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Brain Sciences
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Electrical Stimulation in Epilepsy
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Electrical Stimulation in Epilepsy

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Clinical Neuroscience".

Deadline for manuscript submissions: closed (31 December 2024) | Viewed by 9744

Special Issue Editor

Dr. Vasileios Kokkinos

E-Mail Website1 Website2
Guest Editor
Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Interests: seizures; brain depth stimulation; drug resistant epilepsy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cortical electrical stimulation (CES) has been a key part of the phase II intracranial evaluation for epilepsy surgery, as a complementary means to delineate the seizure onset zone, since mid-twentieth century. CES has also been widely used to identify eloquent cortex regions for the purpose of mapping their spatial distribution with respect to the seizure onset zone. During the past two decades, electrical stimulation of the brain has entered the therapeutic realm of epilepsy, after the approval of neurostimulating devices in open- (Deep Brain Stimulation) and closed-loop (Responsive Neurostimulation) mode. As CES becomes more important in the diagnostic and therapeutic workflow of epilepsy surgery, this special issue welcomes research and review articles covering important aspects of this fast growing field.

Dr. Vasileios Kokkinos
Guest Editor

Manuscript Submission Information

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Keywords

  • epilepsy
  • epilepsy surgery
  • cortical electrical stimulation
  • functional mapping
  • epileptogenic zone

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Published Papers (4 papers)

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Research

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13 pages, 257 KiB  
Article
A Retrospective Study Reviewing Timing to Onset of Habitual Psychogenic Non-Epileptic Seizures in a Home Video Telemetry Cohort
by Jade Cooper, Helen Chester, Arianna Fozzato and Elisaveta Sokolov
Brain Sci. 2024, 14(12), 1187; https://doi.org/10.3390/brainsci14121187 - 26 Nov 2024
Cited by 1 | Viewed by 682 | Correction
Abstract
Objectives: This study aimed to investigate the onset time to habitual psychogenic non-epileptic seizures (PNES) in adults referred to Guy’s and St Thomas’ Neurophysiology Department for home video telemetry (HVT) with a clinical question of PNES. The primary objective was to determine the [...] Read more.
Objectives: This study aimed to investigate the onset time to habitual psychogenic non-epileptic seizures (PNES) in adults referred to Guy’s and St Thomas’ Neurophysiology Department for home video telemetry (HVT) with a clinical question of PNES. The primary objective was to determine the optimal time window for HVT recording for patients with suspected PNES to try to improve the allocation of clinical resources. The secondary objective was to explore any potential association between time to habitual PN ES onset and demographic indexes and other clinical, neuro-radiological and semiological findings. Methods: We performed a retrospective analysis of our XLTEK database between 2019 and 2020. A multifactorial analysis of PNES semiologic subtypes, patient demographics, psychiatric comorbidities and neuroimaging was conducted to explore their impact on time to PNES within an HVT study. People who had at least one typical PNES during their recording were included. The exclusion criteria included people who had the test performed without video recording. The total number of participants was 37. The data were extracted from our local XLTEK database. Statistical analyses using Mann–Whitney U and Fischer exact tests were carried out. Results: The mean time to first habitual PNES onset was seven hours, with a mean recording duration of 46 h. The most commonly occurring event type was blank spells (12, 32%), with the least common presentation being déjà vu (1, 3%). There was a significant association between time to PNES onset and male sex (p = 0.04). There was a significant association between time to PNES onset and abnormal MRI findings (p = 0.02). Particular PNES semiologic subtypes were not significantly linked with PNES onset time. Conclusions: Our study highlights that on average, patients with PNES will rapidly have their first habitual event within an HVT study (mean time to event onset of seven hours), consistent with the current literature. This raises the question of whether HVT study duration could be reduced to release study resources and aid departmental efficiencies. We also observe the novel finding that men presented significantly earlier with their habitual PNES event than women, and that abnormal imaging findings were also significantly associated with an earlier time to event onset, although the reason for this association is yet to be determined. Full article
(This article belongs to the Special Issue Electrical Stimulation in Epilepsy)
14 pages, 4100 KiB  
Article
Magnetoencephalography (MEG) Data Processing in Epilepsy Patients with Implanted Responsive Neurostimulation (RNS) Devices
by Pegah Askari, Natascha Cardoso da Fonseca, Tyrell Pruitt, Joseph A. Maldjian, Sasha Alick-Lindstrom and Elizabeth M. Davenport
Brain Sci. 2024, 14(2), 173; https://doi.org/10.3390/brainsci14020173 - 9 Feb 2024
Viewed by 2451
Abstract
Drug-resistant epilepsy (DRE) is often treated with surgery or neuromodulation. Specifically, responsive neurostimulation (RNS) is a widely used therapy that is programmed to detect abnormal brain activity and intervene with tailored stimulation. Despite the success of RNS, some patients require further interventions. However, [...] Read more.
Drug-resistant epilepsy (DRE) is often treated with surgery or neuromodulation. Specifically, responsive neurostimulation (RNS) is a widely used therapy that is programmed to detect abnormal brain activity and intervene with tailored stimulation. Despite the success of RNS, some patients require further interventions. However, having an RNS device in situ is a hindrance to the performance of neuroimaging techniques. Magnetoencephalography (MEG), a non-invasive neurophysiologic and functional imaging technique, aids epilepsy assessment and surgery planning. MEG performed post-RNS is complicated by signal distortions. This study proposes an independent component analysis (ICA)-based approach to enhance MEG signal quality, facilitating improved assessment for epilepsy patients with implanted RNS devices. Three epilepsy patients, two with RNS implants and one without, underwent MEG scans. Preprocessing included temporal signal space separation (tSSS) and an automated ICA-based approach with MNE-Python. Power spectral density (PSD) and signal-to-noise ratio (SNR) were analyzed, and MEG dipole analysis was conducted using single equivalent current dipole (SECD) modeling. The ICA-based noise removal preprocessing method substantially improved the signal-to-noise ratio (SNR) for MEG data from epilepsy patients with implanted RNS devices. Qualitative assessment confirmed enhanced signal readability and improved MEG dipole analysis. ICA-based processing markedly enhanced MEG data quality in RNS patients, emphasizing its clinical relevance. Full article
(This article belongs to the Special Issue Electrical Stimulation in Epilepsy)
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Review

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11 pages, 270 KiB  
Review
Stereoelectroencephalography-Guided Radiofrequency Thermocoagulation: Diagnostic and Therapeutic Implications
by James F. Castellano, Shobhit Singla, Niravkumar Barot and Joshua P. Aronson
Brain Sci. 2024, 14(2), 110; https://doi.org/10.3390/brainsci14020110 - 23 Jan 2024
Cited by 1 | Viewed by 2723
Abstract
Despite recent medical therapeutic advances, approximately one third of patients do not attain seizure freedom with medications. This drug-resistant epilepsy population suffers from heightened morbidity and mortality. In appropriate patients, resective epilepsy surgery is far superior to continued medical therapy. Despite this efficacy, [...] Read more.
Despite recent medical therapeutic advances, approximately one third of patients do not attain seizure freedom with medications. This drug-resistant epilepsy population suffers from heightened morbidity and mortality. In appropriate patients, resective epilepsy surgery is far superior to continued medical therapy. Despite this efficacy, there remain drawbacks to traditional epilepsy surgery, such as the morbidity of open neurosurgical procedures as well as neuropsychological adverse effects. SEEG-guided Radiofrequency Thermocoagulation (SgRFTC) is a minimally invasive, electrophysiology-guided intervention with both diagnostic and therapeutic implications for drug-resistant epilepsy that offers a convenient adjunct or alternative to ablative and resective approaches. We review the international experience with this procedure, including methodologies, diagnostic benefit, therapeutic benefit, and safety considerations. We propose a framework in which SgRFTC may be incorporated into intracranial EEG evaluations alongside passive recording. Lastly, we discuss the potential role of SgRFTC in both delineating and reorganizing epilepsy networks. Full article
(This article belongs to the Special Issue Electrical Stimulation in Epilepsy)
11 pages, 514 KiB  
Review
The Utility of Responsive Neurostimulation for the Treatment of Pediatric Drug-Resistant Epilepsy
by Martin G. Piazza, Gregory Varga, William Welch and Taylor J. Abel
Brain Sci. 2023, 13(10), 1455; https://doi.org/10.3390/brainsci13101455 - 13 Oct 2023
Cited by 1 | Viewed by 2733
Abstract
Drug-resistant epilepsy (DRE) has a strongly negative impact on quality of life, as well as the development of pediatric patients. Surgical treatments have evolved over time, including more invasive craniotomies for resection or disconnection. More recently, neuromodulation techniques have been employed as a [...] Read more.
Drug-resistant epilepsy (DRE) has a strongly negative impact on quality of life, as well as the development of pediatric patients. Surgical treatments have evolved over time, including more invasive craniotomies for resection or disconnection. More recently, neuromodulation techniques have been employed as a less invasive option for patients. Responsive neurostimulation (RNS) is the first closed-loop technology that allows for both treatment and device data collection, which allows for an internal assessment of the efficacy of treatment. This novel technology has been approved in adults and has been used off label in pediatrics. This review seeks to describe this technology, its history, and future directions. Full article
(This article belongs to the Special Issue Electrical Stimulation in Epilepsy)
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