Cells in the precentral gyrus directly send signals to the periphery to generate movement and are... more Cells in the precentral gyrus directly send signals to the periphery to generate movement and are principally organized as a topological map of the body. We find that movement-induced electrophysiological responses from depth electrodes extend this map three-dimensionally throughout the gyrus. Unexpectedly, this organization is interrupted by a previously undescribed motor association area in the depths of the midlateral aspect of the central sulcus. This ‘Rolandic motor association’ (RMA) area is active during movements of different body parts from both sides of the body and may be important for coordinating complex behaviors.
ObjectiveHigh‐frequency oscillations are considered among the most promising interictal biomarker... more ObjectiveHigh‐frequency oscillations are considered among the most promising interictal biomarkers of the epileptogenic zone in patients suffering from pharmacoresistant focal epilepsy. However, there is no clear definition of pathological high‐frequency oscillations, and the existing detectors vary in methodology, performance, and computational costs. This study proposes relative entropy as an easy‐to‐use novel interictal biomarker of the epileptic tissue.MethodsWe evaluated relative entropy and high‐frequency oscillation biomarkers on intracranial electroencephalographic data from 39 patients with seizure‐free postoperative outcome (Engel Ia) from three institutions. We tested their capability to localize the epileptogenic zone, defined as resected contacts located in the seizure onset zone. The performance was compared using areas under the receiver operating curves (AUROCs) and precision‐recall curves. Then we tested whether a universal threshold can be used to delineate the epi...
Cells in the precentral gyrus of the human brain directly send signals to the periphery to genera... more Cells in the precentral gyrus of the human brain directly send signals to the periphery to generate movement and are topologically organized as a map of the body. We find that movement induced electrophysiological changes from implanted depth electrodes extend this map 3-dimensionally throughout the volume of the gyrus. Unexpectedly, this organization is interrupted by a motor association area in the depths of the central sulcus at its mid-lateral aspect that is active during many different types of movements from both sides of the body.
Stimulation-evoked signals are starting to be used as biomarkers to indicate the state and health... more Stimulation-evoked signals are starting to be used as biomarkers to indicate the state and health of brain networks. The human limbic network, often targeted for brain stimulation therapy, is involved in emotion and memory processing. Previous anatomical, neurophysiological and functional studies suggest distinct subsystems within the limbic network (Rolls, 2015). Previous studies using intracranial electrical stimulation, however, have emphasized the similarities of the evoked waveforms across the limbic network. We test whether these subsystems have distinct stimulation-driven signatures. In seven patients with drug-resistant epilepsy we stimulated the limbic system with single pulse electrical stimulation (SPES). Reliable cortico-cortical evoked potentials (CCEPs) were measured between hippocampus and the posterior cingulate cortex (PCC) and between the amygdala and the anterior cingulate cortex (ACC). However, the CCEP waveform in the PCC after hippocampal stimulation showed a u...
Loss of consciousness is a hallmark of many epileptic seizures and carries risks of serious injur... more Loss of consciousness is a hallmark of many epileptic seizures and carries risks of serious injury and sudden death. While cortical sleep-like activities accompany loss of consciousness during focal impaired awareness seizures, the mechanisms of loss of consciousness during focal to bilateral tonic-clonic seizures remain unclear. Quantifying differences in markers of cortical activation and ictal recruitment between focal impaired awareness and focal to bilateral tonic-clonic seizures may also help us to understand their different consequences for clinical outcomes and to optimize neuromodulation therapies. We quantified clinical signs of loss of consciousness and intracranial EEG activity during 129 focal impaired awareness and 50 focal to bilateral tonic-clonic from 41 patients. We characterized intracranial EEG changes both in the seizure onset zone and in areas remote from the seizure onset zone with a total of 3386 electrodes distributed across brain areas. First, we compared t...
Brain impedance is a fundamental electrical property that depends on tissue extracellular volume.... more Brain impedance is a fundamental electrical property that depends on tissue extracellular volume. We tracked impedance, behavioral state, and epileptiform activity in humans using an investigational device and identified behavioral state dependent impedance oscillations spanning hours to weeks in amygdala, hippocampus, and thalamus. Impedance reaches a minimum in slow wave sleep, is intermediate in rapid-eye-movement sleep and maximal during wakefulness consistent with previously observed extracellular volume changes in rodent glymphatic system.
Single-pulse electrical stimulation in the nervous system, often called cortico-cortical evoked p... more Single-pulse electrical stimulation in the nervous system, often called cortico-cortical evoked potential (CCEP) measurement, is an important technique to understand how brain regions interact with one another. Voltages are measured from implanted electrodes in one brain area while stimulating another with brief current impulses separated by several seconds. Historically, researchers have tried to understand the significance of evoked voltage polyphasic deflections by visual inspection, but no general-purpose tool has emerged to understand their shapes or describe them mathematically. We describe and illustrate a new technique to parameterize brain stimulation data, where voltage response traces are projected into one another using a semi-normalized dot product. The length of timepoints from stimulation included in the dot product is varied to obtain a temporal profile of structural significance, and the peak of the profile uniquely identifies the duration of the response. Using lin...
ABSTRACTThe human ventral temporal cortex (VTC) is highly connected to integrate visual perceptua... more ABSTRACTThe human ventral temporal cortex (VTC) is highly connected to integrate visual perceptual inputs with feedback from cognitive and emotional networks. In this study, we used electrical brain stimulation to understand how different inputs from multiple brain regions drive unique electrophysiological responses in the VTC.We recorded intracranial EEG data in 6 patients implanted with intracranial electrodes for epilepsy surgery evaluation. Pairs of electrodes were stimulated with single pulse electrical stimulation, and corticocortical evoked potential (CCEP) responses were measured at electrodes in the collateral sulcus and lateral occipitotemporal sulcus of the VTC. Using a novel unsupervised machine learning method, we uncovered 2 to 4 distinct response shapes, termed basis profile curves (BPCs), at each recording electrode in the 11 to 500 ms post-stimulation interval.CCEPs of unique shape and high amplitude were elicited following stimulation of several regions and classif...
The epileptic network hypothesis and epileptogenic zone hypothesis are two theories of ictogenesi... more The epileptic network hypothesis and epileptogenic zone hypothesis are two theories of ictogenesis. The network hypothesis posits that coordinated activity among interconnected nodes produces seizures. The epileptogenic zone hypothesis posits that distinct regions are necessary and sufficient for seizure generation. High-frequency oscillations, and particularly fast ripples, are thought to be biomarkers of the epileptogenic zone. We sought to test these theories by comparing high-frequency oscillation rates and networks in surgical responders and non-responders, with no appreciable change in seizure frequency or severity, within a retrospective cohort of 48 patients implanted with stereo-EEG electrodes. We recorded inter-ictal activity during non-rapid eye movement sleep and semi-automatically detected and quantified high-frequency oscillations. Each electrode contact was localized in normalized coordinates. We found that the accuracy of seizure onset zone electrode contact classifi...
OBJECTIVE One of the most disabling aspects of living with chronic epilepsy is the unpredictabili... more OBJECTIVE One of the most disabling aspects of living with chronic epilepsy is the unpredictability of seizures. Cumulative research in the past decades has advanced our understanding of the dynamics of seizure risk. Technological advances have recently made it possible to record pertinent biological signals, including EEG, continuously. We aimed to assess whether patient-specific seizure forecasting is possible using remote, minimally invasive ultra long-term subcutaneous EEG. METHODS We analyzed a two-center cohort of ultra long-term subcutaneous EEG recordings, including six patients with drug-resistant focal epilepsy monitored for 46 to 230 days with median 18 hours/day of recorded data, totaling over 11,000 hours of EEG. Total electrographic seizures identified by visual review ranged from 12 to 36 per patient. Three candidate subject-specific long short-term memory (LSTM) network deep learning classifiers were trained offline and pseudo-prospectively on preictal (1-hour before) and interictal (more than one day from seizures) EEG segments. Performance was assessed relative to a random predictor. Periodicity of the final forecasts was also investigated with autocorrelation. RESULTS Depending on each architecture, significant forecasting performance was achieved in three to five out of six patients, with overall mean area under the ROC curve of 0.65 to 0.74. Significant forecasts showed sensitivity ranging from 64% to 80% and time in warning from 10.9% to 44.4%. Overall, the output of the forecasts closely followed patient-specific circadian patterns of seizure occurrence. SIGNIFICANCE This study demonstrates proof-of-principle for the possibility of subject-specific seizure forecasting using a minimally invasive subcutaneous EEG device capable of ultra long-term at-home recordings. These results are encouraging for the development of a prospective seizure forecasting trial with minimally-invasive EEG.
Data comprise intracranial EEG (iEEG) brain activity represented by stereo EEG (sEEG) signals, re... more Data comprise intracranial EEG (iEEG) brain activity represented by stereo EEG (sEEG) signals, recorded from over 100 electrode channels implanted in any one patient across various brain regions. The iEEG signals were recorded in epilepsy patients (N = 10) undergoing invasive monitoring and localization of seizures when they were performing a battery of four memory tasks lasting approx. 1 hour in total. Gaze tracking on the task computer screen with estimating the pupil size was also recorded together with behavioral performance. Each dataset comes from one patient with anatomical localization of each electrode contact. Metadata contains labels for the recording channels with behavioral events marked from all tasks, including timing of correct and incorrect vocalization of the remembered stimuli. The iEEG and the pupillometric signals are saved in BIDS data structure to facilitate efficient data sharing and analysis.
Cells in the precentral gyrus directly send signals to the periphery to generate movement and are... more Cells in the precentral gyrus directly send signals to the periphery to generate movement and are principally organized as a topological map of the body. We find that movement-induced electrophysiological responses from depth electrodes extend this map three-dimensionally throughout the gyrus. Unexpectedly, this organization is interrupted by a previously undescribed motor association area in the depths of the midlateral aspect of the central sulcus. This ‘Rolandic motor association’ (RMA) area is active during movements of different body parts from both sides of the body and may be important for coordinating complex behaviors.
ObjectiveHigh‐frequency oscillations are considered among the most promising interictal biomarker... more ObjectiveHigh‐frequency oscillations are considered among the most promising interictal biomarkers of the epileptogenic zone in patients suffering from pharmacoresistant focal epilepsy. However, there is no clear definition of pathological high‐frequency oscillations, and the existing detectors vary in methodology, performance, and computational costs. This study proposes relative entropy as an easy‐to‐use novel interictal biomarker of the epileptic tissue.MethodsWe evaluated relative entropy and high‐frequency oscillation biomarkers on intracranial electroencephalographic data from 39 patients with seizure‐free postoperative outcome (Engel Ia) from three institutions. We tested their capability to localize the epileptogenic zone, defined as resected contacts located in the seizure onset zone. The performance was compared using areas under the receiver operating curves (AUROCs) and precision‐recall curves. Then we tested whether a universal threshold can be used to delineate the epi...
Cells in the precentral gyrus of the human brain directly send signals to the periphery to genera... more Cells in the precentral gyrus of the human brain directly send signals to the periphery to generate movement and are topologically organized as a map of the body. We find that movement induced electrophysiological changes from implanted depth electrodes extend this map 3-dimensionally throughout the volume of the gyrus. Unexpectedly, this organization is interrupted by a motor association area in the depths of the central sulcus at its mid-lateral aspect that is active during many different types of movements from both sides of the body.
Stimulation-evoked signals are starting to be used as biomarkers to indicate the state and health... more Stimulation-evoked signals are starting to be used as biomarkers to indicate the state and health of brain networks. The human limbic network, often targeted for brain stimulation therapy, is involved in emotion and memory processing. Previous anatomical, neurophysiological and functional studies suggest distinct subsystems within the limbic network (Rolls, 2015). Previous studies using intracranial electrical stimulation, however, have emphasized the similarities of the evoked waveforms across the limbic network. We test whether these subsystems have distinct stimulation-driven signatures. In seven patients with drug-resistant epilepsy we stimulated the limbic system with single pulse electrical stimulation (SPES). Reliable cortico-cortical evoked potentials (CCEPs) were measured between hippocampus and the posterior cingulate cortex (PCC) and between the amygdala and the anterior cingulate cortex (ACC). However, the CCEP waveform in the PCC after hippocampal stimulation showed a u...
Loss of consciousness is a hallmark of many epileptic seizures and carries risks of serious injur... more Loss of consciousness is a hallmark of many epileptic seizures and carries risks of serious injury and sudden death. While cortical sleep-like activities accompany loss of consciousness during focal impaired awareness seizures, the mechanisms of loss of consciousness during focal to bilateral tonic-clonic seizures remain unclear. Quantifying differences in markers of cortical activation and ictal recruitment between focal impaired awareness and focal to bilateral tonic-clonic seizures may also help us to understand their different consequences for clinical outcomes and to optimize neuromodulation therapies. We quantified clinical signs of loss of consciousness and intracranial EEG activity during 129 focal impaired awareness and 50 focal to bilateral tonic-clonic from 41 patients. We characterized intracranial EEG changes both in the seizure onset zone and in areas remote from the seizure onset zone with a total of 3386 electrodes distributed across brain areas. First, we compared t...
Brain impedance is a fundamental electrical property that depends on tissue extracellular volume.... more Brain impedance is a fundamental electrical property that depends on tissue extracellular volume. We tracked impedance, behavioral state, and epileptiform activity in humans using an investigational device and identified behavioral state dependent impedance oscillations spanning hours to weeks in amygdala, hippocampus, and thalamus. Impedance reaches a minimum in slow wave sleep, is intermediate in rapid-eye-movement sleep and maximal during wakefulness consistent with previously observed extracellular volume changes in rodent glymphatic system.
Single-pulse electrical stimulation in the nervous system, often called cortico-cortical evoked p... more Single-pulse electrical stimulation in the nervous system, often called cortico-cortical evoked potential (CCEP) measurement, is an important technique to understand how brain regions interact with one another. Voltages are measured from implanted electrodes in one brain area while stimulating another with brief current impulses separated by several seconds. Historically, researchers have tried to understand the significance of evoked voltage polyphasic deflections by visual inspection, but no general-purpose tool has emerged to understand their shapes or describe them mathematically. We describe and illustrate a new technique to parameterize brain stimulation data, where voltage response traces are projected into one another using a semi-normalized dot product. The length of timepoints from stimulation included in the dot product is varied to obtain a temporal profile of structural significance, and the peak of the profile uniquely identifies the duration of the response. Using lin...
ABSTRACTThe human ventral temporal cortex (VTC) is highly connected to integrate visual perceptua... more ABSTRACTThe human ventral temporal cortex (VTC) is highly connected to integrate visual perceptual inputs with feedback from cognitive and emotional networks. In this study, we used electrical brain stimulation to understand how different inputs from multiple brain regions drive unique electrophysiological responses in the VTC.We recorded intracranial EEG data in 6 patients implanted with intracranial electrodes for epilepsy surgery evaluation. Pairs of electrodes were stimulated with single pulse electrical stimulation, and corticocortical evoked potential (CCEP) responses were measured at electrodes in the collateral sulcus and lateral occipitotemporal sulcus of the VTC. Using a novel unsupervised machine learning method, we uncovered 2 to 4 distinct response shapes, termed basis profile curves (BPCs), at each recording electrode in the 11 to 500 ms post-stimulation interval.CCEPs of unique shape and high amplitude were elicited following stimulation of several regions and classif...
The epileptic network hypothesis and epileptogenic zone hypothesis are two theories of ictogenesi... more The epileptic network hypothesis and epileptogenic zone hypothesis are two theories of ictogenesis. The network hypothesis posits that coordinated activity among interconnected nodes produces seizures. The epileptogenic zone hypothesis posits that distinct regions are necessary and sufficient for seizure generation. High-frequency oscillations, and particularly fast ripples, are thought to be biomarkers of the epileptogenic zone. We sought to test these theories by comparing high-frequency oscillation rates and networks in surgical responders and non-responders, with no appreciable change in seizure frequency or severity, within a retrospective cohort of 48 patients implanted with stereo-EEG electrodes. We recorded inter-ictal activity during non-rapid eye movement sleep and semi-automatically detected and quantified high-frequency oscillations. Each electrode contact was localized in normalized coordinates. We found that the accuracy of seizure onset zone electrode contact classifi...
OBJECTIVE One of the most disabling aspects of living with chronic epilepsy is the unpredictabili... more OBJECTIVE One of the most disabling aspects of living with chronic epilepsy is the unpredictability of seizures. Cumulative research in the past decades has advanced our understanding of the dynamics of seizure risk. Technological advances have recently made it possible to record pertinent biological signals, including EEG, continuously. We aimed to assess whether patient-specific seizure forecasting is possible using remote, minimally invasive ultra long-term subcutaneous EEG. METHODS We analyzed a two-center cohort of ultra long-term subcutaneous EEG recordings, including six patients with drug-resistant focal epilepsy monitored for 46 to 230 days with median 18 hours/day of recorded data, totaling over 11,000 hours of EEG. Total electrographic seizures identified by visual review ranged from 12 to 36 per patient. Three candidate subject-specific long short-term memory (LSTM) network deep learning classifiers were trained offline and pseudo-prospectively on preictal (1-hour before) and interictal (more than one day from seizures) EEG segments. Performance was assessed relative to a random predictor. Periodicity of the final forecasts was also investigated with autocorrelation. RESULTS Depending on each architecture, significant forecasting performance was achieved in three to five out of six patients, with overall mean area under the ROC curve of 0.65 to 0.74. Significant forecasts showed sensitivity ranging from 64% to 80% and time in warning from 10.9% to 44.4%. Overall, the output of the forecasts closely followed patient-specific circadian patterns of seizure occurrence. SIGNIFICANCE This study demonstrates proof-of-principle for the possibility of subject-specific seizure forecasting using a minimally invasive subcutaneous EEG device capable of ultra long-term at-home recordings. These results are encouraging for the development of a prospective seizure forecasting trial with minimally-invasive EEG.
Data comprise intracranial EEG (iEEG) brain activity represented by stereo EEG (sEEG) signals, re... more Data comprise intracranial EEG (iEEG) brain activity represented by stereo EEG (sEEG) signals, recorded from over 100 electrode channels implanted in any one patient across various brain regions. The iEEG signals were recorded in epilepsy patients (N = 10) undergoing invasive monitoring and localization of seizures when they were performing a battery of four memory tasks lasting approx. 1 hour in total. Gaze tracking on the task computer screen with estimating the pupil size was also recorded together with behavioral performance. Each dataset comes from one patient with anatomical localization of each electrode contact. Metadata contains labels for the recording channels with behavioral events marked from all tasks, including timing of correct and incorrect vocalization of the remembered stimuli. The iEEG and the pupillometric signals are saved in BIDS data structure to facilitate efficient data sharing and analysis.
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Papers by Greg Worrell