Focal motor seizures (FMS) are often unresectable because of motor risk. We aimed to evaluate the long-term effectiveness and safety of subthalamic nucleus deep brain stimulation (STN-DBS) in patients with FMS and to identify suitable candidate patients. We analyzed long-term outcomes in 22 patients with FMS treated with STN-DBS, classifying patients as responders (≥50% seizure reduction) or non-responders and relating outcomes to seizure-focus topography using focus-frequency maps and region-of-interest–based volumetrics. In a SEEG cohort of 13 patients with electrodes in the sensorimotor cortex and the STN, including 1 from the DBS cohort, we quantified changes in interictal spike (IIS) rates and broadband (0.5–90 Hz) power spectral density (PSD) across distinct sensorimotor subregions during 100-Hz STN stimulation. At final follow-up (mean 45 months), median seizure reduction was 55%, with 14/22 responders and six patients achieved >90% reduction, including one seizure-free. STN-DBS was well tolerated, with no surgical complications and one explant for infection. Responders’ seizure foci clustered in a medial sensorimotor strip comprising the paracentral lobule (PCL), supplementary motor area (SMA) and trunk representations of the precentral and postcentral gyri, and greater involvement of the PCL and trunk areas correlated with better outcome. SEEG analyses showed a global reduction in broadband power but regionally selective suppression of epileptiform activity, confined to the PCL and SMA. Together, STN-DBS appears to be a safe, effective option for FMS, and patients whose seizure foci involve the medial sensorimotor strip may be potential candidates.

OBJECTIVE:To assess whether postoperative residual seizure burden may provide patient-centered information beyond relative seizure improvement by examining willingness to undergo vagus nerve stimulation (VNS) again in drug-resistant epilepsy (DRE). METHODS:This single-center cross-sectional study included patients with DRE after VNS implantation. Baseline data were retrieved from an institutional database, and follow-up data were collected using a structured questionnaire. The primary outcome was willingness to undergo VNS again, treated as an exploratory decision-centered patient-reported measure and analyzed as yes versus no/uncertain. Subjective seizure improvement, quality-of-life (QoL) improvement, overall satisfaction, willingness to recommend VNS, and adverse effects were also assessed. Seizure burden before and after VNS was graded using broad frequency-based categories. Category improvement reflected relative improvement, whereas postoperative residual burden reflected the absolute burden remaining after treatment. RESULTS:Of 58 screened patients, 54 were included. Overall, 32/54 (59.3%) would undergo VNS again, 22/54 (40.7%) were satisfied, and 25/54 (46.3%) would recommend VNS. Subjective seizure improvement and QoL improvement were reported by 35/54 (64.8%) and 33/54 (61.1%) patients, respectively. Seizure burden category improved in 35/54 (64.8%), but 11/54 (20.4%) continued to have daily seizures after VNS. Patients willing to undergo VNS again were more likely than those unwilling or uncertain to report subjective seizure improvement (87.5% vs 31.8%, P < 0.001), QoL improvement (90.6% vs 18.2%, P < 0.001), and seizure burden category improvement (81.2% vs 40.9%, P = 0.004). They also had lower postoperative residual seizure burden (median category 1.0 [IQR 0.0-2.3] vs 3.0 [IQR 2.0-4.0], P < 0.001). CONCLUSIONS:Willingness to undergo VNS again was associated with relative improvement and lower postoperative residual seizure burden. These findings suggest that residual seizure burden may provide complementary patient-centered information when interpreted alongside conventional response measures and established patient-reported outcomes.

OBJECTIVE:To compare the effectiveness of closed-loop (AutoStim) versus open-loop vagus nerve stimulation (VNS) in drug-resistant epilepsy (DRE), and to explore predictors of treatment response. METHODS:We conducted a single-centre retrospective cohort study at Xuanwu Hospital (2012-2024). A total of 131 consecutive DRE patients received open-loop (Model 102) or closed-loop (Model 106) VNS; 81 were analysed after follow-up (open-loop n = 44; closed-loop n = 37). The primary outcome was percent reduction in monthly seizure frequency; responders were defined as ≥ 50% reduction. Between-group comparisons accounted for baseline age imbalance using Quade rank ANCOVA. Predictor analyses evaluated clinical covariates, including age at seizure onset. RESULTS:Closed-loop VNS was associated with greater postoperative seizure reduction than open-loop after age adjustment (Quade rank ANCOVA p = 0.007). Overall responder rate was 58% (47/81); by group: 43.2% (19/44) in open-loop versus 75.7% (28/37) in closed-loop, absolute difference 33.8 %age points (95% CI 8.9-58.7), NNT= 3 (95% CI 2-3). Age at seizure onset was associated with response in exploratory analyses (t(79) = -2.241, p = 0.028). CONCLUSIONS:In an Asian cohort, closed-loop VNS seems to be associated with greater seizure reduction than open-loop VNS in this real-world cohort; however, because device type was perfectly aligned with implantation era, findings should be interpreted as comparative effectiveness across eras rather than definitive causal superiority. Age at seizure onset shows an exploratory association with response, but this should be interpreted cautiously given differential attrition and era-related confounding.

BACKGROUND:The cingulo-insular region is crucial for modulating cardiac activity. However, the distinct roles of its anatomic subdivisions in modulating sympathetic-parasympathetic balance remain poorly defined. We aimed to explore the distinct contributions of subdivisions within the cingulo-insular region to modulating cardio-autonomic balance.METHODS:In this prospective observational study, patients with drug-resistant epilepsy undergoing stereo-electroencephalography with electrical cortical stimulation of the cingulo-insular region were enrolled. Stereo-electroencephalography and ECG signals were synchronously recorded during electrical cortical stimulation of the cingulo-insular region. Heart rate variability and R-R interval analyses were conducted to assess cardiac sympathetic-parasympathetic balance. The correlation coefficient between heart rate variability and the strength of phase-amplitude coupling in stereo-electroencephalography was calculated before and after stimulation.RESULTS:Data from 33 patients (70 electrode contacts, 287 trials) were analyzed. Stimulation of the anterior cingulate gyrus enhanced parasympathetic activity, correlated with increased local phase-amplitude coupling strength. The left anterior cingulate gyrus stimulation increased pNN50 (median difference, -5.00% [95% CI, -17.99 to -0.16]; P=0.044); right anterior cingulate gyrus stimulation increased the SD of all normal-to-normal intervals (median difference, -14.22 ms [95% CI, -26.68 to -1.63]; P=0.019) and SD2 (median difference, -19.49 ms [95% CI, -33.26 to -3.22]; P=0.013). Meanwhile, stimulation of the posterior insula significantly reduced the parasympathetic component of heart rate variability and short-term R-R interval. The left posterior insula decreased the SD1/SD2 ratio (median difference, 0.08 [95% CI, 0.03-0.15]; P=0.005); right posterior insula decreased power in the high-frequency range (median difference, 25.30 ms2 [95% CI, 3.98-49.35]; P=0.013) and the approximate entropy (median difference, 0.15 [95% CI, 0.04-0.29]; P=0.004).CONCLUSIONS:Within the cingulo-insular region, the anterior cingulate gyrus is associated with a relative cardio-parasympathetic dominance, while the posterior insula is linked to a relative cardio-sympathetic dominance. These findings provide a deeper understanding of the neural modulation of cardio-autonomic balance, and may have implications for the prevention and treatment of cardio-autonomic dysfunction in neurological disorders.

With the development of deep brain stimulation technique, single-channel intracranial electroencephalography (iEEG) based seizure prediction is a necessary and urgent needed tool for epilepsy closedloop neuromodulation. However, previous prediction methods based on multi-channel scalp signals heavily relied on the spatial information, failing to fully exploit the interdependencies between temporal scales and spectral rhythms of single-channel iEEG. Additionally, current contrastive learning strategies can lead to model overfitting by excessively learning the feature distances in small samples, limiting the precision of seizure prediction. To tackle above issues, based on a single-channel iEEG, we propose a novel dual-cross tri-level routing transformer based metric learning network (DC-TRT-MLNet) for epileptic seizure prediction. First, a scale-rhythm dualcross (DC) graph attention network is introduced to construct the dependent relationships across multi-scale temporal and multi-rhythm spectral features. Second, we design a tri-level routing transformer (TRT) network to comprehensively refine the most seizure-potential routing features while eliminating redundant information. Finally, a hard triplet optimization based metric learning (ML) strategy is developed to iteratively optimize the intra-class and inter-class distances of inter-ictal and pre-ictal routing features. Competitive experimental results on a private Xuanwu Single-Channel iEEG dataset validate the effectiveness of our proposed method, demonstrating the superior prediction performance of our DC-TRT-MLNet compared with the state-of-the-art methods. Our study may offer a new solution for intracranial single-channel seizure prediction.

BACKGROUND:Cingulate epilepsy is rare and can manifest with variable semiology features. The symptomatic diversity elucidates ictal involvement of certain subregions of the cingulate gyrus and early spread patterns. Knowledge of the features of cingulate epilepsy is important for better localization and surgical strategy. OBJECTIVE:The purpose of this study was to characterize the electroclinical features and report our experience in the diagnosis and surgical treatment of patients with focal epilepsy originating from the cingulate gyrus. METHODS:Thirty-one patients with epilepsy were retrospectively analyzed (mean age, 21; range 2-48), who had a mean epilepsy duration of 10 years (range 1-23). We report the clinical semiology, the scalp electroencephalography (EEG)/stereo-electroencephalography (SEEG) findings, surgical strategy, and postoperative follow-up (mean 48 months; range 12-136). RESULTS:Twelve patients (38.7 %) had circumscribed lesions on magnetic resonance imaging (MRI). All patients underwent noninvasive presurgical evaluation, and 26 (83.9 %) underwent invasive recordings with SEEG (n = 18) or subdural electrodes (n = 8). The ictal patterns of scalp EEG were various. The anterior cingulate epilepsy (ACE) patients showed ipsilateral frontal, frontal-temporal, or bifrontal regions discharges. The ictal discharges involved the ipsilateral frontal, temporal, or central-parietal regions in patients with middle cingulate epilepsy (MCE), and the posterior cingulate epilepsy (PCE) patients showed ipsilateral temporal, occipital-temporal, bitemporal-parietal, or generalized discharges. Secondary generalization seizures originated from each subregion of the cingulate gyrus. The ACE patients showed hypermotor seizures, including twisting trunk, pedaling, and flailing. Limbs or body trembling was observed in both MCE and PCE patients, and dialeptic seizures were observed in PCE patients. 58.1 % of patients were seizure-free, and 77.4 % had a satisfactory surgical outcome (Engel I and II). CONCLUSIONS:Cingulate epilepsy is a rare and diagnostically challenging form of epilepsy with diverse and variable electroclinical features. In patients with non-lesional MRI, invasive recording is required to identify defined seizure focus, and the surgical outcome of 1-year follow-up is favorable.

Emotional discrimination provides as a critical perspective on how neural circuits dynamically resolve socio-emotional conflicts, offering insights that inform treatment strategies for autism, depression, and schizophrenia. The right middle frontal gyrus plays a central, though poorly defined, role in resolving implicit facial interference during emotion discrimination. Using stereoelectroencephalography recordings from 11 participants with pharmacologically resistant epilepsy performing a face-implicit emotion discrimination task, we identified dynamic spatiotemporal mechanisms underlying behavioural accuracy. Results indicated that the right middle frontal gyrus functions as a phase-dependent hub. During early emotional discrimination, increased amplitudes in this region during incorrect trials disrupted emotional discrimination. In later decision-making phases, a failure to reverse from positive to inhibitory connectivity between the right middle frontal gyrus and fronto–insulo–temporal nodes predicted misidentification. Notably, the reconfiguration strength of the right middle frontal gyrus correlated with successful resolution of face-implicit interference. This region exhibited dual-pathway control, modulating both local neural gain and global network polarity to guide emotional decisions. These findings identify the right middle frontal gyrus as a key arbitrator of implicit face–emotion integration, with its spatiotemporal dysregulation contribution to emotion recognition deficits in neuropsychiatric populations.

High-throughput single-cell omics of non-human primate tissues present a remarkable opportunity to study primate brain aging. Here, we introduce a transcriptomic and chromatin accessibility landscape of 1,985,317 cells from eight brain regions of 13 cynomolgus female monkeys spanning adult lifespan including exceptionally old individuals up to 29-years old. This dataset uncovers dynamic molecular changes in critical brain functions such as synaptic communication and axon myelination, exhibiting a high degree of cell type and brain region specificity. We identify the multicellular networks of the pons and medulla as a previously unrecognized hotspot for aging. Furthermore, comparative analyses with human neurodegeneration datasets highlight both shared and distinct mechanisms contributing to aging and disease. In addition, we uncover transcription factors implicated in monkey brain aging and pinpoint aging-regulated loci linked to longevity and neurodegeneration. This spatiotemporal atlas will advance our understanding of primate brain aging and its broader implications for health and disease. ### Competing Interest Statement The authors have declared no competing interest.

AIM:A total of 30% of individuals with epilepsy are resistant to drug treatment. Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) shows promise for treating drug-resistant epilepsy (DRE), but further research is needed to optimize DBS parameters, including stimulation frequency. This study aimed to reveal the optimal frequency for ANT-DBS by testing the real-time effects of various stimulation frequencies on the ANT among patients undergoing stereoelectroencephalography (SEEG) electrode implantation. METHODS:Eleven patients (8 males; mean age, 24.2 years; mean epilepsy duration, 13.5 years) were enrolled. Postoperative electrode reconstruction identified ANT contacts for bipolar stimulation between 10 Hz and 100 Hz at 10-Hz increments, with a 1-min interval between stimuli. The effects were analyzed on the basis of spike count, power spectral density, and causal flow. RESULTS:Our study revealed that ANT stimulation suppresses seizure focus activity and modulates brain network dynamics, with the effects varying by individual characteristics and frequency. Stimulation at 10-70 Hz reduced spikes (> 50%) and PSD (p < 0.05) in the epileptogenic region while also influencing network connectivity between the epileptogenic zone and adjacent cortical regions, including the frontal, temporal, and insular lobes, as well as the overall brain network. CONCLUSIONS:Instead of using a fixed high frequency for ANT-DBS, the optimal frequency should be selected for each patient. Patients who do not respond well to high-frequency ANT-DBS can use a lower frequency, such as 10-70 Hz.

Emotion processing is an integral part of everyone's life. The basic neural circuits involved in emotion perception are becoming clear, though the emotion's cognitive processing remains under investigation. Utilizing the stereo-electroencephalograph with high temporal-spatial resolution, this study aims to decipher the neural pathway responsible for discriminating low-arousal and high-arousal emotions. This study involves 19 patients with pharmacologically resistant epilepsy who participate in a delayed match/mismatch sample task designed to separately assess their ability to discriminate between low-arousal and high-arousal emotions. Three groups of 11 brain subregions, with dominant lateralization, compose a network, which is identified as responsible for discriminating arousal-dependent emotions. The connection of these subregions, leading by the left insula and right middle temporal gyrus, defines the pathways for discriminating emotions with different arousals. Further, the separated network patterns related to emotional discrimination are face-independent. Overall, the left insula and the right middle temporal gyrus emerge as core components in the network, which plays key roles in the dynamic course for discriminating low- and high-arousal emotions in the human brain.

Background Frontal lobe epilepsy (FLE), the second most common refractory focal epilepsy, of which focal cortical dysplasia (FCD) is a common etiology. Electrophysiological analysis offers crucial insights into FCD subtype differentiation. Thus, we aim to evaluate scalp electroencephalography (EEG) and stereoelectroencephalography (SEEG) features, clinical characteristics, and postsurgical outcomes in a uniform series of patients with pathologically confirmed FCD type I or II who underwent FLE surgery. Methods Thirty-four consecutive patients were retrospectively analyzed. The interictal and ictal EEG and SEEG features, clinical characteristics, and surgical outcomes were evaluated. Results Six interictal EEG patterns were identified. Focal continuous fast epileptiform discharges were only encountered in FCD II, with a high specificity of 100%. Continuous periodic spikes were predominantly observed in FCD II, with a high specificity of 94.4%; while repetitive discharges were largely observed in FCD I, with a specificity of 94.4%. Patients with a shorter epilepsy duration were more likely to show continuous irregular slowing (P ​= ​0.034). Five EEG ictal onset patterns (IOPs) were identified. Spikes and slow waves were observed only in the FCD I group, whereas alpha activity was observed only in the FCD II group. Four interictal SEEG patterns were identified. Continuous periodic spikes were most frequently observed in the FCD II group (P ​= ​0.044). Seven SEEG IOPs values were identified. Slow-wave or baseline shift followed by low-voltage fast activity (LVFA) and delta brush were observed only in FCD I. In contrast, preictal spiking followed by LVFA was mostly observed in the FCD II. Fast activity was observed only in the FCD I group. The average follow-up time was 1.8 years, and favorable surgical outcomes were observed more often in patients with FCD II (66.7%) than in those with FCD I (44.4%) but without significance (P ​= ​0.315). Conclusion FCD subtypes share distinct EEG and SEEG signatures, and some special patterns may be indicative of specific subtypes.

OBJECTIVE:We aimed to explore the value of magnetoencephalography in the presurgical evaluation of patients with posterior cortex epilepsy.METHODS:A total of 39 patients with posterior cortex epilepsy (PCE) and intact magnetoencephalography (MEG) images were reviewed from August 2019 to July 2022. MEG dipole clusters were classified into single clusters, multiple clusters, and scatter dipoles based on tightness criteria. The association of the surgical outcome with MEG dipole classifications was evaluated using Fisher's exact tests.RESULTS:Among the 39 cases, there were 24 cases of single clusters (61.5%), nine cases of multiple clusters (23.1%), and six cases of scattered dipoles (15.4%). Patients with single dipole clusters were more likely to become seizure-free. Among single dipole cluster cases (n = 24), complete MEG dipole resection yielded a more favorable surgical outcome than incomplete resection (83.3% vs. 16.7%, p = 0.007). Patients with concordant MRI and MEG findings achieved a significantly more favorable surgical outcome than discordant patients (66.7% vs. 33.3%, p = 0.044), especially in single dipole cluster patients (87.5% vs. 25.0%, p = 0.005).SIGNIFICANCE:MEG can provide additional valuable information regarding surgical candidate selection, epileptogenic zone localization, electrode implantation schedule, and final surgical planning in patients with posterior cortex epilepsy.

OBJECTIVE:The cortical representation of emotions is complex, and cortical mapping of emotional experience is incomplete. We aimed to contribute to cortical mapping of emotional experience.METHODS:Clinical data from 400 patients with medically refractory epilepsy who underwent stereo-electroencephalography implantation for localization of the epileptogenic zone at the Beijing Institute of Functional Neurosurgery between October 2015 and June 2021 were collected retrospectively. Furthermore, we reviewed studies that described cortical mapping of emotional experience through electrical cortical stimulation (ECS). Affective responses similar to ictal aura and electrode contacts located in the SOZ were excluded to investigate emotional experiences in normal brain regions.RESULTS:Emotional experiences were evoked by stimulation at 10 electrode contacts in the seven patients, including five contacts that evoked mirth and excitement, one contact that evoked calmness, three contacts that evoked fear, and one contact that evoked sadness. In addition, 21 studies that evaluated emotional experiences in response to cortical electrical stimulation were reviewed. Emotions were distributed in the amygdala, hippocampus, temporal lobe, frontal lobe, insula, frontal operculum, parietal operculum, and cingulate cortex.SIGNIFICANCE:We provided additional evidence that brain regions including the amygdala, hippocampus, temporal lobe, frontal lobe, insula, frontal operculum, parietal operculum, and cingulate cortex were associated with emotional experience.

Our understanding of cingulate cortex function is limited. As a method for locating the epileptogenic zone, direct electrical cortical stimulation (ECS) provides an opportunity to understand the functional localization of the cingulate cortex. This study aimed to learn more about the function of the cingulate cortex by analyzing a large body of data from our center and by reviewing existing literature on cortical mapping. We retrospectively analyzed the ECS data of 124 patients with drug‐resistant epilepsy who had undergone electrode implantation in the cingulate cortex. The standard stimulation parameters included a biphasic pulse and bipolar stimulation at 50 Hz. Furthermore, we reviewed existing studies on cingulate responses elicited by the ECS and compared them with our results. A total of 329 responses were evoked in 276 contacts using ECS. Of these, 196 were physiological functional responses, which included sensory, affective, autonomic, language, visual, vestibular, and motor responses, along with a few other sensations. Sensory, motor, vestibular, and visual responses were concentrated in the cingulate sulcus visual area (CSv). Furthermore, 133 epilepsy‐related responses were evoked, most of which were concentrated in the ventral cingulate cortex. No responses were evoked by 498 contacts. Furthermore, the comparison of our ECS results with those reported in 11 comprehensive reviews revealed that the cingulate cortex is involved in complicated functions. The cingulate cortex is involved in sensory, affective, autonomic, language, visual, vestibular, and motor functions. The CSv is an integrating node of sensory, motor, vestibular, and visual systems.

ObjectiveBy studying the surgical outcome of deep brain stimulation (DBS) of different target nuclei for patients with refractory epilepsy, we aimed to explore a clinically feasible target nucleus selection strategy.MethodsWe selected patients with refractory epilepsy who were not eligible for resective surgery. For each patient, we performed DBS on a thalamic nucleus [anterior nucleus of the thalamus (ANT), subthalamic nucleus (STN), centromedian nucleus (CMN), or pulvinar nucleus (PN)] selected based on the location of the patient's epileptogenic zone (EZ) and the possible epileptic network involved. We monitored the clinical outcomes for at least 12 months and analyzed the clinical characteristics and seizure frequency changes to assess the postoperative efficacy of DBS on the different target nuclei.ResultsOut of the 65 included patients, 46 (70.8%) responded to DBS. Among the 65 patients, 45 underwent ANT-DBS, 29 (64.4%) responded to the treatment, and four (8.9%) of them reported being seizure-free for at least 1 year. Among the patients with temporal lobe epilepsy (TLE, n = 36) and extratemporal lobe epilepsy (ETLE, n = 9), 22 (61.1%) and 7 (77.8%) responded to the treatment, respectively. Among the 45 patients who underwent ANT-DBS, 28 (62%) had focal to bilateral tonic-clonic seizures (FBTCS). Of these 28 patients, 18 (64%) responded to the treatment. Out of the 65 included patients, 16 had EZ related to the sensorimotor cortex and underwent STN-DBS. Among them, 13 (81.3%) responded to the treatment, and two (12.5%) were seizure-free for at least 6 months. Three patients had Lennox–Gastaut syndrome (LGS)-like epilepsy and underwent CMN-DBS; all of them responded to the treatment (seizure frequency reductions: 51.6%, 79.6%, and 79.5%). Finally, one patient with bilateral occipital lobe epilepsy underwent PN-DBS, reducing the seizure frequency by 69.7%.SignificanceANT-DBS is effective for patients with TLE or ETLE. In addition, ANT-DBS is effective for patients with FBTCS. STN-DBS might be an optimal treatment for patients with motor seizures, especially when the EZ overlaps the sensorimotor cortex. CMN and PN may be considered modulating targets for patients with LGS-like epilepsy or occipital lobe epilepsy, respectively.

Our understanding of cingulate cortex function is limited. As a method for locating the epileptogenic zone, direct electrical cortical stimulation (ECS) provides an opportunity to understand the functional localization of the cingulate cortex. This study aimed to learn more about the function of the cingulate cortex by analyzing a large body of data from our center and by reviewing existing literature on cortical mapping. We retrospectively analyzed the ECS data of 124 patients with drug-resistant epilepsy who had undergone electrode implantation in the cingulate cortex. The standard stimulation parameters included a biphasic pulse and bipolar stimulation at 50 Hz. Furthermore, we reviewed existing studies on cingulate responses elicited by the ECS and compared them with our results. A total of 329 responses were evoked in 276 contacts using ECS. Of these, 196 were physiological functional responses, which included sensory, affective, autonomic, language, visual, vestibular, and motor responses, along with a few other sensations. Sensory, motor, vestibular, and visual responses were concentrated in the cingulate sulcus visual area (CSv). Furthermore, 133 epilepsy-related responses were evoked, most of which were concentrated in the ventral cingulate cortex. No responses were evoked by 498 contacts. Furthermore, the comparison of our ECS results with those reported in 11 comprehensive reviews revealed that the cingulate cortex is involved in complicated functions. The cingulate cortex is involved in sensory, affective, autonomic, language, visual, vestibular, and motor functions. The CSv is an integrating node of sensory, motor, vestibular, and visual systems.

Limb loss experience is a type of body illusion characterized by the sensation of a missing limb or body part. We aimed to investigate the brain areas involved in this unusual somatosensory experience evoked by electric cortical stimulation with stereo-electroencephalography electrodes. We retrospectively reviewed the data of patients with medical intractable epilepsy, from October 2015 to December 2020, who underwent stereo-electroencephalography implantation and electric cortical stimulation in order to locate the epileptogenic zone and obtain a functional map. We included patients who reported experiences of limb loss during the process of electric cortical stimulation for functional mapping. Three patients reported experiences of limb loss in the process of electric cortical stimulation. Limb loss experience (including the right hand, right upper limb and right side of the body) occurred when the cortex of the left posterior insula, posterior dorsal cingulate and parietal operculum were stimulated. Limb loss experience can be evoked by electric cortical stimulation of the posterior insula, parietal operculum, and posterior cingulate cortex, and provides additional evidence that these cortices play a role in the integration of body sensory perception.

Objectives: Based on data for a large population of patients from a single center accumulated over 22 years, the present study aimed to reveal an overall profile of movement disorders (MDs) in terms of their demographic features and surgical treatment. Methods: This study was conducted on 21,005 outpatients (2008-2019) and 5,126 inpatients (1998-2019) with MDs who underwent radiofrequency ablation (RFA) or deep-brain stimulation (DBS). Patients were categorized into those with Parkinson's disease (PD), essential tremor (ET), dystonia, tics, or involuntary movements (IMs). The clinical data of these patients were analyzed retrospectively. Results: PD accounted for the largest proportion (75.4%) among surgically treated MD patients, and was asso-ciated with the highest surgical rate (18.8%), followed by ET (proportion: 12.1%, surgical rate: 10.4%) and dystonia (proportion: 5.7%, surgical rate: 5.7%). The male:female ratio was higher in surgical patients than in outpatients (1.49 vs. 1.27, p < 0.001). The surgery ages in patients with PD, ET, dystonia, tics, or IMs was 62 (54-67), 61 (46-68), 40 (26-53), 21 (19-25), and 21 (17-28) years; and the duration of illness (DOI was 6 (4-10), 14 (9-20), 4 (2-10), 11 (7-17), and 17 (10-22) years, respectively. Between 1998 and 2019, the per-centage of patients undergoing DBS among surgically treated MD patients increased from 0% to 85%, and the shift towards DBS in PD was larger than that shift for dystonia or ET. Conclusion: PD is the most common MD that necessitates surgical treatment, followed by ET and dystonia. Surgical timing is individualized and varies among different types of MDs. DBS has become the dominant surgical modality for MDs.

Abstract Objectives We investigated both the metabolic differences and interictal/ictal discharges of the anterior nucleus of the thalamus (ANT) in patients with epilepsy to clarify the relationship between the ANT and the epileptic network. Methods Nineteen patients with drug‐resistant epilepsy who underwent stereoelectroencephalography were studied. Metabolic differences in ANT were analyzed using [18F] fluorodeoxyglucose–positron emission tomography with three‐dimensional (3D) visual and quantitative analyses. Interictal and ictal discharges in the ANT were analyzed using visual and time‐frequency analyses. The relationship between interictal discharge and metabolic differences was analyzed. Results We found that patients with temporal lobe epilepsy (TLE) showed significant metabolic differences in bilateral ANT compared with extratemporal lobe epilepsy in 3D visual and quantitative analyses. Four types of interictal activities were recorded from the ANT: spike, high‐frequency oscillation (HFO), slow‐wave, and α‐rhythmic activity. Spike and HFO waveforms were recorded mainly in patients with TLE. Two spike patterns were recorded: synchronous and independent. In 83.3% of patients, ANT was involved during seizures. Three seizure onset types of ANT were recorded: low‐voltage fast activity, rhythmic spikes, and theta band discharge. The time interval of seizure onset between the seizure onset zone and ANT showed two patterns: immediate and delayed. Interpretation ANT can receive either interictal discharges or ictal discharges which propagate from the epileptogenic zones. Independent epileptic discharges can also be recorded from the ANT in some patients. Metabolic anomalies and epileptic discharges in the ANT indicate that the ANT plays a role in the epileptic network in most patients with epilepsy, especially TLE.

Objective:To preliminarily observe the efficacy and postoperative complications of epileptogenic zonectomy in the treatment of epilepsy arising from supplementary motor area (SMA).Methods:A retrospective analysis was conducted on the clinical data of 9 patients with SMA epilepsy admitted to the Department of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University from June 2015 to December 2020. In all 9 patients, their seizures were confirmed by stereotactic electroencephalography (SEEG) to originate from SMA, and they underwent epileptogenic zonectomy. All patients underwent daily examinations of limb muscle strength, muscle tone and language function (comprehension, reading, repetition, etc.) during the postoperative hospital stay. Outpatient follow-up was performed at 1, 3, 6, 12 and 24 months after operation, and electroencephalography was performed. The postoperative outcome was evaluated according to the modified Engel grading system.Results:Among the 9 patients, 5 underwent epileptogenic zonectomy in the left hemisphere and 4 in the right hemisphere. The resected area included ipsilateral SMA. Postoperative pathological examination revealed focal cortical dysplasia in all cases. After operation, 8 patients reached seizure free, and 1 patient reported occasional short periods of loss of consciousness. Nine patients had different degrees of limb movement impairment, and all returned to normal one month after surgery. Four patients had language dysfunction, out of whom 1 patient recovered 7 days after surgery and 3 returned to normal 1 month after operation. The median follow-up time of 9 patients was 3 years (1-5 years). At the last follow-up, 8 cases were classified as Ⅰa and 1 case as Ⅰb according to the modified Engel grading system.Conclusion:Preliminary observation has suggested that epileptogenic zonectomy for patients with epilepsy originating from SMA has good long-term efficacy. Although SMA syndrome often occurs after surgery, patients would recover within 1 month after surgery.