS-R results did not show any significant deterioration, with a mean follow-up of 15 months (range: 12-24). The resected amygdala showed no histopathological abnormality. The epileptogenic zone of TLE-AE involves both the amygdala and hippocampus. ivEEG may be needed to explore the SOZ in normal hippocampus in addition to enlarged amygdala. Amygdala resection and multiple hippocampal transections may control the epileptogenic limbic system and save memory function in patients with TLE-AE.


Assuntos
Tonsila do Cerebelo/patologia , Epilepsia Resistente a Medicamentos/patologia , Eletrocorticografia , Hipocampo/patologia , Adulto , Tonsila do Cerebelo/fisiopatologia , Lobectomia Temporal Anterior/métodos , Epilepsia Resistente a Medicamentos/fisiopatologia , Eletrocorticografia/métodos , Eletroencefalografia/métodos , Epilepsia do Lobo Temporal/fisiopatologia , Feminino , Hipocampo/fisiopatologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Convulsões/fisiopatologia , Lobo Temporal/fisiopatologia
19.
Brain Topogr ; 32(4): 550-568, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31209695

RESUMO

Electrophysiological Source Imaging (ESI) is hampered by lack of "gold standards" for model validation. Concurrent electroencephalography (EEG) and electrocorticography (ECoG) experiments (EECoG) are useful for this purpose, especially primate models due to their flexibility and translational value for human research. Unfortunately, there is only one EECoG experiments in the public domain that we know of: the Multidimensional Recording (MDR) is based on a single monkey ( www.neurotycho.org ). The mining of this type of data is hindered by lack of specialized procedures to deal with: (1) Severe EECoG artifacts due to the experimental produces; (2) Sophisticated forward models that account for surgery induced skull defects and implanted ECoG electrode strips; (3) Reliable statistical procedures to estimate and compare source connectivity (partial correlation). We provide solutions to the processing issues just mentioned with EECoG-Comp: an open source platform ( https://github.com/Vincent-wq/EECoG-Comp ). EECoG lead fields calculated with FEM (Simbio) for MDR data are also provided and were used in other papers of this special issue. As a use case with the MDR, we show: (1) For real MDR data, 4 popular ESI methods (MNE, LCMV, eLORETA and SSBL) showed significant but moderate concordance with a usual standard, the ECoG Laplacian (standard partial [Formula: see text]); (2) In both monkey and human simulations, all ESI methods as well as Laplacian had a significant but poor correspondence with the true source connectivity. These preliminary results may stimulate the development of improved ESI connectivity estimators but require the availability of more EECoG data sets to obtain neurobiologically valid inferences.


Assuntos
Eletroencefalografia/métodos , Artefatos , Eletrocorticografia , Eletrodos Implantados , Humanos
20.
Nat Commun ; 10(1): 2509, 2019 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-31175304

RESUMO

Speech communication in real-world environments requires adaptation to changing acoustic conditions. How the human auditory cortex adapts as a new noise source appears in or disappears from the acoustic scene remain unclear. Here, we directly measured neural activity in the auditory cortex of six human subjects as they listened to speech with abruptly changing background noises. We report rapid and selective suppression of acoustic features of noise in the neural responses. This suppression results in enhanced representation and perception of speech acoustic features. The degree of adaptation to different background noises varies across neural sites and is predictable from the tuning properties and speech specificity of the sites. Moreover, adaptation to background noise is unaffected by the attentional focus of the listener. The convergence of these neural and perceptual effects reveals the intrinsic dynamic mechanisms that enable a listener to filter out irrelevant sound sources in a changing acoustic scene.


Assuntos
Córtex Auditivo/fisiologia , Ruído , Percepção da Fala/fisiologia , Adaptação Fisiológica , Adulto , Atenção/fisiologia , Epilepsia Resistente a Medicamentos/fisiopatologia , Epilepsia Resistente a Medicamentos/cirurgia , Eletrocorticografia , Feminino , Humanos , Masculino , Acústica da Fala
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