Direct Cortical Stimulation to Probe the Ictogenicity of the Epileptogenic Nodes in Temporal Lobe Epilepsy
Accurate mapping of the seizure onset zone (SOZ) is critical to the success of epilepsy surgery outcomes. Epileptogenicity index (EI) is a statistical method that delineates hyperexcitable brain regions involved in the generation and early propagation of seizures. However, EI can overestimate the SO...
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Frontiers Media S.A.
2022-01-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2021.761412/full |
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| author | Auriana Irannejad Auriana Irannejad Ganne Chaitanya Ganne Chaitanya Emilia Toth Emilia Toth Diana Pizarro Diana Pizarro Sandipan Pati Sandipan Pati |
| author_facet | Auriana Irannejad Auriana Irannejad Ganne Chaitanya Ganne Chaitanya Emilia Toth Emilia Toth Diana Pizarro Diana Pizarro Sandipan Pati Sandipan Pati |
| author_sort | Auriana Irannejad |
| collection | DOAJ |
| description | Accurate mapping of the seizure onset zone (SOZ) is critical to the success of epilepsy surgery outcomes. Epileptogenicity index (EI) is a statistical method that delineates hyperexcitable brain regions involved in the generation and early propagation of seizures. However, EI can overestimate the SOZ for particular electrographic seizure onset patterns. Therefore, using direct cortical stimulation (DCS) as a probing tool to identify seizure generators, we systematically evaluated the causality of the high EI nodes (>0.3) in replicating the patient's habitual seizures. Specifically, we assessed the diagnostic yield of high EI nodes, i.e., the proportion of high EI nodes that evoked habitual seizures. A retrospective single-center study that included post-stereo encephalography (SEEG) confirmed TLE patients (n = 37) that had all high EI nodes stimulated, intending to induce a seizure. We evaluated the nodal responses (true and false responder rate) to stimulation and correlated with electrographic seizure onset patterns (hypersynchronous-HYP and low amplitude fast activity patterns-LAFA) and clinically defined SOZ. The ictogenicity (i.e., the propensity to induce the patient's habitual seizure) of a high EI node was only 44.5%. The LAFA onset pattern had a significantly higher response rate to DCS (i.e., higher evoked seizures). The concordance of an evoked habitual seizure with a clinically defined SOZ with good outcomes was over 50% (p = 0.0025). These results support targeted mapping of SOZ in LAFA onset patterns by performing DCS in high EI nodes to distinguish seizure generators (true responders) from hyperexcitable nodes that may be involved in early propagation. |
| first_indexed | 2024-04-11T16:51:50Z |
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| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-11T16:51:50Z |
| publishDate | 2022-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-1cc21f0ef84b42d1ab426295f09259572022-12-22T04:13:23ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-01-011210.3389/fneur.2021.761412761412Direct Cortical Stimulation to Probe the Ictogenicity of the Epileptogenic Nodes in Temporal Lobe EpilepsyAuriana Irannejad0Auriana Irannejad1Ganne Chaitanya2Ganne Chaitanya3Emilia Toth4Emilia Toth5Diana Pizarro6Diana Pizarro7Sandipan Pati8Sandipan Pati9Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United StatesEpilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, United StatesDepartment of Neurology, University of Alabama at Birmingham, Birmingham, AL, United StatesEpilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, United StatesDepartment of Neurology, University of Alabama at Birmingham, Birmingham, AL, United StatesEpilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, United StatesDepartment of Neurology, University of Alabama at Birmingham, Birmingham, AL, United StatesEpilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, United StatesDepartment of Neurology, University of Alabama at Birmingham, Birmingham, AL, United StatesEpilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, United StatesAccurate mapping of the seizure onset zone (SOZ) is critical to the success of epilepsy surgery outcomes. Epileptogenicity index (EI) is a statistical method that delineates hyperexcitable brain regions involved in the generation and early propagation of seizures. However, EI can overestimate the SOZ for particular electrographic seizure onset patterns. Therefore, using direct cortical stimulation (DCS) as a probing tool to identify seizure generators, we systematically evaluated the causality of the high EI nodes (>0.3) in replicating the patient's habitual seizures. Specifically, we assessed the diagnostic yield of high EI nodes, i.e., the proportion of high EI nodes that evoked habitual seizures. A retrospective single-center study that included post-stereo encephalography (SEEG) confirmed TLE patients (n = 37) that had all high EI nodes stimulated, intending to induce a seizure. We evaluated the nodal responses (true and false responder rate) to stimulation and correlated with electrographic seizure onset patterns (hypersynchronous-HYP and low amplitude fast activity patterns-LAFA) and clinically defined SOZ. The ictogenicity (i.e., the propensity to induce the patient's habitual seizure) of a high EI node was only 44.5%. The LAFA onset pattern had a significantly higher response rate to DCS (i.e., higher evoked seizures). The concordance of an evoked habitual seizure with a clinically defined SOZ with good outcomes was over 50% (p = 0.0025). These results support targeted mapping of SOZ in LAFA onset patterns by performing DCS in high EI nodes to distinguish seizure generators (true responders) from hyperexcitable nodes that may be involved in early propagation.https://www.frontiersin.org/articles/10.3389/fneur.2021.761412/fulldirect cortical stimulationseizure onset zoneictogenicitytemporal lobe epilepsyepileptogenicity |
| spellingShingle | Auriana Irannejad Auriana Irannejad Ganne Chaitanya Ganne Chaitanya Emilia Toth Emilia Toth Diana Pizarro Diana Pizarro Sandipan Pati Sandipan Pati Direct Cortical Stimulation to Probe the Ictogenicity of the Epileptogenic Nodes in Temporal Lobe Epilepsy Frontiers in Neurology direct cortical stimulation seizure onset zone ictogenicity temporal lobe epilepsy epileptogenicity |
| title | Direct Cortical Stimulation to Probe the Ictogenicity of the Epileptogenic Nodes in Temporal Lobe Epilepsy |
| title_full | Direct Cortical Stimulation to Probe the Ictogenicity of the Epileptogenic Nodes in Temporal Lobe Epilepsy |
| title_fullStr | Direct Cortical Stimulation to Probe the Ictogenicity of the Epileptogenic Nodes in Temporal Lobe Epilepsy |
| title_full_unstemmed | Direct Cortical Stimulation to Probe the Ictogenicity of the Epileptogenic Nodes in Temporal Lobe Epilepsy |
| title_short | Direct Cortical Stimulation to Probe the Ictogenicity of the Epileptogenic Nodes in Temporal Lobe Epilepsy |
| title_sort | direct cortical stimulation to probe the ictogenicity of the epileptogenic nodes in temporal lobe epilepsy |
| topic | direct cortical stimulation seizure onset zone ictogenicity temporal lobe epilepsy epileptogenicity |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2021.761412/full |
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