立体脑电图引导下的电刺激感觉运动映射。

Electrical stimulation sensorimotor mapping with stereo-EEG.

机构信息

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.

出版信息

Clin Neurophysiol. 2020 Aug;131(8):1691-1701. doi: 10.1016/j.clinph.2020.04.159. Epub 2020 May 18.

DOI:10.1016/j.clinph.2020.04.159

PMID:32504928

Abstract

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

We provide evidence for diagnostic validity and safety of stereo-EEG sensorimotor ESM.

SIGNIFICANCE

The somatotopy of sensorimotor responses elicited with electrical stimulation provide new insights into mechanisms of motor control and sensory perception.

摘要

目的

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。

方法

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。

结果

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。