PMC9095747_01
PMC9095747_02
PMC9095747_03
Interictal epileptiform activity on MEG A - Scalp-EEG with subtle sharp wave discharges (negative at P7 and positive at F3); B - MEG spike-wave discharge over the left frontal and temporal sensors with counter map; C - ECD of MEG spike-wave discharge mapping to the left posterior sylvian region within the left parietal operculum. Note, 4 second page speed on EEG and MEG. Interictal epileptiform activity was defined by isolated sharp and spike-wave discharges that were not distinctly associated with repetition or rhythmicity. These discharges were not accompanied by evolving epileptiform activity.
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The interictal epileptiform activity on MEG also mapped in a tight cluster within the left posterior sylvian fissure, left posterior superior temporal gyrus, and left parietal operculum (Fig. 1, Fig. 2, Fig. 3, Fig. 4).
sEEG preictal spike-waves with evolving to an electrographic seizure A - Coregistration of the left parietal operculum sEEG electrode to the patient's brain MRI; B - Early preictal spiking (orange arrows) within the left parietal operculum; C and D - Increase frequency of preictal spiking with parietal operculum and adjacent contacts (PO - parietal operculum, PI - posterior insula, LES - lower extremity sensory); E - Transition of preictal spiking to an electrographic seizure (large red arrow).
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The interictal epileptiform activity on MEG also mapped in a tight cluster within the left posterior sylvian fissure, left posterior superior temporal gyrus, and left parietal operculum (Fig. 1, Fig. 2, Fig. 3, Fig. 4).
Responsive Neural Stimulator (RNS) settings and seizure outcomes Initiation of thalamic stimulation (0.5 microC/cm2, 125 Hz, 5 s); Initiation of two therapy stimulation with cortical bipolar (+-+-) stimulation (0.5 microC/cm2, 200 Hz, 100 ms) followed immediately by thalamic stimulation (0.5 microC/cm2, 125 Hz, 5 s); Reduction in cortical and thalamic charge density due to paresthesias; Two therapy stimulation with cortical bipolar (+-+-) stimulation (1.0 microC/cm2, 200 Hz, 100 ms) followed immediately by low frequency thalamic stimulation (1.0 microC/cm2, 5 Hz, 5 s); Two therapy, lead-to-lead, low frequency stimulation with cortical leads anodal (+) and thalamic leads cathodal (-) for 5 s (1.0 microC/cm2, 7.1 Hz) followed immediately by lead-to-lead stimulation with cortical leads cathodal (-) and thalamic leads anodal (+) for 5 s (1.0 microC/cm2, 7.1 Hz).
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Responsive neurostimulator (RNS) detection was fine-tuned, and eventually cathodal stimulation was initiated on all four centromedian contacts (details of the RNS adjustments and seizure frequency are detailed below, in Fig. 5).