Imaging the effective networks associated with cortical function through intracranial high-frequency stimulation.
Imaging the effective networks associated with cortical function through intracranial high-frequency stimulation.
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DOI：
10.1002/hbm.25749
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发表时间：
2022-04-01
影响因子：
4.8
通讯作者：
Mindruta I
中科院分区：
文献类型：
--
作者：
Barborica A;Oane I;Donos C;Daneasa A;Mihai F;Pistol C;Dabu A;Roceanu A;Mindruta I
直接电刺激（DES）被认为是绘制皮质功能的金标准。在治疗耐药癫痫时，仔细绘制脑皮层是切除或消融手术成功的关键，术后缺损最小。越来越多的证据表明，不仅局部激活，而且远程激活在引起临床效果方面也起着同样重要的作用。通过引入一种新的颅内刺激范式和信号分析方法，可以从刺激伪影中消除脑电图反应的歧义，我们强调了与临床效果相关的网络的空间范围。我们的研究包括26例接受立体脑电图调查的耐药癫痫患者，使用337个深度电极和4351个触点采样大多数脑结构。通过交替双相脉冲的极性，以一种微妙的方式改变了用于大脑皮层映射的常规高频电刺激方案，导致人工成分的谱线分裂，暴露出潜在的组织反应。通过对DES期间的脑电图反应进行频域分析，我们能够捕获远程激活并突出显示该效应的网络。通过使用标准的受试者间平均和细粒度HCP - MMP分割，我们能够为614个刺激创建本地和远程连接图，从而引发特定的临床效果。这些地图的临床价值不仅在于更好地理解影响网络的程度，指导侵入性探查，而且还在于理解癫痫发作传播的空间模式。该研究涉及到一种新方法的应用，以消除组织对高频颅内刺激的反应与人工成分的歧义，从而创建刺激引起的临床效应的有效网络图谱。这种图谱的临床价值不仅在于更好地理解影响网络的程度，指导侵入性探查，而且还在于理解癫痫发作传播的空间模式，给定癫痫发作符号学的时间线，以提高手术行为的质量。
Direct electrical stimulation (DES) is considered to be the gold standard for mapping cortical function. A careful mapping of the eloquent cortex is key to successful resective or ablative surgeries, with a minimal postoperative deficit, for treatment of drug‐resistant epilepsy. There is accumulating evidence suggesting that not only local, but also remote activations play an equally important role in evoking clinical effects. By introducing a new intracranial stimulation paradigm and signal analysis methodology allowing to disambiguate EEG responses from stimulation artifacts we highlight the spatial extent of the networks associated with clinical effects. Our study includes 26 patients that underwent stereoelectroencephalographic investigations for drug‐resistant epilepsy, having 337 depth electrodes with 4,351 contacts sampling most brain structures. The routine high‐frequency electrical stimulation protocol for eloquent cortex mapping was altered in a subtle way, by alternating the polarity of the biphasic pulses in a train, causing the splitting the spectral lines of the artifactual components, exposing the underlying tissue response. By performing a frequency‐domain analysis of the EEG responses during DES we were able to capture remote activations and highlight the effect's network. By using standard intersubject averaging and a fine granularity HCP‐MMP parcellation, we were able to create local and distant connectivity maps for 614 stimulations evoking specific clinical effects. The clinical value of such maps is not only for a better understanding of the extent of the effects' networks guiding the invasive exploration, but also for understanding the spatial patterns of seizure propagation given the timeline of the seizure semiology. The study refers to the application of a novel methodology to disambiguate the tissue responses to high‐frequency intracranial stimulation from the artifactual components, enabling the creation of an atlas of the effective networks underlying clinical effects evoked by stimulation. The clinical value of such an atlas is not only for a better understanding of the extent of the effects' networks guiding the invasive exploration, but also for understanding the spatial patterns of seizure propagation given the timeline of the seizure semiology, for a better quality of the surgical act.
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