Cortico-cortical evoked potentials in response to varying stimulation intensity improves seizure localization
•Cortico-cortical evoked potential amplitude increases with current intensity with a greater effect in the seizure onset zone (SOZ).•SOZ response distributions are maximized at lower currents, while those outside the SOZ gradually increase with current intensity.•Responses to a range of current inte...
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Published in | Clinical neurophysiology Vol. 145; pp. 119 - 128 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
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Elsevier B.V
01.01.2023
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Abstract | •Cortico-cortical evoked potential amplitude increases with current intensity with a greater effect in the seizure onset zone (SOZ).•SOZ response distributions are maximized at lower currents, while those outside the SOZ gradually increase with current intensity.•Responses to a range of current intensities provide better classification of the SOZ than responses to only one maximal intensity.
As single pulse electrical stimulation (SPES) is increasingly utilized to help localize the seizure onset zone (SOZ), it is important to understand how stimulation intensity can affect the ability to use cortico-cortical evoked potentials (CCEPs) to delineate epileptogenic regions.
We studied 15 drug-resistant epilepsy patients undergoing intracranial EEG monitoring and SPES with titrations of stimulation intensity. The N1 amplitude and distribution of CCEPs elicited in the SOZ and non-seizure onset zone (nSOZ) were quantified at each intensity. The separability of the SOZ and nSOZ using N1 amplitudes was compared between models using responses to titrations, responses to one maximal intensity, or both.
At 2 mA and above, the increase in N1 amplitude with current intensity was greater for responses within the SOZ, and SOZ response distribution was maximized by 4–6 mA. Models incorporating titrations achieved better separability of SOZ and nSOZ compared to those using one maximal intensity.
We demonstrated that differences in CCEP amplitude over a range of current intensities can improve discriminability of SOZ regions.
This study provides insight into the underlying excitability of the SOZ and how differences in current-dependent amplitudes of CCEPs may be used to help localize epileptogenic sites. |
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AbstractList | •Cortico-cortical evoked potential amplitude increases with current intensity with a greater effect in the seizure onset zone (SOZ).•SOZ response distributions are maximized at lower currents, while those outside the SOZ gradually increase with current intensity.•Responses to a range of current intensities provide better classification of the SOZ than responses to only one maximal intensity.
As single pulse electrical stimulation (SPES) is increasingly utilized to help localize the seizure onset zone (SOZ), it is important to understand how stimulation intensity can affect the ability to use cortico-cortical evoked potentials (CCEPs) to delineate epileptogenic regions.
We studied 15 drug-resistant epilepsy patients undergoing intracranial EEG monitoring and SPES with titrations of stimulation intensity. The N1 amplitude and distribution of CCEPs elicited in the SOZ and non-seizure onset zone (nSOZ) were quantified at each intensity. The separability of the SOZ and nSOZ using N1 amplitudes was compared between models using responses to titrations, responses to one maximal intensity, or both.
At 2 mA and above, the increase in N1 amplitude with current intensity was greater for responses within the SOZ, and SOZ response distribution was maximized by 4–6 mA. Models incorporating titrations achieved better separability of SOZ and nSOZ compared to those using one maximal intensity.
We demonstrated that differences in CCEP amplitude over a range of current intensities can improve discriminability of SOZ regions.
This study provides insight into the underlying excitability of the SOZ and how differences in current-dependent amplitudes of CCEPs may be used to help localize epileptogenic sites. OBJECTIVEAs single pulse electrical stimulation (SPES) is increasingly utilized to help localize the seizure onset zone (SOZ), it is important to understand how stimulation intensity can affect the ability to use cortico-cortical evoked potentials (CCEPs) to delineate epileptogenic regions.METHODSWe studied 15 drug-resistant epilepsy patients undergoing intracranial EEG monitoring and SPES with titrations of stimulation intensity. The N1 amplitude and distribution of CCEPs elicited in the SOZ and non-seizure onset zone (nSOZ) were quantified at each intensity. The separability of the SOZ and nSOZ using N1 amplitudes was compared between models using responses to titrations, responses to one maximal intensity, or both.RESULTSAt 2 mA and above, the increase in N1 amplitude with current intensity was greater for responses within the SOZ, and SOZ response distribution was maximized by 4-6 mA. Models incorporating titrations achieved better separability of SOZ and nSOZ compared to those using one maximal intensity.CONCLUSIONSWe demonstrated that differences in CCEP amplitude over a range of current intensities can improve discriminability of SOZ regions.SIGNIFICANCEThis study provides insight into the underlying excitability of the SOZ and how differences in current-dependent amplitudes of CCEPs may be used to help localize epileptogenic sites. As single pulse electrical stimulation (SPES) is increasingly utilized to help localize the seizure onset zone (SOZ), it is important to understand how stimulation intensity can affect the ability to use cortico-cortical evoked potentials (CCEPs) to delineate epileptogenic regions. We studied 15 drug-resistant epilepsy patients undergoing intracranial EEG monitoring and SPES with titrations of stimulation intensity. The N1 amplitude and distribution of CCEPs elicited in the SOZ and non-seizure onset zone (nSOZ) were quantified at each intensity. The separability of the SOZ and nSOZ using N1 amplitudes was compared between models using responses to titrations, responses to one maximal intensity, or both. At 2 mA and above, the increase in N1 amplitude with current intensity was greater for responses within the SOZ, and SOZ response distribution was maximized by 4-6 mA. Models incorporating titrations achieved better separability of SOZ and nSOZ compared to those using one maximal intensity. We demonstrated that differences in CCEP amplitude over a range of current intensities can improve discriminability of SOZ regions. This study provides insight into the underlying excitability of the SOZ and how differences in current-dependent amplitudes of CCEPs may be used to help localize epileptogenic sites. |
Author | Wang, Yujing Crone, Nathan E. Smith, Rachel J. Sarma, Sridevi V. Hays, Mark A. Coogan, Christopher Kang, Joon Y. |
AuthorAffiliation | b Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA a Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA c Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA |
AuthorAffiliation_xml | – name: c Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA – name: a Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA – name: b Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA |
Author_xml | – sequence: 1 givenname: Mark A. surname: Hays fullname: Hays, Mark A. email: mhays6@jhmi.edu organization: Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA – sequence: 2 givenname: Rachel J. surname: Smith fullname: Smith, Rachel J. organization: Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA – sequence: 3 givenname: Yujing surname: Wang fullname: Wang, Yujing organization: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA – sequence: 4 givenname: Christopher surname: Coogan fullname: Coogan, Christopher organization: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA – sequence: 5 givenname: Sridevi V. surname: Sarma fullname: Sarma, Sridevi V. organization: Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA – sequence: 6 givenname: Nathan E. surname: Crone fullname: Crone, Nathan E. organization: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA – sequence: 7 givenname: Joon Y. surname: Kang fullname: Kang, Joon Y. organization: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA |
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Keywords | nSOZ Epilepsy EEG ROC S-EEG EP Single pulse electrical stimulation SPES intracranial EEG AUC IZ CCEP Epileptogenic network SNR RMS Cortico-cortical evoked potential Effective connectivity SOZ |
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Snippet | •Cortico-cortical evoked potential amplitude increases with current intensity with a greater effect in the seizure onset zone (SOZ).•SOZ response distributions... As single pulse electrical stimulation (SPES) is increasingly utilized to help localize the seizure onset zone (SOZ), it is important to understand how... OBJECTIVEAs single pulse electrical stimulation (SPES) is increasingly utilized to help localize the seizure onset zone (SOZ), it is important to understand... |
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SubjectTerms | Cortico-cortical evoked potential Drug Resistant Epilepsy - diagnosis Drug Resistant Epilepsy - therapy Effective connectivity Electric Stimulation Electrocorticography Electroencephalography Epilepsy Epileptogenic network Evoked Potentials - physiology Humans intracranial EEG Seizures Single pulse electrical stimulation |
Title | Cortico-cortical evoked potentials in response to varying stimulation intensity improves seizure localization |
URI | https://dx.doi.org/10.1016/j.clinph.2022.08.024 https://www.ncbi.nlm.nih.gov/pubmed/36127246 https://search.proquest.com/docview/2716524594 https://pubmed.ncbi.nlm.nih.gov/PMC9771930 |
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