Bilderbeek Jordan A, Gregg Nicholas M, Yanez-Ramos Maria Guadalupe, Huang Harvey, Montoya Morgan, Brunner Peter, Willie Jon T, Van Gompel Jamie J, Worrell Gregory A, Miller Kai J, Hermes Dora
Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester MN.
Department of Neurology, Mayo Clinic, Rochester, MN.
bioRxiv. 2025 Mar 13:2025.03.11.642694. doi: 10.1101/2025.03.11.642694.
The pulvinar has been proposed as an effective neuromodulation target for patients with posterior quadrant and temporal epilepsies. However, the pulvinar has a large tissue volume, multiple subnuclei, and widespread cortical connections. It remains unknown whether electrical stimulation of distinct pulvinar subregions affects the temporal, occipital, and parietal areas differently. To address this gap, we delivered single-pulse electrical stimulation to the pulvinar and measured the resulting brain stimulation evoked potentials in twelve patients undergoing stereotactic EEG for drug-resistant epilepsy. Brain stimulation evoked potentials were parameterized across the occipital, temporal and parietal cortex. Stimulation of the lateral pulvinar elicited significant brain stimulation evoked potentials in striate and extrastriate areas that diminish as stimulation shifts towards the medial pulvinar. Conversely, stimulation of the ventral aspect of the medial pulvinar produced significant lateral temporal evoked potentials, which diminish with lateral pulvinar stimulation. We also found that stimulation of the dorsomedial pulvinar evoked significant parietal responses with limited striate/extrastriate and lateral temporal responses. These results demonstrate that electrical stimulation of specific pulvinar subregions influences distinct occipital, parietal and lateral temporal areas. Selective targeting of pulvinar subregions to maximize seizure network engagement may be essential for individualized treatment of posterior quadrant and temporal epilepsies.
丘脑枕已被提议作为后象限和颞叶癫痫患者有效的神经调节靶点。然而，丘脑枕组织体积大、有多个亚核且具有广泛的皮质连接。不同的丘脑枕亚区域进行电刺激是否会对颞叶、枕叶和顶叶区域产生不同影响仍不清楚。为了填补这一空白，我们对12例因耐药性癫痫接受立体定向脑电图检查的患者的丘脑枕进行单脉冲电刺激，并测量由此产生的脑刺激诱发电位。脑刺激诱发电位在枕叶、颞叶和顶叶皮质进行参数化。刺激外侧丘脑枕在纹状和纹状外区域诱发显著的脑刺激诱发电位，随着刺激向内侧丘脑枕转移，该电位减弱。相反，刺激内侧丘脑枕腹侧产生显著的颞叶外侧诱发电位，该电位在外侧丘脑枕刺激时减弱。我们还发现，刺激背内侧丘脑枕诱发显著的顶叶反应，同时伴有有限的纹状/纹状外和颞叶外侧反应。这些结果表明，对特定丘脑枕亚区域进行电刺激会影响不同的枕叶、顶叶和颞叶外侧区域。选择性靶向丘脑枕亚区域以最大限度地激活癫痫网络，对于后象限和颞叶癫痫的个体化治疗可能至关重要。
