Tomlinson Samuel B, Baumgartner Michael E, Darlington Timothy R, Marsh Eric D, Kennedy Benjamin C
Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
J Clin Med. 2025 Mar 13;14(6):1956. doi: 10.3390/jcm14061956.
Cortical stimulation is the process of delivering brief pulses of electrical current and visualizing the distributed pattern of evoked responses across the brain. Compared to high-frequency stimulation, which has long been used for seizure provocation and functional mapping, low-frequency stimulation (<1-2 Hz) is rarely incorporated into the epilepsy surgery evaluation. Increasingly, researchers have demonstrated that various cortico-cortical evoked potential (CCEP) features, including early and delayed responses, evoked high-frequency oscillations, and derived network metrics, may be useful biomarkers of tissue excitability and abnormal connectivity. Emerging evidence also highlights a potential role of CCEPs in guiding neuromodulatory therapies like responsive neurostimulation. In this review, we examine the past two decades of innovation in low-frequency stimulation as it pertains to pre-surgical evaluation. We begin with a basic overview of single-pulse electrical stimulation and CCEPs, including definitions, methodology, physiology, and traditional interpretation. We then explore the literature examining CCEPs as markers of cortical excitability, seizure onset, and network-level dysfunction. Finally, the relationship between stimulation-induced and spontaneous seizures is considered. By examining these questions, we identify both opportunities and pitfalls along the path towards integrating low-frequency stimulation into clinical practice.
皮质刺激是指施加短暂电流脉冲并可视化大脑中诱发反应的分布模式的过程。与长期用于诱发癫痫发作和功能定位的高频刺激相比，低频刺激（<1-2赫兹）很少被纳入癫痫手术评估中。越来越多的研究人员表明，各种皮质-皮质诱发电位（CCEP）特征，包括早期和延迟反应、诱发高频振荡以及衍生的网络指标，可能是组织兴奋性和异常连接的有用生物标志物。新出现的证据还突出了CCEP在指导如反应性神经刺激等神经调节疗法方面的潜在作用。在本综述中，我们考察了过去二十年来低频刺激在术前评估方面的创新。我们首先对单脉冲电刺激和CCEP进行基本概述，包括定义、方法、生理学和传统解释。然后，我们探讨将CCEP作为皮质兴奋性、癫痫发作起始和网络水平功能障碍标志物的相关文献。最后，考虑刺激诱发癫痫发作与自发性癫痫发作之间的关系。通过研究这些问题，我们确定了将低频刺激整合到临床实践过程中的机遇与陷阱。
