Engagement of cortico-cortical and cortico-subcortical networks in a patient with epileptic spasms: An integrated neurophysiological study. Issue 9 (September 2020)

• Record Type: Journal Article
• Authors: Inoue, Takeshi; Kobayashi, Katsuya; Matsumoto, Riki; Inouchi, Morito; Togo, Masaya; Togawa, Jumpei; Usami, Kiyohide; Shimotake, Akihiro; Matsuhashi, Masao; Kikuchi, Takayuki; Yoshida, Kazumichi; Kawawaki, Hisashi; Sawamoto, Nobukatsu; Kunieda, Takeharu; Miyamoto, Susumu; Takahashi, Ryosuke; Ikeda, Akio
• Is Part Of: Clinical neurophysiology. Volume 131:Issue 9(2020:Sep.)
• Page Start: 2255
• Page End: 2264
• Publication Date: 2020-09
• Subjects: Epileptic spasm -- High frequency oscillation -- Cortico-cortical evoked potential -- EEG with functional MRI (EEG-fMRI); ES epileptic spasms -- HFO high-frequency oscillation -- EMG electromyogram -- CCEP cortico-cortical evoked potential -- ECoG electrocorticogram -- EEG-fMRI EEG with functional MRI -- BOLD blood-oxygen-level-dependent -- PMA positive motor area -- STFT short-time Fourier transform -- IPL inferior parietal lobule -- CST corticospinal tract -- CRT corticoreticular tract -- RST reticulospinal tract; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2020.04.167
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: We applied integrated neurophysiology to investigate epileptic network activity during epileptic spasms (ES). Neurophysiological techniques revealed the engagement of cortico-cortical and subcortical networks. Pathways other than the direct descending pathway from the positive motor area may be important in the generation of ES. Abstract: Objective: We aimed to delineate the engagement of cortico-cortical and cortico-subcortical networks in the generation of epileptic spasms (ES) using integrated neurophysiological techniques. Methods: Seventeen-year-old male patient with intractable ES underwent chronic subdural electrode implantation for presurgical evaluation. Networks were evaluated in ictal periods using high-frequency oscillation (HFO) analysis and in interictal periods using magnetoencephalography (MEG) and simultaneous electroencephalography, and functional magnetic resonance imaging (EEG-fMRI). Cortico-cortical evoked potentials (CCEPs) were recorded to trace connections among the networks. Results: Ictal HFO revealed a network comprising multilobar cortical regions (frontal, parietal, and temporal), but sparing the positive motor area. Interictally, MEG and EEG-fMRI revealed spike-and-wave-related activation in these cortical regions. Analysis of CCEPs provided evidence of connectivity within the cortico-cortical network. Additionally, EEG-fMRI results indicate the involvement of subcortical structures, such as bilateral thalamus (predominantly right) and midbrain. Conclusions: In this case study, integrated neurophysiological techniques provided converging evidence for the involvement of a cortico-cortical network (sparing the positive motor area) and a cortico-subcortical network in the generation of ES in the patient. Significance: Cortico-cortical and cortico-subcortical pathways, with the exception of the direct descending corticospinal pathway from the positive motor area, may play important roles in the generation of ES.