Method Article

Een Multimodaal Beeldverwerking en-stimulatie gebaseerde methode voor de beoordeling Connectivity-gerelateerde Brain Exciteerbaarheid bij patiënten met epilepsie

DOI:

10.3791/53727

November 13th, 2016

In This Article

Summary

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Resting-state functional-connectivity MRI has identified abnormalities in patients with a wide range of neuropsychiatric disorders, including epilepsy due to malformations of cortical development. Transcranial Magnetic Stimulation in combination with EEG can demonstrate that patients with epilepsy have cortical hyperexcitability in regions with abnormal connectivity.

Abstract

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Resting-state functional connectivity MRI (rs-fcMRI) is a technique that identifies connectivity between different brain regions based on correlations over time in the blood-oxygenation level dependent signal. rs-fcMRI has been applied extensively to identify abnormalities in brain connectivity in different neurologic and psychiatric diseases. However, the relationship among rs-fcMRI connectivity abnormalities, brain electrophysiology and disease state is unknown, in part because the causal significance of alterations in functional connectivity in disease pathophysiology has not been established. Transcranial Magnetic Stimulation (TMS) is a technique that uses electromagnetic induction to noninvasively produce focal changes in cortical activity. When combined with electroencephalography (EEG), TMS can be used to assess the brain's response to external perturbations. Here we provide a protocol for combining rs-fcMRI, TMS and EEG to assess the physiologic significance of alterations in functional connectivity in patients with neuropsychiatric disease. We provide representative results from a previously published study in which rs-fcMRI was used to identify regions with abnormal connectivity in patients with epilepsy due to a malformation of cortical development, periventricular nodular heterotopia (PNH). Stimulation in patients with epilepsy resulted in abnormal TMS-evoked EEG activity relative to stimulation of the same sites in matched healthy control patients, with an abnormal increase in the late component of the TMS-evoked potential, consistent with cortical hyperexcitability. This abnormality was specific to regions with abnormal resting-state functional connectivity. Electrical source analysis in a subject with previously recorded seizures demonstrated that the origin of the abnormal TMS-evoked activity co-localized with the seizure-onset zone, suggesting the presence of an epileptogenic circuit. These results demonstrate how rs-fcMRI, TMS and EEG can be utilized together to identify and understand the physiological significance of abnormal brain connectivity in human diseases.

Introduction

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Transcraniële magnetische stimulatie (TMS) is een middel om niet-invasief stimuleren gebieden van cortex via elektromagnetische inductie. In TMS is een groot, maar ruimtelijk beperkt magnetische flux gebruikt om een ​​elektrisch veld te induceren in een doel corticale gebied en daardoor de activiteit van de onderliggende zenuwweefsel moduleren. TMS om motorische cortex resultaten in motor evoked potentials die perifeer kan worden gemeten via elektromyografie (EMG). Toegepast in paren of drietallen pulsen, TMS kan worden gebruikt om de activiteit van specifieke intracorticale GABAerge en glutaminergische schakelingen 1-3 beoordelen en daardoor het evenwicht....

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Protocol

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Het hier beschreven protocol werd goedgekeurd door de institutionele review boards van het Beth Israel Deaconess Medical Center en het Massachusetts Institute of Technology.

1. Onder Selection

  1. Selectie van patiënten voor onderzoek protocol.
    1. Identificeer patiënten met actieve epilepsie (aanvallen in het afgelopen jaar) of een voorgeschiedenis van remote epilepsie (voorafgaande aanvallen, maar met geen aanvallen in de afgelopen vijf jaar in of uit medicatie) en periventriculaire nodulaire heterotopie op imaging structurele hersenafwijkingen.
    2. Uitsluiten patiënten zonder voorgeschiedenis van epileptische aanvalle....

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Results

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Rusten-state functionele connectiviteit fMRI kan worden gebruikt om de regio's van de cortex die een hoge functionele connectiviteit met de heterotope periventriculaire grijze stof knobbeltjes te tonen (figuur 1), en controle gebieden te identificeren zonder een dergelijke verbinding. Om te bepalen of een dergelijke abnormale functionele connectiviteit heeft fysiologische betekenis, kan de corticale regio met gecorreleerde resting state activiteit worden gekozen als .......

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Discussion

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Rusttoestand functionele connectiviteit MRI gebruikt om netwerkverbindingen identificeren in het menselijk brein, en veranderingen van verbindingen die optreden in verschillende ziektetoestanden 26,31,32 identificeren. Aangezien fMRI functionele verbinding is gebaseerd op het identificeren van correlaties in het signaal BOLD en bloed oxygenatie veranderingen een niet-triviale relatie met onderliggende neurale activiteit, het causale betekenis en fysiologische relevantie van deze bevindingen fMRI connectivitei.......

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Disclosures

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MMS, SWG, CJC and BSC have nothing to disclose. APL serves on the scientific advisory boards for Nexstim, Neuronix, Starlab Neuroscience, Neuroelectrics, and Neosync, and is listed as an inventor on several issued and pending patents on the real-time integration of transcranial magnetic stimulation (TMS) with electroencephalography (EEG) and magnetic resonance imaging (MRI).

Acknowledgements

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The authors would like to thank Emily L. Thorn, B.A., for her assistance with the Source estimation of evoked electrical activity Section. MMS was supported by a KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst/The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award KL2 TR001100). CJC was supported by a grant from the National Institutes of Health (5K12NS066225). APL was supported in part by grants from the Sidney R. Baer Jr. Foundation, the National Institutes of Health (R01 HD069776, R01 NS073601, R21 ....

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Materials

List of materials used in this article
NameCompanyCatalog NumberComments
3T MRI scanner
MRI functional connectivity software
MRI image viewing softwareMRICron
Transcranial Magnetic StimulatorNexstimeXimia StimulatorCan use stimulators from other suppliers, e.g., Magventure, Magstim
MRI neuronavigation systemNexstimNBS v3.2.1Alternative MRI neuronavigation system, e.g., Brainsight, Localite
TMS-compatible EEG systemNexstimEximia EEGAlternatives: Brain Products, Synamps, ANT
MatlabMathworksR2012bAlternatives: Octave
EEGLab
Minimum Norm Estimate (MNE) software
FreeSurfer

References

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  1. Florian, J., Müller-Dahlhaus, M., Liu, Y., Ziemann, U. Inhibitory circuits and the nature of their interactions in the human motor cortex a pharmacological TMS study. J. Physiol. 586 (2), 495-514 (2008).
  2. Rotenberg, A.

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Tags

Resting State Functional ConnectivityTranscranial Magnetic StimulationElectroencephalography RecordingEpilepsy Brain ExcitabilityCortical Hyperexcitability AssessmentTMS Evoked EEG ActivityFunctional Connectivity MRINeuronavigation Guided StimulationIndependent Component AnalysisSeizure Onset Zone Localization

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