Search

Abstract Objective To predict one‐year seizure freedom, using a combination of relevant clinical variables, following stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy in a series of 101 patients. Methods Eight predictors of seizure freedom were selected based on their association with medial temporal lobe epilepsy: (1) MRI evidence of mesial temporal sclerosis (MTS); (2) unitemporal interictal epileptiform discharges; (3) absence of generalized tonic–clonic seizures; (4) history of febrile seizures; (5) onset of epilepsy ≤16 years; (6) absence of an auditory, visual, or vertiginous aura; and (7) unitemporal ictal onset; (8) unitemporal PET hypometabolism. We compared four multivariate models: “MTS,” using just evidence of MTS; “FULL,” using all eight binary predictors; “AIC” using backwards selection of variables; and “SCORE,” using a 0‐to‐8‐point ordinal score awarding one point for each binary predictor. Results In univariate analysis, significant predictors for seizure freedom were evidence of mesial temporal sclerosis (p = 0.011, Fisher exact) and unitemporal interictal discharges (p = 0.005). For multivariate prediction (using leave one‐out cross‐validation), the ordinal SCORE model had a significantly higher area under the curve (AUC 0.70) than the other three models: MTS (AUC 0.54, p = 0.002, Delong's test), FULL (AUC 0.62, p = 0.003), or AIC (AUC 0.53, p

Abstract Studies of epilepsy surgery outcomes are often small and thus underpowered to reach statistically valid conclusions. We hypothesized that ordinal logistic regression would have greater statistical power than binary logistic regression when analyzing epilepsy surgery outcomes. We reviewed 10 manuscripts included in a recent meta‐analysis which found that mesial temporal sclerosis (MTS) predicted better surgical outcomes after a stereotactic laser amygdalohippocampectomy (SLAH). We extracted data from 239 patients from eight studies that reported four discrete Engel surgical outcomes after SLAH, stratified by the presence or absence of MTS. The rate of freedom from disabling seizures (Engel I) was 64.3% (110/171) for patients with MTS compared to 44.1% (30/68) without MTS. The statistical power to detect MTS as a predictor for better surgical outcome after a SLAH was 29% using ordinal regression, which was significantly more than the 13% power using binary logistic regression (paired t‐test, P

Mapping of cortical functions is critical for the best clinical care of patients undergoing epilepsy and tumor surgery, but also to better understand human brain function and connectivity. The purpose of this review is to explore existing and potential means of mapping higher cortical functions, including stimulation mapping, passive mapping, and connectivity analyses. We examine the history of mapping, differences between subdural and stereoelectroencephalographic approaches, and some risks and safety aspects, before examining different types of functional mapping. Much of this review explores the prospects for new mapping approaches to better understand other components of language, memory, spatial skills, executive, and socio-emotional functions. We also touch on brain-machine interfaces, philosophical aspects of aligning tasks to brain circuits, and the study of consciousness. We end by discussing multi-modal testing and virtual reality approaches to mapping higher cortical functions.

Robotic systems have fundamentally altered the landscape of functional neurosurgery. These allow automated stereotaxy with high accuracy and reliability, and are rapidly becoming a mainstay in stereotactic surgeries such as deep brain stimulation (DBS), stereoelectroencephalography (SEEG), and stereotactic laser ablation/MRI guided laser interstitial thermal therapy (MRgLITT). Robotic systems have been effectively applied to create a minimally invasive approach for diagnostics and therapeutics in the treatment of epilepsy, utilizing robots for expeditious and accurate stereotaxy for SEEG and MRgLITT. MRgLITT has been shown to approach open surgical techniques in efficacy of seizure control while minimizing collateral injury. We describe the use of robot assisted MRgLITT for a minimally invasive laser anterior temporal lobotomy, describing the approach and potential pitfalls. Goals of MRgLITT are complete ablation of the epileptogenic zone and avoiding injury to uninvolved structures. In the middle fossa these include structures such as cranial nerves in the skull base and cavernous sinus and the thalamus. These can be mitigated with careful trajectory planning and control of laser ablation intensity.

The use of chronic intracortical multielectrode arrays has become increasingly prevalent in neurophysiological experiments. However, it is not obvious whether neuronal signals obtained over multiple recording sessions come from the same or different neurons. Here, we develop a criterion to assess single-unit stability by measuring the similarity of 1) average spike waveforms and 2) interspike interval histograms (ISIHs). Neuronal activity was recorded from four Utah arrays implanted in primary motor and premotor cortices in three rhesus macaque monkeys during 10 recording sessions over a 15- to 17-day period. A unit was defined as stable through a given day if the stability criterion was satisfied on all recordings leading up to that day. We found that 57% of the original units were stable through 7 days, 43% were stable through 10 days, and 39% were stable through 15 days. Moreover, stable units were more likely to remain stable in subsequent recording sessions (i.e., 89% of the neurons that were stable through four sessions remained stable on the fifth). Using both waveform and ISIH data instead of just waveforms improved performance by reducing the number of false positives. We also demonstrate that this method can be used to track neurons across days, even during adaptation to a visuomotor rotation. Identifying a stable subset of neurons should allow the study of long-term learning effects across days and has practical implications for pooling of behavioral data across days and for increasing the effectiveness of brain–machine interfaces. [ABSTRACT FROM AUTHOR]

During a reach, neural activity recorded from motor cortex is typically thought to linearly encode the observed movement. However, it has also been reported that during a double-step reaching paradigm, neural coding of the original movement is replaced by that of the corrective movement. Here, we use neural data recorded from multi-electrode arrays implanted in the motor and premotor cortices of rhesus macaques to directly compare these two hypotheses. We show that while a majority of neurons display linear encoding of movement during a double-step, a minority display a dramatic drop in firing rate that is predicted by the replacement hypothesis. Neural activity in the subpopulation showing replacement is more likely to lag the observed movement, and may therefore be involved in the monitoring of the sensory consequences of a motor command.