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Title: Cortex leads the thalamic centromedian nucleus in generalized epileptic discharges in Lennox-Gastaut syndrome.
Austin Authors: Dalic, Linda J ;Warren, Aaron E L;Young, James C;Thevathasan, Wesley;Roten, Annie ;Bulluss, Kristian J ;Archer, John S 
Affiliation: The Florey Institute of Neuroscience and Mental Health
Department of Medicine, Royal Melbourne Hospital and Department of Neurology, University of Melbourne, Parkville, Victoria, Australia
Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
Medicine (University of Melbourne)
Bionics Institute, East Melbourne, Victoria, Australia
Murdoch Children's Research Institute, Parkville, Victoria, Australia
Issue Date: Oct-2020 2020-09-18
Publication information: Epilepsia 2020; 61(10): 2214-2223
Abstract: We aimed to assess the roles of the cortex and thalamus (centromedian nucleus [CM]) during epileptic activity in Lennox-Gastaut syndrome (LGS) patients undergoing deep brain stimulation (DBS) surgery as part of the ESTEL (Electrical Stimulation of the Thalamus for Epilepsy of Lennox-Gastaut Phenotype) trial. Twelve LGS patients (mean age = 26.8 years) underwent bilateral CM-DBS implantation. Intraoperatively, simultaneous electroencephalogram (EEG) was recorded (range = 10-34 minutes) from scalp electrodes and bilateral thalamic DBS electrodes. Temporal onsets of epileptic discharges (generalized paroxysmal fast activity [GPFA] and slow spike-and-wave [SSW]) were manually marked on recordings from scalp (ie, "cortex") and thalamus (ie, CM-DBS electrodes). Phase transfer entropy (PTE) analysis quantified the degree of information transfer from cortex to thalamus within different frequency bands around GPFA events. GPFA was captured in eight of 12 patients (total event number across patients = 168, cumulative duration = 358 seconds). Eighty-six percent of GPFA events were seen in both scalp and thalamic recordings. In most events (83%), onset occurred first at scalp, with thalamic onset lagging by a median of 98 milliseconds (interquartile range = 78.5 milliseconds). Results for SSW were more variable and seen in 11 of 12 patients; 25.4% of discharges were noted in both scalp and thalamus. Of these, 74.5% occurred first at scalp, with a median lag of 75 milliseconds (interquartile range = 228 milliseconds). One to 0.5 seconds and 0.5-0 seconds before GPFA onset, PTE analysis showed significant energy transfer from scalp to thalamus in the delta (1-3 Hz) frequency band. For alpha (8-12 Hz) and beta (13-30 Hz) frequencies, PTE was greatest 1-0.5 seconds before GPFA onset. Epileptic activity is detectable in CM of thalamus, confirming that this nucleus participates in the epileptic network of LGS. Temporal onset of GPFA mostly occurs earlier at the scalp than in the thalamus. This supports our prior EEG-functional magnetic resonance imaging results and provides further evidence for a cortically driven process underlying GPFA in LGS.
DOI: 10.1111/epi.16657
ORCID: 0000-0001-8335-1348
Journal: Epilepsia
PubMed URL: 32944944
Type: Journal Article
Subjects: DBS
centromedian nucleus
deep brain stimulation
effective connectivity
generalized paroxysmal fast activity
Appears in Collections:Journal articles

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