Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, OH, USA.
Clin Neurophysiol. 2020 Aug;131(8):1691-1701. doi: 10.1016/j.clinph.2020.04.159. Epub 2020 May 18.
We evaluated stereo-EEG electrical stimulation mapping (ESM) for localization of anatomic sensorimotor parcels in pediatric patients with drug-resistant epilepsy. We also analyzed sensorimotor and after-discharge thresholds, and the somatotopy of sensorimotor responses.
ESM was performed with 50 Hz, biphasic, 2-3 s trains, using 1-9 mA current. Pre- and post-implant neuroimaging was co-registered and intersected with Neurosynth reference, to classify each electrode contact as lying within/outside an anatomic sensorimotor parcel. Indices of diagnostic performance were computed. Sensorimotor and after-discharge thresholds were analyzed using multivariable linear mixed models.
In 15 patients (6 females), aged 5.5-21.2 years, ESM showed high accuracy (0.80), high specificity (0.86), and diagnostic odds ratio (11.4, p < 0.0001) for localization of sensorimotor parcels. Mean sensorimotor threshold (3.4 mA) was below mean after-discharge threshold (4.2 mA, p = 0.0004). Sensorimotor and after-discharge thresholds showed a significant decrease with increasing intelligence quotient. Somatotopy of sensorimotor responses was mapped to standardized brain parcels.
We provide evidence for diagnostic validity and safety of stereo-EEG sensorimotor ESM.
The somatotopy of sensorimotor responses elicited with electrical stimulation provide new insights into mechanisms of motor control and sensory perception.
我们评估立体脑电图电刺激定位（ESM）在耐药性癫痫患儿中的解剖感觉运动区定位。我们还分析了感觉运动和放电阈值，以及感觉运动反应的躯体定位。
使用 50 Hz、双相、2-3 s 刺激，电流为 1-9 mA，进行 ESM。在植入前和植入后进行神经影像学检查，并与神经综合参考进行配准和交叉，以将每个电极触点分类为位于解剖感觉运动区内部/外部。计算了诊断性能的指标。使用多变量线性混合模型分析感觉运动和放电阈值。
在 15 名患者（6 名女性）中，年龄为 5.5-21.2 岁，ESM 显示出较高的准确性（0.80）、高特异性（0.86）和诊断比值比（11.4，p < 0.0001），用于定位感觉运动区。平均感觉运动阈值（3.4 mA）低于平均放电阈值（4.2 mA，p = 0.0004）。感觉运动和放电阈值随智商的增加而显著降低。感觉运动反应的躯体定位映射到标准化的脑区。
我们提供了立体脑电图感觉运动 ESM 诊断有效性和安全性的证据。
电刺激引起的感觉运动反应的躯体定位为运动控制和感觉感知的机制提供了新的见解。
