Towards network-guided neuromodulation for epilepsy

Brain, Journal Year: 2022, Volume and Issue: 145(10), P. 3347 - 3362

Published: June 30, 2022

Abstract Epilepsy is well-recognized as a disorder of brain networks. There growing body research to identify critical nodes within dynamic epileptic networks with the aim target therapies that halt onset and propagation seizures. In parallel, intracranial neuromodulation, including deep stimulation responsive neurostimulation, are well-established expanding reduce seizures in adults focal-onset epilepsy; there emerging evidence for their efficacy children generalized-onset seizure disorders. The convergence these advancing fields driving an era ‘network-guided neuromodulation’ epilepsy. this review, we distil current literature on network mechanisms underlying neurostimulation We discuss modulation key ‘propagation points’ epileptogenic network, focusing primarily thalamic nuclei targeted clinical practice. These include (i) anterior nucleus thalamus, now clinically approved site open loop stimulation, increasingly neurostimulation; (ii) centromedian both epilepsies. briefly associated other neuromodulation targets, such pulvinar piriform cortex, septal area, subthalamic nucleus, cerebellum others. report synergistic findings garnered from multiple modalities investigation have revealed structural functional points — scalp invasive EEG, diffusion MRI. also recordings implanted devices which provide us data aiming modulate. Finally, review continuing evolution network-guided epilepsy accelerate progress towards two translational goals: use pre-surgical analyses determine patient candidacy by providing biomarkers predict efficacy; deliver precise, personalized effective antiepileptic prevent arrest through mapping each patients’ individual

Language: Английский

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Deep brain stimulation targets in epilepsy: Systematic review and meta‐analysis of anterior and centromedian thalamic nuclei and hippocampus

Epilepsia, Journal Year: 2022, Volume and Issue: 63(3), P. 513 - 524

Published: Jan. 3, 2022

Abstract Deep brain stimulation (DBS) is a neuromodulatory treatment used in patients with drug‐resistant epilepsy (DRE). The primary goal of this systematic review and meta‐analysis to describe recent advancements the field DBS for epilepsy, compare results published trials, clarify clinical utility DRE. A literature search was performed by two independent authors. Forty‐four articles were included (23 anterior thalamic nucleus [ANT], 8 centromedian [CMT], 13 hippocampus) total 527 patients. mean seizure reduction after ANT, CMT, hippocampus our 60.8%, 73.4%, 67.8%, respectively. an effective safe therapy Based on randomized controlled trials larger series, best evidence exists nucleus. Further are required role CMT hippocampal stimulation. Our analysis suggests more efficient deep ANT focal seizures, wider use generalized temporal lobe seizures. Factors associated outcome electrode location, parameters, type longer time Recent anatomical targeting, functional neuroimaging, responsive neurostimulation, sensing local potentials could potentially lead improved outcomes reduced sudden, unexpected death epilepsy. Biomarkers needed successful patient selection, targeting electrodes optimization parameters.

Language: Английский

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Practical considerations in epilepsy neurostimulation

Epilepsia, Journal Year: 2022, Volume and Issue: 63(10), P. 2445 - 2460

Published: June 14, 2022

Neuromodulation is a key therapeutic tool for clinicians managing patients with drug-resistant epilepsy. Multiple devices are available long-term follow-up and real-world experience. The aim of this review to give practical summary neuromodulation techniques guide the selection modalities, focusing on patient devices, common approaches initiation programming, outpatient management issues. Vagus nerve stimulation (VNS), deep brain anterior nucleus thalamus (DBS-ANT), responsive neurostimulation (RNS) all supported by randomized controlled trials that show safety significant impact seizure reduction, as well suggestion reduction in risk sudden unexplained death epilepsy (SUDEP). Significant reductions observed after 3 months DBS, RNS, VNS trials, efficacy appears improve time out 7 10 years albeit uncontrolled or retrospective studies. A number experience seizure-free intervals 6 more three modalities. Number location epileptogenic foci important factors affecting efficacy, together comorbidities such severe mood sleep disorders, may influence choice modality. Programming has evolved-DBS typically initiated at lower current/voltage than used pivotal trial, whereas target charge density however generalizable optimal parameters yet be defined. Noninvasive an emerging modality, although it currently not widely. In summary, clinical practice evolved from those established trials. Guidance now who wish expand their approach, technique tailored individual based characteristics, tolerance, preferences.

Language: Английский

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Thalamic deep brain stimulation modulates cycles of seizure risk in epilepsy

Scientific Reports, Journal Year: 2021, Volume and Issue: 11(1)

Published: Dec. 20, 2021

Abstract Chronic brain recordings suggest that seizure risk is not uniform, but rather varies systematically relative to daily (circadian) and multiday (multidien) cycles. Here, one human seven dogs with naturally occurring epilepsy had continuous intracranial EEG (median 298 days) using novel implantable sensing stimulation devices. Two pet the subject received concurrent thalamic deep (DBS) over multiple months. All subjects circadian cycles in rate of interictal epileptiform spikes (IES). There was phase locking IES five out eight subjects, respectively. Thalamic DBS modified (all 3 subjects) (analysis limited participant) clustering subject. Multiscale excitability are features canine modifiable by DBS.

Language: Английский

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Distributed brain co-processor for tracking spikes, seizures and behaviour during electrical brain stimulation

Brain Communications, Journal Year: 2022, Volume and Issue: 4(3)

Published: May 2, 2022

Abstract Early implantable epilepsy therapy devices provided open-loop electrical stimulation without brain sensing, computing, or an interface for synchronized behavioural inputs from patients. Recent provide sensing but have not yet developed analytics accurately tracking and quantifying behaviour seizures. Here we describe a distributed co-processor providing intuitive bi-directional between patient, implanted neural device, local computing resources. Automated analysis of continuous streaming electrophysiology is with patient reports using handheld device integrated cloud resources seizures, interictal epileptiform spikes symptoms during therapeutic stimulation. The classification algorithms seizures were parameterized long-term ambulatory data nine humans eight canines epilepsy, then implemented prospectively in out-of-sample testing two pet four drug-resistant living their natural environments. Accurate seizure diaries are needed as the primary clinical outcome measure to guide brain-stimulation optimization. system described here enables spikes, correlation reports. In future, will allow more detailed investigation impact on

Language: Английский

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Pulvinar neuromodulation for seizure monitoring and network modulation in temporal plus epilepsy

Annals of Clinical and Translational Neurology, Journal Year: 2023, Volume and Issue: 10(7), P. 1254 - 1259

Published: May 25, 2023

ABSTRACT Deep brain stimulation (DBS) is a promising treatment for drug‐refractory epilepsies (DRE) when targeting the anterior nuclei of thalamus (ANT). However, other thalamic nuclei, such as pulvinar, shows therapeutic promise. Our pioneering case study presents application ambulatory seizure monitoring using spectral fingerprinting (12.15–17.15 Hz) recorded through Medtronic Percept DBS implanted bilaterally in medial pulvinar thalami. This technology offers unprecedented opportunities real‐time burden and thalamocortical network modulation effective reduction patients with bilateral mesial temporal plus that are not suitable resection.

Language: Английский

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Neural signal data collection and analysis of Percept™ PC BrainSense recordings for thalamic stimulation in epilepsy

Journal of Neural Engineering, Journal Year: 2024, Volume and Issue: 21(1), P. 012001 - 012001

Published: Jan. 11, 2024

Abstract Deep brain stimulation (DBS) using Medtronic’s Percept™ PC implantable pulse generator is FDA-approved for treating Parkinson’s disease (PD), essential tremor, dystonia, obsessive compulsive disorder, and epilepsy. enables simultaneous recording of neural signals from the same lead used stimulation. Many sensing features were built with PD patients in mind, but these are potentially useful to refine therapies many different processes. When starting our ongoing epilepsy research study, we found it difficult find detailed descriptions about have compiled information multiple sources understand as a tool, particularly use other than those PD. Here provide tutorial scientists physicians interested PC’s examples how time series data often represented saved. We address characteristics recorded discuss hardware software capabilities pre-processing, signal filtering, DBS performance. explain power spectrum shaped by filter response well aliasing due digitally sampling data. present ability extract biomarkers that may be optimize therapy. show differences type affects noise implanted leads seven enrolled clinical trial. has sufficient signal-to-noise ratio, capabilities, stimulus artifact rejection activity recording. Limitations rate, potential artifacts during stimulation, shortening battery life when monitoring at home observed. Despite limitations, demonstrates tool order personalize treatment.

Language: Английский

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Proceedings of the Ninth Annual Deep Brain Stimulation Think Tank: Advances in Cutting Edge Technologies, Artificial Intelligence, Neuromodulation, Neuroethics, Pain, Interventional Psychiatry, Epilepsy, and Traumatic Brain Injury

Frontiers in Human Neuroscience, Journal Year: 2022, Volume and Issue: 16

Published: March 4, 2022

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely person and overseas joining by video conferencing technology. The founded 2012 provides an open platform where clinicians, engineers researchers (from industry academia) can freely discuss current emerging deep brain stimulation (DBS) technologies as well the logistical ethical issues facing field. consensus among speakers that expanded its scope has been applied to multiple disorders effort modulate neural circuitry. After collectively sharing our experiences, it estimated globally more than 230,000 devices have implanted for neurological neuropsychiatric disorders. As such, this year’s meeting focused advances following areas: neuromodulation Europe, Asia Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, pain, network epilepsy traumatic injury.

Language: Английский

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Seizure forecasting: Bifurcations in the long and winding road

Epilepsia, Journal Year: 2022, Volume and Issue: 64(S4)

Published: May 23, 2022

To date, the unpredictability of seizures remains a source suffering for people with epilepsy, motivating decades research into methods to forecast seizures. Originally, only few scientists and neurologists ventured this niche endeavor, which, given difficulty task, soon turned long winding road. Over past decade, however, our narrow field has seen major acceleration, trials chronic electroencephalographic devices subsequent discovery cyclical patterns in occurrence Now, burgeoning science seizure timing is emerging, which turn informs best forecasting strategies upcoming clinical trials. Although finish line might be view, many challenges remain make reality. This review covers most recent scientific, technical, medical developments, discusses methodology detail, sets number goals future studies.

Language: Английский

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Patient‐specific structural connectivity informs outcomes of responsive neurostimulation for temporal lobe epilepsy

Epilepsia, Journal Year: 2022, Volume and Issue: 63(8), P. 2037 - 2055

Published: May 13, 2022

Abstract Objective Responsive neurostimulation is an effective therapy for patients with refractory mesial temporal lobe epilepsy. However, clinical outcomes are variable, few become seizure‐free, and the optimal stimulation location currently undefined. The aim of this study was to quantify responsive in lobe, identify stimulation‐dependent networks associated seizure reduction, determine if or inform outcomes. Methods We modeled patient‐specific volumes tissue activated created probabilistic maps local regions across a retrospective cohort 22 then mapped network effects by seeding tractography from volume both normative diffusion‐weighted imaging. identified reduction using predicted cohort. Results Patient‐specific connectivity correlated effectiveness after cross‐validation ( p = .03); however, derived healthy subjects not .44). Increased medial prefrontal cortex, cingulate precuneus greater reduction. Significance Overall, our results suggest that therapeutic effect may be mediated specific connected activated. In addition, required structural It therefore likely altered epilepsy utilizing imaging could important future studies. here utilized target improve treated neurostimulation.

Language: Английский

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