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Stability of infraslow correlation structure in time-shifted intracranial EEG signals. 时移颅内脑电信号的次低相关结构的稳定性。
Pub Date : 2024-08-27 eCollection Date: 2024-01-01 DOI: 10.3389/fnetp.2024.1441294
Rasesh B Joshi, Robert B Duckrow, Irina I Goncharova, Lawrence J Hirsch, Dennis D Spencer, Dwayne W Godwin, Hitten P Zaveri

It is increasingly understood that the epilepsies are characterized by network pathology that can span multiple spatial and temporal scales. Recent work indicates that infraslow (<0.2 Hz) envelope correlations may form a basis for distant spatial coupling in the brain. We speculated that infraslow correlation structure may be preserved even with some time lag between signals. To this end, we studied intracranial EEG (icEEG) data collected from 22 medically refractory epilepsy patients. For each patient, we selected hour-long background, awake icEEG epochs before and after antiseizure medication (ASM) taper. For each epoch, we selected 5,000 random electrode contact pairs and estimated magnitude-squared coherence (MSC) below 0.15 Hz of band power time-series in the traditional EEG frequency bands. Using these same contact pairs, we shifted one signal of the pair by random durations in 15-s increments between 0 and 300 s. We aggregated these data across all patients to determine how infraslow MSC varies with duration of lag. We further examined the effect of ASM taper on infraslow correlation structure. We also used surrogate data to empirically characterize MSC estimator and to set optimal parameters for estimation specifically for the study of infraslow activity. Our empirical analysis of the MSC estimator showed that hour-long segments with MSC computed using 3-min windows with 50% overlap was sufficient to capture infraslow envelope correlations while minimizing estimator bias and variance. The mean MSC decreased monotonically with increasing time lag until 105 s of lag, then plateaued between 106 and 300 s. Significantly nonzero infraslow envelope MSC was preserved in all frequency bands until about 1 min of time lag, both pre- and post-ASM taper. We also saw a slight, but significant increase in infraslow MSC post-ASM taper, consistent with prior work. These results provide evidence for the feasibility of examining infraslow activity via its modulation of higher-frequency activity in the absence of DC-coupled recordings. The use of surrogate data also provides a general methodology for benchmarking measures used in network neuroscience studies. Finally, our study points to the clinical relevance of infraslow activity in assessing seizure risk.

越来越多的人认识到,癫痫的特点是可以跨越多个空间和时间尺度的网络病理学。最近的研究表明,下流(
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引用次数: 0
Review: seizure-related consolidation and the network theory of epilepsy. 回顾:癫痫发作相关巩固和癫痫网络理论。
Pub Date : 2024-08-22 eCollection Date: 2024-01-01 DOI: 10.3389/fnetp.2024.1430934
Mark R Bower

Epilepsy is a complex, multifaceted disease that affects patients in several ways in addition to seizures, including psychological, social, and quality of life issues, but epilepsy is also known to interact with sleep. Seizures often occur at the boundary between sleep and wake, patients with epilepsy often experience disrupted sleep, and the rate of inter-ictal epileptiform discharges increases during non-REM sleep. The Network Theory of Epilepsy did not address a role for sleep, but recent emphasis on the interaction between epilepsy and sleep suggests that post-seizure sleep may also be involved in the process by which seizures arise and become more severe with time ("epileptogenesis") by co-opting processes related to the formation of long-term memories. While it is generally acknowledged that recurrent seizures arise from the aberrant function of neural circuits, it is possible that the progression of epilepsy is aided by normal, physiological function of neural circuits during sleep that are driven by pathological signals. Studies recording multiple, single neurons prior to spontaneous seizures have shown that neural assemblies activated prior to the start of seizures were reactivated during post-seizure sleep, similar to the reactivation of behavioral neural assemblies, which is thought to be involved in the formation of long-term memories, a process known as Memory Consolidation. The reactivation of seizure-related neural assemblies during sleep was thus described as being a component of Seizure-Related Consolidation (SRC). These results further suggest that SRC may viewed as a network-related aspect of epilepsy, even in those seizures that have anatomically restricted neuroanatomical origins. As suggested by the Network Theory of Epilepsy as a means of interfering with ictogenesis, therapies that interfered with SRC may provide some anti-epileptogenic therapeutic benefit, even if the interference targeted structures that were not involved originally in the seizure. Here, we show how the Network Theory of Epilepsy can be expanded to include neural plasticity mechanisms associated with learning by providing an overview of Memory Consolidation, the mechanisms thought to underlie MC, their relation to Seizure-Related Consolidation, and suggesting novel, anti-epileptogenic therapies targeting interference with network activation in epilepsy following seizures during post-seizure sleep.

癫痫是一种复杂的、多方面的疾病,除了癫痫发作外,它还在多个方面对患者造成影响,包括心理、社交和生活质量问题,但众所周知,癫痫还会与睡眠产生相互作用。癫痫发作常常发生在睡眠与觉醒的交界处,癫痫患者常常经历睡眠中断,发作间期痫样放电率在非快速眼动睡眠期间会增加。癫痫网络理论并没有提到睡眠的作用,但最近对癫痫与睡眠之间相互作用的强调表明,癫痫发作后的睡眠也可能参与到癫痫发作的过程中,并通过与长期记忆形成相关的过程共同作用,使癫痫发作随着时间的推移而变得更加严重("癫痫发生")。虽然人们普遍认为癫痫的反复发作源于神经回路功能的异常,但也有可能是睡眠期间神经回路的正常生理功能在病理信号的驱动下帮助了癫痫的发展。在自发癫痫发作前记录多个单个神经元的研究表明,在癫痫发作开始前激活的神经集合在癫痫发作后的睡眠中被重新激活,这与行为神经集合的重新激活类似,被认为参与了长期记忆的形成,这一过程被称为记忆巩固(Memory Consolidation)。因此,睡眠期间癫痫发作相关神经组合的重新激活被描述为癫痫发作相关巩固(SRC)的一个组成部分。这些结果进一步表明,SRC 可被视为癫痫的一个与网络相关的方面,即使在那些神经解剖学起源受限的癫痫发作中也是如此。正如癫痫网络理论所建议的那样,作为干扰癫痫发生的一种手段,干扰 SRC 的疗法可能会提供一些抗致痫治疗益处,即使这种干扰针对的结构原本并不涉及癫痫发作。在此,我们通过概述记忆巩固(Memory Consolidation)、被认为是MC基础的机制、它们与癫痫发作相关巩固的关系,并提出了针对癫痫发作后在发作后睡眠期间干扰癫痫网络激活的新型抗致痫性疗法,展示了如何将癫痫网络理论扩展到与学习相关的神经可塑性机制。
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引用次数: 0
Emergence of metastability in frustrated oscillatory networks: the key role of hierarchical modularity. 受挫振荡网络中出现的不稳定性:分层模块化的关键作用。
Pub Date : 2024-08-21 eCollection Date: 2024-01-01 DOI: 10.3389/fnetp.2024.1436046
Enrico Caprioglio, Luc Berthouze

Oscillatory complex networks in the metastable regime have been used to study the emergence of integrated and segregated activity in the brain, which are hypothesised to be fundamental for cognition. Yet, the parameters and the underlying mechanisms necessary to achieve the metastable regime are hard to identify, often relying on maximising the correlation with empirical functional connectivity dynamics. Here, we propose and show that the brain's hierarchically modular mesoscale structure alone can give rise to robust metastable dynamics and (metastable) chimera states in the presence of phase frustration. We construct unweighted 3-layer hierarchical networks of identical Kuramoto-Sakaguchi oscillators, parameterized by the average degree of the network and a structural parameter determining the ratio of connections between and within blocks in the upper two layers. Together, these parameters affect the characteristic timescales of the system. Away from the critical synchronization point, we detect the emergence of metastable states in the lowest hierarchical layer coexisting with chimera and metastable states in the upper layers. Using the Laplacian renormalization group flow approach, we uncover two distinct pathways towards achieving the metastable regimes detected in these distinct layers. In the upper layers, we show how the symmetry-breaking states depend on the slow eigenmodes of the system. In the lowest layer instead, metastable dynamics can be achieved as the separation of timescales between layers reaches a critical threshold. Our results show an explicit relationship between metastability, chimera states, and the eigenmodes of the system, bridging the gap between harmonic based studies of empirical data and oscillatory models.

可变系统中的振荡复杂网络已被用于研究大脑中综合和分离活动的出现,这些活动被认为是认知的基础。然而,实现可变机制所需的参数和内在机制却很难确定,通常只能依靠最大限度地提高与经验功能连接动态的相关性。在这里,我们提出并证明,大脑的分层模块化中尺度结构本身就能在存在相位挫折的情况下产生稳健的可迁移动力学和(可迁移)嵌合体状态。我们构建了由相同的仓本-坂口振荡器组成的非加权三层分层网络,其参数为网络的平均度和一个结构参数,该参数决定了上两层区块之间和区块内部的连接比例。这些参数共同影响系统的特征时标。在远离临界同步点的地方,我们检测到最底层分层中出现了与上层中的嵌合态和陨落态共存的陨落态。利用拉普拉斯重正化群流方法,我们发现了在这些不同层次中实现可变状态的两种不同途径。在上层,我们展示了对称破缺态如何依赖于系统的慢特征模型。相反,在最底层,当层与层之间的时标分离达到临界阈值时,就可以实现可迁移动力学。我们的研究结果表明,可代谢性、嵌合体状态和系统的特征模型之间存在明确的关系,从而弥补了基于谐波的经验数据研究和振荡模型之间的差距。
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引用次数: 0
Virtual stimulation of the interictal EEG network localizes the EZ as a measure of cortical excitability. 对发作间期脑电图网络的虚拟刺激可定位 EZ,以此衡量大脑皮层的兴奋性。
IF 3 Pub Date : 2024-08-20 eCollection Date: 2024-01-01 DOI: 10.3389/fnetp.2024.1425625
Sophia R Zhai, Sridevi V Sarma, Kristin Gunnarsdottir, Nathan E Crone, Adam G Rouse, Jennifer J Cheng, Michael J Kinsman, Patrick Landazuri, Utku Uysal, Carol M Ulloa, Nathaniel Cameron, Sara Inati, Kareem A Zaghloul, Varina L Boerwinkle, Sarah Wyckoff, Niravkumar Barot, Jorge A González-Martínez, Joon Y Kang, Rachel June Smith

Introduction: For patients with drug-resistant epilepsy, successful localization and surgical treatment of the epileptogenic zone (EZ) can bring seizure freedom. However, surgical success rates vary widely because there are currently no clinically validated biomarkers of the EZ. Highly epileptogenic regions often display increased levels of cortical excitability, which can be probed using single-pulse electrical stimulation (SPES), where brief pulses of electrical current are delivered to brain tissue. It has been shown that high-amplitude responses to SPES can localize EZ regions, indicating a decreased threshold of excitability. However, performing extensive SPES in the epilepsy monitoring unit (EMU) is time-consuming. Thus, we built patient-specific in silico dynamical network models from interictal intracranial EEG (iEEG) to test whether virtual stimulation could reveal information about the underlying network to identify highly excitable brain regions similar to physical stimulation of the brain. Methods: We performed virtual stimulation in 69 patients that were evaluated at five centers and assessed for clinical outcome 1 year post surgery. We further investigated differences in observed SPES iEEG responses of 14 patients stratified by surgical outcome. Results: Clinically-labeled EZ cortical regions exhibited higher excitability from virtual stimulation than non-EZ regions with most significant differences in successful patients and little difference in failure patients. These trends were also observed in responses to extensive SPES performed in the EMU. Finally, when excitability was used to predict whether a channel is in the EZ or not, the classifier achieved an accuracy of 91%. Discussion: This study demonstrates how excitability determined via virtual stimulation can capture valuable information about the EZ from interictal intracranial EEG.

简介:对于耐药性癫痫患者来说,成功定位致痫区(EZ)并对其进行手术治疗可使癫痫发作痊愈。然而,由于目前还没有临床验证的 EZ 生物标志物,手术成功率差异很大。高致痫区通常会表现出皮质兴奋性增高,这可以通过单脉冲电刺激(SPES)来探测,即向脑组织输送短脉冲电流。研究表明,SPES 的高振幅反应可以定位 EZ 区域,表明兴奋性阈值降低。然而,在癫痫监测室(EMU)进行广泛的 SPES 需要耗费大量时间。因此,我们从发作间期颅内脑电图(iEEG)中建立了患者特异性的硅动态网络模型,以测试虚拟刺激是否能揭示潜在的网络信息,从而识别出与大脑物理刺激类似的高兴奋脑区。方法:我们对在五个中心接受评估的 69 名患者进行了虚拟刺激,并对术后一年的临床效果进行了评估。我们进一步研究了按手术结果分层的 14 例患者的 SPES iEEG 反应差异。结果临床标记的 EZ 皮层区域在虚拟刺激下的兴奋性高于非 EZ 区域,成功患者的差异最大,失败患者的差异很小。这些趋势在 EMU 进行的广泛 SPES 反应中也能观察到。最后,当兴奋性被用来预测通道是否在 EZ 中时,分类器的准确率达到了 91%。讨论本研究展示了通过虚拟刺激确定的兴奋性如何从发作间期颅内脑电图中捕捉到有关 EZ 的宝贵信息。
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引用次数: 0
How synaptic function controls critical transitions in spiking neuron networks: insight from a Kuramoto model reduction 突触功能如何控制尖峰神经元网络中的临界转换:仓本模型还原的启示
Pub Date : 2024-08-09 DOI: 10.3389/fnetp.2024.1423023
L. Smirnov, V. O. Munyayev, M. Bolotov, Grigory V. Osipov, I. Belykh
The dynamics of synaptic interactions within spiking neuron networks play a fundamental role in shaping emergent collective behavior. This paper studies a finite-size network of quadratic integrate-and-fire neurons interconnected via a general synaptic function that accounts for synaptic dynamics and time delays. Through asymptotic analysis, we transform this integrate-and-fire network into the Kuramoto-Sakaguchi model, whose parameters are explicitly expressed via synaptic function characteristics. This reduction yields analytical conditions on synaptic activation rates and time delays determining whether the synaptic coupling is attractive or repulsive. Our analysis reveals alternating stability regions for synchronous and partially synchronous firing, dependent on slow synaptic activation and time delay. We also demonstrate that the reduced microscopic model predicts the emergence of synchronization, weakly stable cyclops states, and non-stationary regimes remarkably well in the original integrate-and-fire network and its theta neuron counterpart. Our reduction approach promises to open the door to rigorous analysis of rhythmogenesis in networks with synaptic adaptation and plasticity.
尖峰神经元网络中突触相互作用的动力学在形成突发性集体行为方面起着根本性的作用。本文研究了一个有限大小的二次整合-发射神经元网络,该网络通过一般突触函数相互连接,该函数考虑了突触动力学和时间延迟。通过渐近分析,我们将这种积分-发射网络转化为仓本-阪口模型,其参数通过突触函数特征明确表达。这种简化产生了突触激活率和时间延迟的分析条件,决定了突触耦合是吸引性还是排斥性的。我们的分析揭示了同步和部分同步发射的交替稳定区域,这取决于缓慢的突触激活和时间延迟。我们还证明,还原的微观模型能很好地预测原始积分点火网络及其对应的θ神经元中同步、弱稳定环状状态和非稳态的出现。我们的还原方法有望为严格分析具有突触适应性和可塑性的网络中的节奏发生打开一扇大门。
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引用次数: 0
The contribution of granger causality analysis to our understanding of cardiovascular homeostasis: from cardiovascular and respiratory interactions to central autonomic network control 格兰杰因果关系分析对我们理解心血管平衡的贡献:从心血管和呼吸系统的相互作用到中枢自律神经网络控制
Pub Date : 2024-08-08 DOI: 10.3389/fnetp.2024.1315316
Vincent Pichot, Christophe Corbier, F. Chouchou
Homeostatic regulation plays a fundamental role in maintenance of multicellular life. At different scales and in different biological systems, this principle allows a better understanding of biological organization. Consequently, a growing interest in studying cause-effect relations between physiological systems has emerged, such as in the fields of cardiovascular and cardiorespiratory regulations. For this, mathematical approaches such as Granger causality (GC) were applied to the field of cardiovascular physiology in the last 20 years, overcoming the limitations of previous approaches and offering new perspectives in understanding cardiac, vascular and respiratory homeostatic interactions. In clinical practice, continuous recording of clinical data of hospitalized patients or by telemetry has opened new applicability for these approaches with potential early diagnostic and prognostic information. In this review, we describe a theoretical background of approaches based on linear GC in time and frequency domains applied to detect couplings between time series of RR intervals, blood pressure and respiration. Interestingly, these tools help in understanding the contribution of homeostatic negative feedback and the anticipatory feedforward mechanisms in homeostatic cardiovascular and cardiorespiratory controls. We also describe experimental and clinical results based on these mathematical tools, consolidating previous experimental and clinical evidence on the coupling in cardiovascular and cardiorespiratory studies. Finally, we propose perspectives allowing to complete the understanding of these interactions between cardiovascular and cardiorespiratory systems, as well as the interplay between brain and cardiac, and vascular and respiratory systems, offering a high integrative view of cardiovascular and cardiorespiratory homeostatic regulation.
平衡调节在维持多细胞生命方面发挥着根本性的作用。在不同尺度和不同生物系统中,这一原理有助于更好地理解生物组织。因此,人们对研究生理系统之间的因果关系越来越感兴趣,例如在心血管和心肺调节领域。为此,格兰杰因果关系(GC)等数学方法在过去 20 年中被应用于心血管生理学领域,克服了以往方法的局限性,为理解心脏、血管和呼吸系统的平衡相互作用提供了新的视角。在临床实践中,通过遥测技术连续记录住院病人的临床数据为这些方法提供了新的适用性,并为早期诊断和预后提供了潜在信息。在这篇综述中,我们介绍了基于时域和频域线性 GC 的方法的理论背景,这些方法适用于检测 RR 间期、血压和呼吸时间序列之间的耦合。有趣的是,这些工具有助于理解在心血管和心肺平衡控制中平衡负反馈和预期前馈机制的贡献。我们还描述了基于这些数学工具的实验和临床结果,巩固了之前在心血管和心肺研究中有关耦合的实验和临床证据。最后,我们提出了一些视角,有助于全面了解心血管和心肺系统之间的相互作用,以及大脑和心脏、血管和呼吸系统之间的相互作用,为心血管和心肺的平衡调节提供了一个高度综合的视角。
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引用次数: 0
Case report: Bridging limbic network epilepsy with psychiatric, memory, and sleep comorbidities: case illustrations of reversible psychosis symptoms during continuous, high-frequency ANT-DBS 病例报告:边缘网络癫痫与精神、记忆和睡眠合并症的衔接:连续高频 ANT-DBS 治疗期间出现可逆性精神病症状的病例说明
Pub Date : 2024-08-08 DOI: 10.3389/fnetp.2024.1426743
Lydia P. Wheeler, Samuel Worrell, I. Balzekas, Jordan Bilderbeek, Dora Hermes, Paul E. Croarkin, Steven Messina, Jamie J Van Gompel, Kai J. Miller, V. Kremen, Gregory A Worrell
The network nature of focal epilepsy is exemplified by mesial temporal lobe epilepsy (mTLE), characterized by focal seizures originating from the mesial temporal neocortex, amygdala, and hippocampus. The mTLE network hypothesis is evident in seizure semiology and interictal comorbidities, both reflecting limbic network dysfunction. The network generating seizures also supports essential physiological functions, including memory, emotion, mood, and sleep. Pathology in the mTLE network often manifests as interictal behavioral disturbances and seizures. The limbic circuit is a vital network, and here we review one of the most common focal epilepsies and its comorbidities. We describe two people with drug resistant mTLE implanted with an investigational device enabling continuous hippocampal local field potential sensing and anterior nucleus of thalamus deep brain stimulation (ANT-DBS) who experienced reversible psychosis during continuous high-frequency stimulation. The mechanism(s) of psychosis remain poorly understood and here we speculate that the anti-epileptic effect of high frequency ANT-DBS may provide insights into the physiology of primary disorders associated with psychosis.
局灶性癫痫的网络性质以颞叶中叶癫痫(mTLE)为例,其特点是局灶性癫痫发作源自颞叶中叶新皮质、杏仁核和海马。mTLE 网络假说在癫痫发作的半身性和发作间期的合并症中表现明显,两者都反映了边缘网络功能障碍。产生癫痫发作的网络也支持重要的生理功能,包括记忆、情感、情绪和睡眠。mTLE 网络的病理变化通常表现为发作间期行为紊乱和癫痫发作。边缘回路是一个重要的网络,在此我们回顾了最常见的局灶性癫痫之一及其合并症。我们描述了两名植入了可实现连续海马局部场电位感应和丘脑前核深部脑刺激(ANT-DBS)研究设备的耐药 mTLE 患者,他们在连续高频刺激期间出现了可逆性精神病。我们在此推测,高频 ANT-DBS 的抗癫痫作用可能有助于了解与精神病相关的原发性疾病的生理学。
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引用次数: 0
Data-driven and equation-free methods for neurological disorders: analysis and control of the striatum network. 神经系统疾病的数据驱动和无方程方法:纹状体网络的分析与控制。
Pub Date : 2024-08-07 eCollection Date: 2024-01-01 DOI: 10.3389/fnetp.2024.1399347
Konstantinos Spiliotis, Rüdiger Köhling, Wolfram Just, Jens Starke

The striatum as part of the basal ganglia is central to both motor, and cognitive functions. Here, we propose a large-scale biophysical network for this part of the brain, using modified Hodgkin-Huxley dynamics to model neurons, and a connectivity informed by a detailed human atlas. The model shows different spatio-temporal activity patterns corresponding to lower (presumably normal) and increased cortico-striatal activation (as found in, e.g., obsessive-compulsive disorder), depending on the intensity of the cortical inputs. By applying equation-free methods, we are able to perform a macroscopic network analysis directly from microscale simulations. We identify the mean synaptic activity as the macroscopic variable of the system, which shows similarity with local field potentials. The equation-free approach results in a numerical bifurcation and stability analysis of the macroscopic dynamics of the striatal network. The different macroscopic states can be assigned to normal/healthy and pathological conditions, as known from neurological disorders. Finally, guided by the equation-free bifurcation analysis, we propose a therapeutic close loop control scheme for the striatal network.

纹状体是基底神经节的一部分,是运动和认知功能的核心。在这里,我们提出了大脑这一部分的大规模生物物理网络,使用改进的霍奇金-赫胥黎动力学来模拟神经元,并根据详细的人体图谱建立连接。该模型显示了不同的时空活动模式,这些模式与皮质纹状体激活较低(推测为正常)和较高(如强迫症)相对应,取决于皮质输入的强度。通过应用无方程方法,我们能够直接从微观模拟中进行宏观网络分析。我们将平均突触活动确定为系统的宏观变量,它与局部场电位显示出相似性。无方程方法可对纹状体网络的宏观动力学进行数值分岔和稳定性分析。不同的宏观状态可被归类为正常/健康状态和病理状态,正如神经系统疾病中已知的那样。最后,在无方程分岔分析的指导下,我们提出了纹状体网络的治疗性闭环控制方案。
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引用次数: 0
Therapeutic approaches targeting seizure networks. 针对癫痫发作网络的治疗方法。
Pub Date : 2024-08-07 eCollection Date: 2024-01-01 DOI: 10.3389/fnetp.2024.1441983
Jenna Langbein, Ujwal Boddeti, Matthew Kreinbrink, Ziam Khan, Ihika Rampalli, Muzna Bachani, Alexander Ksendzovsky

Epilepsy is one of the most common neurological disorders, affecting over 65 million people worldwide. Despite medical management with anti-seizure medications (ASMs), many patients fail to achieve seizure freedom, with over one-third of patients having drug-resistant epilepsy (DRE). Even with surgical management through resective surgery and/or neuromodulatory interventions, over 50 % of patients continue to experience refractory seizures within a year of surgery. Over the past 2 decades, studies have increasingly suggested that treatment failure is likely driven by untreated components of a pathological seizure network, a shift in the classical understanding of epilepsy as a focal disorder. However, this shift in thinking has yet to translate to improved treatments and seizure outcomes in patients. Here, we present a narrative review discussing the process of surgical epilepsy management. We explore current surgical interventions and hypothesized mechanisms behind treatment failure, highlighting evidence of pathologic seizure networks. Finally, we conclude by discussing how the network theory may inform surgical management, guiding the identification and targeting of more appropriate surgical regions. Ultimately, we believe that adapting current surgical practices and neuromodulatory interventions towards targeting seizure networks offers new therapeutic strategies that may improve seizure outcomes in patients suffering from DRE.

癫痫是最常见的神经系统疾病之一,影响着全球 6500 多万人。尽管使用抗癫痫药物(ASMs)进行内科治疗,但许多患者仍无法摆脱癫痫发作,超过三分之一的患者患有耐药性癫痫(DRE)。即使通过切除手术和/或神经调节干预进行手术治疗,50% 以上的患者在术后一年内仍会出现难治性癫痫发作。在过去的 20 年中,越来越多的研究表明,治疗失败很可能是由病理发作网络中未经治疗的成分导致的,这改变了人们对癫痫是一种局灶性疾病的传统认识。然而,这种思维方式的转变尚未转化为治疗方法的改进和患者发作结果的改善。在此,我们将对癫痫外科治疗过程进行叙述性回顾。我们探讨了当前的手术干预措施和治疗失败背后的假设机制,并强调了病理发作网络的证据。最后,我们讨论了网络理论如何为手术管理提供信息,指导识别和定位更合适的手术区域。最终,我们认为,调整当前的手术方法和神经调节干预措施,以癫痫发作网络为目标,可提供新的治疗策略,从而改善 DRE 患者的癫痫发作预后。
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引用次数: 0
The network is more important than the node: stereo-EEG evidence of neurocognitive networks in epilepsy 网络比节点更重要:癫痫患者神经认知网络的立体电子脑电图证据
Pub Date : 2024-07-24 DOI: 10.3389/fnetp.2024.1424004
Nicholas W. G. Murray, Anthony C. Kneebone, Petra L. Graham, Chong H. Wong, Greg Savage, Lisa Gillinder, Michael W. K. Fong
Neuropsychological assessment forms an integral part of the presurgical evaluation for patients with medically refractory focal epilepsy. Our understanding of cognitive impairment in epilepsy is based on seminal lesional studies that have demonstrated important structure-function relationships within the brain. However, a growing body of literature demonstrating heterogeneity in the cognitive profiles of patients with focal epilepsy (e.g., temporal lobe epilepsy; TLE) has led researchers to speculate that cognition may be impacted by regions outside the seizure onset zone, such as those involved in the interictal or “irritative” network.Neuropsychological data from 48 patients who underwent stereoelectroencephalography (SEEG) monitoring between 2012 and 2023 were reviewed. Patients were categorized based on the site of seizure onset, as well as their irritative network, to determine the impact of wider network activity on cognition. Neuropsychological data were compared with normative standards (i.e., z = 0), and between groups.There were very few distinguishing cognitive features between patients when categorized based purely on the seizure onset zone (i.e., frontal lobe vs. temporal lobe epilepsy). In contrast, patients with localized irritative networks (i.e., frontal or temporal interictal epileptiform discharges [IEDs]) demonstrated more circumscribed profiles of impairment compared with those demonstrating wider irritative networks (i.e., frontotemporal IEDs). Furthermore, the directionality of propagation within the irritative network was found to influence the manifestations of cognitive impairment.The findings suggest that neuropsychological assessment is sensitive to network activity beyond the site of seizure onset. As such, an overly focal interpretation may not accurately reflect the distribution of the underlying pathology. This has important implications for presurgical work-up in epilepsy, as well as subsequent surgical outcomes.
神经心理学评估是药物难治性局灶性癫痫患者术前评估不可或缺的一部分。我们对癫痫认知障碍的认识基于开创性的病变研究,这些研究证明了大脑内部重要的结构与功能关系。然而,越来越多的文献显示,局灶性癫痫(如颞叶癫痫)患者的认知特征具有异质性,这让研究人员推测,认知可能会受到发作起始区以外区域的影响,例如那些参与发作间期或 "刺激性 "网络的区域。根据发作开始的部位及其刺激性网络对患者进行分类,以确定更广泛的网络活动对认知的影响。神经心理学数据与常模标准(即 z = 0)进行了比较,并在组间进行了比较。相比之下,具有局部刺激性网络(即额叶或颞叶发作间期癫痫样放电 [IEDs])的患者与具有较广泛刺激性网络(即额颞叶 IEDs)的患者相比,表现出更多的障碍特征。研究结果表明,神经心理学评估对癫痫发作部位以外的网络活动非常敏感。因此,过于聚焦的解释可能无法准确反映潜在病理的分布。这对癫痫的术前检查和后续手术结果都有重要影响。
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Frontiers in network physiology
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