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Pre-implant Brain Activation Modeling to Drive Placement of Depth Leads in White Matter for Direct Neurostimulation Therapy in Epilepsy
Title
Pre-implant Brain Activation Modeling to Drive Placement of Depth Leads in White Matter for Direct Neurostimulation Therapy in Epilepsy
Creator
Cendejas Zaragoza, Leopoldo
Date
2019
Description
A critical step towards applying direct brain stimulation therapy in focal onset epilepsy is to effectively interface with epileptogenic...
Show moreA critical step towards applying direct brain stimulation therapy in focal onset epilepsy is to effectively interface with epileptogenic neural circuits using a limited set of active contacts. This takes special relevance when interacting with networks that exhibit two or more foci. A strategy to influence the maximum extent of the epileptogenic circuit is to stimulate white matter pathways to enhance propagation to distant epileptic tissue.A significant number of elements must be considered in the clinical response to stimulation delivered directly to neuronal populations. These variables include: stimulation parameter settings, number and interdependence of anatomical targets, electrode number, electrode location and orientation, geometry or shape of the electrode contacts, contact polarity, biophysical properties of stimulated medium, andtrajectory of axonal bundles adjacent to the stimulation site.This document addresses the development of a computational model which takes into consideration all the mentioned variables to predict activation of distant sites via white matter pathways. A method to calculate the extracellular potential field, induced by the application of time-dependent stimulation waveforms, is discussed. Such a method considers both the anisotropic conductivity nature of neural tissue and the electrochemical phenomena of the electrode-tissue interface. The response of white matter fibers is then evaluated by solving a compartmental cable model based in the Hodgkin and Huxley membrane description.The model was integrated into a pre-surgical workflow and was used prospectively to guide stereotactic implantation of depth leads to apply direct neurostimulation therapy in four patients with refractory focal onset epilepsy.
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Quality of Life in People with Epilepsy: The Associations of Anti-seizure Medications and Biopsychosocial Variables
Title
Quality of Life in People with Epilepsy: The Associations of Anti-seizure Medications and Biopsychosocial Variables
Creator
Thomas, Julia A.
Date
2022
Description
People with epilepsy, on average, experience lower quality of life (QOL) than healthy controls (Taylor et al., 2011). This study examined the...
Show morePeople with epilepsy, on average, experience lower quality of life (QOL) than healthy controls (Taylor et al., 2011). This study examined the associations between specific anti-seizure medication, biopsychosocial factors, and QOL in people with epilepsy. Analysis of covariance revealed that individuals taking three or more anti-seizure medications had significantly lower QOL than those taking levetiracetam. Findings also demonstrated that when looking at biopsychosocial factors as predictors of QOL in hierarchical regression, anxiety, depression, and daytime sleepiness were significant predictors of QOL. Once these factors were entered into the model, number of medications was no longer significant. The final model predicted 59.6% of the variance in QOL. Lastly, a moderation analysis to examine the moderating effect of employment on the association between number of anti-seizure medications and QOL was not significant. Additional exploratory analyses looking at individuals who were employed versus those who were not employed were completed. These findings underscore the importance of addressing psychological health and sleep factors within the epilepsy population.
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