机构:[1]Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China首都医科大学宣武医院功能神经外科[2]Mayo Systems Electrophysiology Laboratory, Departments of Neurology and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA[3]UMR 1106 INSERM, Institut de Neurosciences des Systemes, Aix-Marseille University, Marseille, France[4]Epilepsy Center, Cleveland Clinic, Cleveland, OH 44195, USA[5]Comprehensive Epilepsy Center of Beijing, The Beijing Key Laboratory of Neuromodulation, Department of Neurology, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China神经内科脑功能疾病调控治疗北京市重点实验室首都医科大学宣武医院
Epilepsy has been classically seen as a brain disorder resulting from abnormally enhanced neuronal excitability and synchronization. Although it has been described since antiquity, there are still significant challenges achieving the therapeutic goal of seizure freedom. Deep brain stimulation of the anterior nucleus of the thalamus has emerged as a promising therapy for focal drug-resistant epilepsy; the basic mechanism of action, however, remains unclear. Here, we show that desynchronization is a potential mechanism of deep brain stimulation of the anterior nucleus of the thalamus by studying local field potentials recordings from the cortex during high-frequency stimulation (130 Hz) of the anterior nucleus of the thalamus in nine patients with drug-resistant focal epilepsy. We demonstrate that high-frequency stimulation applied to the anterior nucleus of the thalamus desynchronizes ipsilateral hippocampal background electrical activity over a broad frequency range, and reduces pathological epileptic discharges including interictal spikes and high-frequency oscillations. Furthermore, high-frequency stimulation of the anterior nucleus of the thalamus is capable of decoupling large-scale neural activity involving the hippocampus and distributed cortical areas. We found that stimulation frequencies ranging from 15 to 45 Hz were associated with synchronization of hippocampal local field potentials, whereas higher frequencies (>45 Hz) promoted desynchronization of ipsilateral hippocampal activity. Moreover, reciprocal effective connectivity between the anterior nucleus of the thalamus and the hippocampus was demonstrated by hippocampal-thalamic evoked potentials and thalamic-hippocampal evoked potentials. In summary, high-frequency stimulation of the anterior nucleus of the thalamus is shown to desynchronize focal and large-scale epileptic networks, and here is proposed as the mechanism for reducing seizure generation and propagation. Our data also demonstrate position-specific correlation between deep brain stimulation applied to the anterior nucleus of the thalamus and patients with temporal lobe epilepsy and seizure onset zone within the Papaz circuit or limbic system. Our observation may prove useful for guiding electrode implantation to increase clinical efficacy.
基金:
National Natural Science Foundation of China [81771395, 81571271, 81771398]; Beijing Municipal Science & Technology Commission [Z161100002616001]; Beijing Municipal Education Commission [TJSH20161002502]
第一作者机构:[1]Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
通讯作者:
通讯机构:[5]Comprehensive Epilepsy Center of Beijing, The Beijing Key Laboratory of Neuromodulation, Department of Neurology, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China[*]Department of Neurology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, 100053, Beijing, China
推荐引用方式(GB/T 7714):
Tao Yu ,Xueyuan Wang ,Yongjie Li,et al.High-frequency stimulation of anterior nucleus of thalamus desynchronizes epileptic network in humans[J].BRAIN.2018,141(5):2631-2643.doi:10.1093/brain/awy187.
APA:
Tao Yu,,Xueyuan Wang,,Yongjie Li,Guojun Zhang,,Gregory Worrel...&Yuping Wang.(2018).High-frequency stimulation of anterior nucleus of thalamus desynchronizes epileptic network in humans.BRAIN,141,(5)
MLA:
Tao Yu,,et al."High-frequency stimulation of anterior nucleus of thalamus desynchronizes epileptic network in humans".BRAIN 141..5(2018):2631-2643