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.
Attentional control is important both for learning to read and for performing difficult reading tasks. A previous study invoked 2 mechanisms to explain reaction time (RT) differences between reading ...tasks with variable attentional demands. The present study combined behavioral and neuroimaging measures to test the hypotheses that there are 2 mechanisms of interaction between attentional control and reading; that these mechanisms are dissociable both behaviorally and neuro-anatomically; and that the 2 mechanisms involve functionally separable control systems. First, RT evidence was found in support of the 2-mechanism model, corroborating the previous study. Next, 2 sets of brain regions were identified as showing functional magnetic resonance imaging blood oxygen level-dependent activity that maps onto the 2-mechanism distinction. One set included bilateral Cingulo-opercular regions and mostly right-lateralized Dorsal Attention regions (CO/DA+). This CO/DA+ region set showed response properties consistent with a role in reporting which processing pathway (phonological or lexical) was biased for a particular trial. A second set was composed primarily of left-lateralized Frontal-parietal (FP) regions. Its signal properties were consistent with a role in response checking. These results demonstrate how the subcomponents of attentional control interact with subcomponents of reading processes in healthy young adults.
Objective
Electrical stimulation mapping (ESM) is the clinical standard for functional localization with subdural electrodes (SDE). As stereoelectroencephalography (SEEG) has emerged as an ...alternative option, we compared functional responses, afterdischarges (ADs), and unwanted ESM‐induced seizures (EISs) between the two electrode types.
Methods
Incidence and current thresholds for functional responses (sensory, motor, speech/language), ADs, and EISs were compared between SDE and SEEG using mixed models incorporating relevant covariates.
Results
We identified 67 SEEG ESM and 106 SDE ESM patients (7207 and 4980 stimulated contacts, respectively). We found similar incidence of language and motor responses between electrode types; however, more SEEG patients reported sensory responses. ADs and EISs occurred less commonly with SEEG than SDE. Current thresholds for language, face motor, and upper extremity (UE) motor responses and EIS significantly decreased with age. However, they were not affected by electrode type, premedication, or dominant hemispheric stimulation. AD thresholds were higher with SEEG than with SDE. For SEEG ESM, language thresholds remained below AD thresholds up to 26 years of age, whereas this relationship was inverse for SDE. Also, face and UE motor thresholds fell below AD thresholds at earlier ages for SEEG than SDE. AD and EIS thresholds were not affected by premedication.
Significance
SEEG and SDE have clinically relevant differences for functional brain mapping with electrical stimulation. Although evaluation of language and motor regions is comparable between SEEG and SDE, SEEG offers a higher likelihood of identifying sensory areas. A lower incidence of ADs and EISs, and a favorable relationship between functional and AD thresholds suggest superior safety and neurophysiologic validity for SEEG ESM than SDE ESM.
We analyzed the association of neuropsychological outcomes after epilepsy surgery with the intracranial electrode type (stereo electroencephalography SEEG and subdural electrodes SDE), and electrical ...stimulation mapping (ESM) of speech/language.
Drug-resistant epilepsy patients who underwent comprehensive neuropsychological evaluation before and 1 year after epilepsy surgery were included. SEEG and SDE subgroups were matched by age, handedness, operated hemisphere, and seizure freedom. Postsurgical neuropsychological outcomes (adjusted for presurgical scores) and reliable change indices were analyzed as functions of electrode type and ESM.
Ninety-nine patients aged 6-29 years were included with similar surgical resection/ablation volumes in the SEEG and SDE subgroups. Most of the neuropsychological outcomes were comparable between SEEG and SDE subgroups; however, Working Memory and Processing Speed were significantly improved in the SEEG subgroup. Undergoing language ESM was associated with significant improvements in Spelling, Letter-Word Identification, Vocabulary, Verbal Comprehension, Verbal Learning, and Story Memory scores, but a decline in Calculation scores.
Intracranial evaluations with SEEG and SDE are comparable in terms of long-term postsurgical neuropsychological outcomes. Our data suggest that SEEG may be associated with improvements in working memory and processing speed, representing cognitive domains served by spatially distributed networks. Our study also supports wider use of language ESM before epilepsy surgery, preferably using other language tasks in addition to visual naming. Rather than the type of electrode, postsurgical neuropsychological outcomes are driven by whether language ESM was performed or not, with beneficial effects of language mapping.
A lack of consensus exists as to whether there are sex differences in the fMRI BOLD signal correlates of language processing in the human brain. Here, whole-brain fMRI was used to examine the neural ...activity of 46 adults performing one of two sets of language tasks. Conservative quantitative and qualitative criteria identified a handful of statistically significant regions of “sex difference” within each task separately. When each of the two sets of regions was investigated in the group of subjects performing the other task set, however, most of the identified “sex differences” failed to generalize. Identical analyses of the same subjects divided into sex-matched pseudorandom control groups for each task set separately revealed that it is possible to observe a similar number of statistically significant regions of “group difference” in the task-associated BOLD signal, even when the groups do not differ on any of the measured behavioral parameters, or any obvious demographic characteristic. Together, these results suggest that one should be cautious when interpreting studies that purport to have identified regions of difference between groups, whether those groups are divided by sex or by any other criterion. In particular, generalization or replication of a result in independent data sets is necessary for establishing conclusive support for any hypothesis about differences in brain function between groups.
Epilepsy in tuberous sclerosis complex (TSC) typically presents with early onset, multiple seizure types, and intractability. However, variability is observed among individuals. Here, detailed ...individual data on seizure characteristics collected prospectively during early life were used to define epilepsy profiles in this population.
Children aged zero to 36 months were followed longitudinally. Caregivers kept daily seizure diaries, including onset and daily counts for each seizure type. Patients with >70% seizure diary completion and >365 diary days were included. Developmental outcomes at 36 months were compared between subgroups.
Epilepsy was seen in 124 of 156 (79%) participants. Seizure onset occurred from zero to 29.5 months; 93% had onset before age 12 months. Focal seizures and epileptic spasms were most common. Number of seizures (for median 897 days) ranged from 1 to 9128. Hierarchical clustering based on six metrics of seizure burden (age of onset, total seizures, ratio of seizure days to nonseizure days, seizures per seizure day, and worst seven- and 30-day stretches) revealed two distinct groups with broadly favorable and unfavorable epilepsy profiles. Subpopulations within each group showed clinically meaningful differences in seizure burden. Groups with higher seizure burden had worse developmental outcomes at 36 months.
Although epilepsy is highly prevalent in TSC, not all young children with TSC have the same epilepsy profile. At least two phenotypic subpopulations are discernible based on seizure burden. Early and aggressive treatments for epilepsy in TSC may be best leveraged by targeting specific subgroups based on phenotype severity.
PDF
