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Association of cortical spreading depression and seizures in patients with medically intractable epilepsy
Affiliation:1. Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK;2. Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, UK;3. NeuroEngineering Laboratory, Department of Electrical and Electronic Engineering, The University of Melbourne, Melbourne, VIC, Australia;4. Department of Medicine, St. Vincent''s Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia;5. Department of Statistics, Columbia University, New York, NY 10027, USA;6. Centre for Neural Engineering, The University of Melbourne, Melbourne, VIC, Australia
Abstract:ObjectiveMonitoring of the ultra-low frequency potentials, particularly cortical spreading depression (CSD), is excluded in epilepsy monitoring due to technical barriers imposed by the scalp ultra-low frequency electroencephalogram (EEG). As a result, clinical studies of CSD have been limited to invasive EEG. Therefore, the occurrence of CSD and its interaction with epileptiform field potentials (EFP) require investigation in epilepsy monitoring.MethodsUsing a novel AC/DC-EEG approach, the occurrence of DC potentials in patients with intractable epilepsy presenting different symptoms of aura was investigated during long-term video-EEG monitoring.ResultsVarious forms of slow potentials, including simultaneous negative direct current (DC) potentials and prolonged EFP, propagated negative DC potentials, and non-propagated single negative DC potentials were recorded from the scalp of the epileptic patients. The propagated and single negative DC potentials preceded the prolonged EFP with a time lag and seizure appeared at the final shoulder of some instances of the propagated negative DC potentials. The slow potential deflections had a high amplitude and prolonged duration and propagated slowly through the brain. The high-frequency EEG was suppressed in the vicinity of the negative DC potential propagations.ConclusionsThe study is the first to report the recording of the propagated and single negative DC potentials with EFP at the scalp of patients with intractable epilepsy. The negative DC potentials preceded the prolonged EFP and may trigger seizures. The propagated and single negative DC potentials may be considered as CSD.SignificanceRecordings of CSD may serve as diagnostic and prognostic monitoring tools in epilepsy.
Keywords:Refractory epilepsy  Seizures  Spreading depolarization  DC recordings  Brain  AC"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0035"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  Alternating current  ADIF"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0045"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  Amplitude differential gain  CSD"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0055"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  cortical spreading depression  CMRR"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0065"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  Common Mode Rejection Ratio  DC"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0075"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  Direct current  DRL"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0085"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  driven Right Leg  ECG"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0095"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  electrocorticography  ECoG"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0105"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  Electrocardiogram  EEG"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0115"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  electroencephalogram  EFP"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0125"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  Epileptiform field potentials  GABA"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0135"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  γ-aminobutyric acid  LTM"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0145"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  long-term video-EEG monitoring  MDC"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0155"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  mobility and complexity  PRED"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0165"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  pattern related event distribution  RSP"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0175"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  relative spectral power  SD"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0185"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  standard deviation  SE"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0195"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  standard error  STFT"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0205"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  short-time Fourier transform
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