Multisite thalamic recordings to characterize seizure propagation in the human brain.
Multisite thalamic recordings to characterize seizure propagation in the human brain.
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多部位丘脑记录用于表征人脑中癫痫发作的传播。
DOI：
10.1093/brain/awad121
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Parvizi,Josef
中科院分区：
文献类型：
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作者：
Wu,TeresaQ;Kaboodvand,Neda;McGinn,RyanJ;Veit,Mike;Davey,Zachary;Datta,Anjali;Graber,KevinD;Meador,KimfordJ;Fisher,Robert;Buch,Vivek;Parvizi,Josef
丘脑前核（ANT）的神经调节已被证明是有效的一个子集的难治性局灶性癫痫患者。一个重要的不确定性是在何种程度上丘脑亚区以外的ANT可以招募更突出的传播局灶性发作癫痫发作。我们设计了目前的研究，同时监测参与的ANT，mediodorsal（MD）和枕（PUL）在癫痫发作的患者谁可能是丘脑神经modulation.We研究了11例患者的临床表现假定颞叶癫痫（TLE）进行侵入性立体脑电描记术（sEEG）监测，以确认其癫痫发作的来源。我们将皮层电极延伸至丘脑的ANT、MD和PUL核。在9例患者中同时询问了一个以上的丘脑分区。我们记录了癫痫发作与植入电极在大脑的各个区域和记录癫痫发作区（SOZ）在每个记录的癫痫发作。我们直观地确定了第一个丘脑亚区参与癫痫发作传播。此外，在8名患者中，我们在每个SOZ中施加重复的单脉冲电刺激，并记录植入丘脑区域的诱发反应的时间和突出度。我们的多部位丘脑采样方法是安全的，没有引起不良事件。颅内EEG记录证实了内侧颞叶、颞叶、眶额和颞叶新皮质部位的SOZ，强调了侵入性监测对准确定位SOZ的重要性。在所有患者中，具有相同传播网络且起源于相同SOZ的癫痫发作涉及相同的丘脑亚区，具有刻板的丘脑EEG特征。定性视觉回顾发作脑电图在很大程度上是一致的定量分析的皮质丘脑诱发电位，都记录了丘脑核团以外的ANT可以有最早参与癫痫发作传播。具体而言，超过一半的患者中，枕核比ANT更早和更显著地受累。然而，哪一个特定的丘脑亚区首先表现出发作活动不能可靠地预测基于临床症状学或SOZs.Our研究结果文件的脑叶本地化的可行性和安全性，从人类丘脑双侧多位点采样。这可以允许识别用于神经调节的更个性化的丘脑靶点。未来的研究需要确定个性化的丘脑神经调节是否会导致临床结局的更大改善。
Neuromodulation of the anterior nuclei of the thalamus (ANT) has shown to be efficacious in a subset of patients with refractory focal epilepsy. One important uncertainty is to what extent thalamic subregions other than the ANT could be recruited more prominently in the propagation of focal onset seizures. We designed the current study to simultaneously monitor the engagement of the ANT, mediodorsal (MD) and pulvinar (PUL) nuclei during seizures in patients who could be candidates for thalamic neuromodulation.We studied 11 patients with clinical manifestations of presumed temporal lobe epilepsy (TLE) undergoing invasive stereo-encephalography (sEEG) monitoring to confirm the source of their seizures. We extended cortical electrodes to reach the ANT, MD and PUL nuclei of the thalamus. More than one thalamic subdivision was simultaneously interrogated in nine patients. We recorded seizures with implanted electrodes across various regions of the brain and documented seizure onset zones (SOZ) in each recorded seizure. We visually identified the first thalamic subregion to be involved in seizure propagation. Additionally, in eight patients, we applied repeated single pulse electrical stimulation in each SOZ and recorded the time and prominence of evoked responses across the implanted thalamic regions.Our approach for multisite thalamic sampling was safe and caused no adverse events. Intracranial EEG recordings confirmed SOZ in medial temporal lobe, insula, orbitofrontal and temporal neocortical sites, highlighting the importance of invasive monitoring for accurate localization of SOZs. In all patients, seizures with the same propagation network and originating from the same SOZ involved the same thalamic subregion, with a stereotyped thalamic EEG signature. Qualitative visual reviews of ictal EEGs were largely consistent with the quantitative analysis of the corticothalamic evoked potentials, and both documented that thalamic nuclei other than ANT could have the earliest participation in seizure propagation. Specifically, pulvinar nuclei were involved earlier and more prominently than ANT in more than half of the patients. However, which specific thalamic subregion first demonstrated ictal activity could not be reliably predicted based on clinical semiology or lobar localization of SOZs.Our findings document the feasibility and safety of bilateral multisite sampling from the human thalamus. This may allow more personalized thalamic targets to be identified for neuromodulation. Future studies are needed to determine if a personalized thalamic neuromodulation leads to greater improvements in clinical outcome.