Bilateral temporal lobe epilepsy (TLE) is a complex form of epilepsy, characterized by seizures originating from both temporal lobes. Its intricate nature presents significant challenges for both medical and surgical treatment, often necessitating a multidisciplinary approach. While resective surgery is generally unsuitable for bilateral TLE, neuromodulation offers more of a remission-focused approach, which better preserves neuropsychological function. In this study, we presented the case of a 45-year-old female with a 16-years history of recurrent seizures, diagnosed as drug-resistant bilateral TLE. After a comprehensive multidisciplinary epilepsy evaluation—encompassing detailed patient history, neurological examination, scalp audiovisual electroencephalogram monitoring, high-resolution brain magnetic resonance imaging, neuropsychological testing, and cerebrospinal fluid analysis—stereoelectroencephalogram (SEEG) confirmed the diagnosis. The patient subsequently underwent asymmetric radiofrequency thermocoagulation guided by SEEG results, targeting bilateral temporal lobes. Despite experiencing transient psychiatric symptoms postprocedure, she achieved seizure freedom and showed improved neuropsychological function over a 3-year follow-up period. This case demonstrates that, with thorough evaluation, seizure freedom is attainable in bilateral TLE patients, even when bilateral injury is present, without significant impairment to neuropsychological function.

Brief periods of rest after learning facilitate consolidation of new memories. Memory reactivation and hippocampal-cortical dialogue have been proposed as candidate mechanisms supporting consolidation. However, the study of these mechanisms has mostly concerned sleep-based consolidation. Whether and how awake reactivation can selectively consolidate cortical memory traces to guide subsequent behavior requires more human electrophysiological evidence. This study addressed these issues by utilizing intracranial electroencephalography (iEEG) recordings from 11 patients with drug-resistant epilepsy, who learned a set of object-location associations. Using representational similarity analysis, we found that, among the multiple cortical memory traces of object-location associations for the same object generated through several rounds of learning, the association corresponding to memory traces with stronger cortical activation during wakeful rest was more likely to be retrieved later. Awake reactivation of cortical memory trace was accompanied by increased hippocampal ripple rates and enhanced theta-band hippocampal-cortical communication, with hippocampal interactions with cortical regions within the default mode network preceding cortical reactivation. Together, these results suggest that awake reactivation of cortical memory trace during post-learning rest supports memory consolidation, predicting subsequent recall.

We experience countless pieces of new information each day, but remembering them later depends on firmly instilling memory storage in the brain. Numerous studies have implicated non-rapid eye movement (NREM) sleep in consolidating memories via interactions between hippocampus and cortex. However, the temporal dynamics of this hippocampal-cortical communication and the concomitant neural oscillations during memory reactivations remains unclear. To address this issue, the present study used the procedure of targeted memory reactivation (TMR) following learning of object-location associations to selectively reactivate memories during human NREM sleep. Cortical pattern reactivation and hippocampal-cortical coupling were measured with intracranial EEG recordings in patients with epilepsy. We found that TMR produced variable amounts of memory enhancement across a set of object-location associations. Successful TMR increased hippocampal ripples and cortical spindles, apparent during two discrete sweeps of reactivation. The first reactivation sweep was accompanied by increased hippocampal-cortical communication and hippocampal ripple events coupled to local cortical activity (cortical ripples and high-frequency broadband activity). In contrast, hippocampal-cortical coupling decreased during the second sweep, while increased cortical spindle activity indicated continued cortical processing to achieve long-term storage. Taken together, our findings show how dynamic patterns of item-level reactivation and hippocampal-cortical communication support memory enhancement during NREM sleep.

OBJECTIVE:Electroencephalography (EEG) microstate analysis is widely used in the study of various neurological and psychiatric disorders. We aim to assess whether EEG microstates are altered in TLE patients with and without cognitive decline. METHODS:This study included a total of 47 temporal lobe epilepsy (TLE) patients with or without cognitive decline and 14 healthy controls (HCs). All participants underwent 64-channel EEG monitoring. Two-minute epochs of preprocessed eye closed awake EEG data were extracted for microstate analysis. Participants were divided into groups based on intelligence quotient (IQ) scores assessed by the Wechsler Intelligence Scale: normal cognition group (n = 23, IQ ≥ 90) and abnormal cognition group (n = 24, IQ < 90). We conducted frequency spectral analysis on each frequency sub-bands (delta, 1-4 Hz; theta, 4-8 Hz; alpha, 8-12 Hz; beta, 12-30 Hz) of the three groups. Then the following microstate parameters were extracted for analysis over the full frequency band (1-30 Hz) and frequency sub-bands: duration, coverage, occurrence, and transition probability. Statistical analysis using multivariate analysis of variance (MANOVA) with Bonferroni correction (α = 0.0025). RESULT:Microstate analysis in the beta sub-band revealed significant differences among groups. TLE patients with abnormal cognition showed increased occurrence of Map-D; significantly higher transition probabilities from Map-A, Map-B, and Map-C to Map-D; and distinct microstate characteristics compared to patients with normal cognition and HCs. In frequency spectral analysis, the power across all frequency sub-bands showed no significant differences among TLE patients with normal cognition, TLE patients with abnormal cognition, and HCs. CONCLUSION:Beta sub-band EEG microstates, particularly Map-D characteristics, may serve as potential neurophysiological markers for cognitive decline in TLE patients.

Background Endovascular thrombectomy (EVT) is a standard treatment for acute ischemic stroke (AIS) with large vessel occlusion. Hypertension and increased blood pressure variability within the first 24 h after successful reperfusion are related to a higher risk of symptomatic intracerebral hemorrhage and higher mortality. AIS patients might suffer from ischemia-reperfusion injury following reperfusion, especially within 24 h. Dexmedetomidine (DEX), a sedative commonly used in EVT, can stabilize hemodynamics by inhibiting the sympathetic nervous system and alleviate ischemia-reperfusion injury through anti-inflammatory and antioxidative properties. Postoperative prolonged sedation for 24 h with DEX might be a potential pharmacological approach to improve long-term prognosis after EVT. Methods This single-center, open-label, prospective, randomized controlled trial will include 368 patients. The ethics committee has approved the protocol. After successful reperfusion (modified thrombolysis in cerebral infarction scores 2b–3, indicating reperfusion of at least 50% of the affected vascular territory), participants are randomly assigned to the intervention or control group. In the intervention group, participants will receive 0.1~1.0 μg/kg/h DEX for 24 h. In the control group, participants will receive an equal dose of saline for 24 h. The primary outcome is the functional outcome at 90 days, measured with the categorical scale of the modified Rankin Scale, ranging from 0 (no symptoms) to 6 (death). The secondary outcome includes (1) the changes in stroke severity between admission and 24 h and 7 days after EVT, measured by the National Institute of Health Stroke Scale (ranging from 0 to 42, with higher scores indicating greater severity); (2) the changes in ischemic penumbra volume/infarct volume between admission and 7 days after EVT, measured by neuroimaging scan; (3) the length of ICU/hospital stay; and (4) adverse events and the all-cause mortality rate at 90 days. Discussion This randomized clinical trial is expected to verify the hypothesis that postoperative prolonged sedation with DEX after successful reperfusion may promote the long-term prognosis of patients with AIS and may reduce the related socio-economic burden. Trial registration ClinicalTrials.gov NCT04916197. Prospectively registered on 7 June 2021.

Visual perception is more than just a passive process of receiving environmental stimuli. It arises from the complex interaction with sensory input and the brain's pre-existing state [1–4]. The pre-stimulation state, particularly the cortical excitability, plays a crucial role in how we consciously perceive stimuli with near-threshold intensity [5]. One of the most direct methodologies to assess cortical excitability is to measure neurons' spontaneous firing rates prior to stimulus presentation [4].

Objective: To evaluate the long-term outcomes of subtotal hemispherotomy (SH) in treating drug-resistant epilepsy caused by unilateral hemispheric lesions and try to give the prognostic factors for these outcomes. Methods: We retrospectively reviewed the clinical data of 19 patients who underwent SH in Sanbo Brain Hospital, Capital Medical University, Beijing, China, from May 2008 to April 2021. All clinical data and factors related to surgical and functional outcomes, including motor, neuropsychiatric, and language function, were collected and analyzed. Results: The surgical outcomes showed 13 (68 %) patients were seizure-free at the last follow-up (2-14 years, mean: 5.6 +/- 2.9). +/- 2.9). No changes were found in motor outcomes in 12 (63%) patients; seven (37%) patients had new permanent motor deficits (NPMD). Improvement in the full-scale intelligence quotient (FIQ) (p p = 0.009) was observed. Univariate analysis found that patients who did not achieve seizure freedom had a significantly older age at surgery (p p = 0.017) and acute post-operative seizures (APOS) (p p = 0.046). Kaplan-Meier analysis also identified significant differences in seizure outcomes between the children and adult subgroups (p p = 0.0017). Multivariate Cox analysis showed that older age at surgery (HR=1.055, =1.055, p = 0.034) was associated with shorter time-to-seizure-recurrence. Resection of the central operculum and insula (OR= = 80.433, p =0.031) and higher monthly seizure frequency (OR= = 1.073, p = 0.040) were also poor prognostic factors for motor function outcomes. Conclusion: SH is an effective treatment procedure in treating patients with drug-resistant epilepsy caused by hemispheric lesions with satisfied seizure outcomes, limited impairment of motor function, and preserving neuropsychiatric outcomes.

OBJECTIVES:In physiological situations, the anterior cingulate cortex (ACC) and anterior insular cortex (AIC) are prone to coactivation. The functional connectivity and interaction between ACC and AIC in the context of epilepsy remain unclear. This study aimed to investigate the dynamic coupling between these two brain regions during seizures.METHODS:Patients who underwent stereoelectroencephalography (SEEG) recording were included in this study. The SEEG data were visually inspected and quantitatively analyzed. The narrowband oscillations and aperiodic components at seizure onset were parameterized. The frequency-specific non-linear correlation analysis was applied to the functional connectivity. The excitation/inhibition ratio (E:I ratio) reflected by the aperiodic slope was performed to evaluate the excitability.RESULTS:Twenty patients were included in the study, with 10 diagnosed with anterior cingulate epilepsy and 10 with anterior insular epilepsy. In both types of epilepsy, the correlation coefficient (h2 ) between the ACC and AIC at seizure onset exhibited a significantly higher value than that during interictal and preictal periods (p < 0.05). The direction index (D) showed a significant increase at seizure onset, serving as an indicator for the direction of information flow between these two brain regions with up to 90% accuracy. The E:I ratio increased significantly at seizure onset, with the seizure-onset zone (SOZ) demonstrating a more pronounced increase compared to non-SOZ (p < 0.05). For seizures originating from AIC, the E:I ratio was significantly higher in the AIC than in the ACC (p = 0.0364).CONCLUSIONS:In the context of epilepsy, the ACC and AIC are dynamically coupled during seizures. The functional connectivity and excitability exhibit a significant increase at seizure onset. By analyzing connectivity and excitability, the SOZ in ACC and AIC can be identified. The direction index (D) serves as an indicator for the direction of information flow from SOZ to non-SOZ. Notably, the excitability of SOZ changes more significantly than that of non-SOZ.

Objective: To study the semiology characteristics of motor seizures of axial and shoulder girdle muscles (ASMs) by stereoelectroencephalography (SEEG) and its value in determining location of epileptogenic zone.Methods: A total of 598 patients underwent SEEG assessment in Sanbo Brain Hospital were reviewed; 65 patients with ASMs selected. Thirteen semiology feature items were extracted according to the location and symmetry of involved axial muscles, direction of movement, etc. Seizures were grouped with items, and the k-means was used to analyze association between ASMs semiology characteristics and seizure-onset zone (SOZ).Results: The SOZs of ASMs involved 23 combinations of seven different brain regions: 31 patients (47.7%) had one brain region, 19 (29.2%) had two, 14 (21.5%) had three, and one patient (1.5%) had four. One hundred and fifteen brain regions were analyzed. Seven brain regions accounted for a significant difference in chi-square test, ?(2) = 62.79, p < 0.0001, with the highest proportion of insular and perisylvian. The k-means method identified two clusters: cluster 1 had a high degree of agreement with temporal lobe epilepsy (12/15), characterized by less shrug-like movement, later involvement of axial shoulder girdle muscles, longer duration, and lower seizure frequency; cluster 2 had a high degree of agreement with posterior cortex epilepsy (14/18), characterized by earlier involvement of axial shoulder girdle muscles, shorter duration, and higher seizure frequency. In frontal lobe, insular and perisylvian, anterior and middle cingulate gyrus, are the two categories accounted for similar proportion. Seizure-onset lateralized at the contralateral of unilateral cervical tonic, with rate of seizure-free was 73.7%.Significance: The incidence of ASMs is high in insular and perisylvian. Unilateral cervical tonic seizures have good lateralizing value. Based on semiology characteristics, ASMs can be roughly clustered into two categories, which can only effectively distinguish the origins of temporal lobe and posterior cortex, with low discrimination for the seizure-onset of other lobes.

Objective Vagus nerve stimulation (VNS) is an adjunctive treatment for pharmacoresistant epilepsy. Encephalomalacia is one of the most common MRI findings in the preoperative evaluation of patients with pharmacoresistant epilepsy. This is the first study that aimed to determine the effectiveness of VNS for pharmacoresistant epilepsy secondary to encephalomalacia and evaluate the potential predictors of VNS effectiveness. Methods We retrospectively analyzed the seizure outcomes of VNS with at least 1 year of follow-up in all patients with pharmacoresistant epilepsy secondary to encephalomalacia. Based on the effectiveness of VNS (≥50% or <50% reduction in seizure frequency), patients were divided into two subgroups: responders and non-responders. Preoperative data were analyzed to screen for potential predictors of VNS effectiveness. Results A total of 93 patients with epilepsy secondary to encephalomalacia who underwent VNS therapy were recruited. Responders were found in 64.5% of patients, and 16.1% of patients achieved seizure freedom at the last follow-up. In addition, the responder rate increased over time, with 36.6, 50.5, 64.5, and 65.4% at the 3-, 6-, 12-, and 24-month follow-ups, respectively. After multivariate analysis, seizure onset in adults (>18 years old) (OR: 0.236, 95%CI: 0.059–0.949) was found to be a positive predictor, and the bilateral interictal epileptic discharges (IEDs) (OR: 3.397, 95%CI: 1.148–10.054) and the bilateral encephalomalacia on MRI (OR: 3.193, 95%CI: 1.217–8.381) were found to be negative predictors of VNS effectiveness. Conclusion The results demonstrated the effectiveness and safety of VNS therapy in patients with pharmacoresistant epilepsy secondary to encephalomalacia. Patients with seizure onset in adults (>18 years old), unilateral IEDs, or unilateral encephalomalacia on MRI were found to have better seizure outcomes after VNS therapy.

Wang et al. report that epilepsy surgery results in good seizure and cognitive outcomes and shows acceptable safety for patients with epilepsy in Sturge-Weber syndrome. Early surgery may be helpful in achieving better seizure outcomes and cognitive protection, although the risks should also be considered. Few studies have reported the clinical presentation, surgical treatment, outcomes and influential factors for patients with epilepsy and Sturge-Weber syndrome. This large-scale retrospective study continuously enrolled 132 patients with Sturge-Weber syndrome and epilepsy from January 2008 to December 2018 at our hospital to analyse their characteristics. Among these patients, 90 underwent epilepsy surgery, and their postoperative 2-year follow-up seizure, cognitive and motor functional outcomes were assessed and analysed. Univariable and multivariable logistic analyses were conducted to explore the influential factors. Among the patients with Sturge-Weber syndrome for whom characteristics were analysed (n = 132), 76.52% of patients had their first epileptic seizures within their first year of life. The risk factors for cognitive decline were seizure history >= 2 years [adjusted odds ratio (aOR) = 3.829, 95% confidence interval (CI): 1.810-9.021, P = 0.008)], bilateral leptomeningeal angiomas (aOR = 3.173, 95% CI: 1.970-48.194, P = 0.013), age at onset <1 year (aOR = 2.903, 95% CI: 1.230-6.514, P = 0.013), brain calcification (aOR = 2.375, 95% CI: 1.396-5.201, P = 0.021) and left leptomeningeal angiomas (aOR = 2.228, 95% CI: 1.351-32.571, P = 0.030). Of the patients who underwent epilepsy surgery (n = 90), 44 were subject to focal resection, and 46 underwent hemisphere surgery (19 anatomical hemispherectomies and 27 modified hemispherotomies). A postoperative seizure-free status, favourable cognitive outcomes, and favourable motor outcomes were achieved in 83.33%, 44.44% and 43.33% of surgical patients, respectively. The modified hemispherotomy group had similar surgical outcomes, less intraoperative blood loss and shorter postoperative hospital stays than the anatomical hemispherectomy group. Regarding seizure outcomes, full resection (aOR = 11.115, 95% CI: 1.260-98.067, P = 0.020) and age at surgery < 2 years (aOR = 6.040, 95% CI: 1.444-73.367, P = 0.031) were positive influential factors for focal resection. Age at surgery < 2 years (aOR = 15.053, 95% CI: 1.050-215.899, P = 0.036) and infrequent seizures (aOR = 8.426, 95% CI: 1.086-87.442, P = 0.042; monthly versus weekly) were positive influential factors for hemisphere surgery. In conclusion, epilepsy surgery resulted in a good postoperative seizure-free rate and favourable cognitive and motor functional outcomes and showed acceptable safety for patients with epilepsy and Sturge-Weber syndrome. Modified hemispherotomy is a less invasive and safer type of hemisphere surgery than traditional anatomic hemispherectomy with similar surgical outcomes. Early surgery may be helpful to achieve better seizure outcomes and cognitive protection, while the risk of surgery for young children should also be considered.

It is extremely dangerous for epilepsy patients to become sick when no one is accompanying them in their daily life. The alarm for epilepsy patients can be timely notified to their families to take measures. In this context, a scheme for the identification of general tonic-clonic seizures (GTCs) based on wrist signals is proposed. Firstly, features were extracted from wrist acceleration(ACC), skin conductance response(SCR), number of wrist movements(NOWM) and heart rate(HR) signals. Secondly, in order to reduce the interference of unnecessary features on classification, feature dimensions were reduced by random forest algorithm. Finally, the number of normal data samples is much larger than the number of diseased data samples, and the training model is adopted to sacrifice the accuracy of identifying diseased data and improve the accuracy of identifying normal data. The detection and recognition effects of SVM (Support vector machine), AdaBoost and XGBoost machine learning models are compared. The results showed that the SVM algorithm could recognize all GTCs episodes (median 39.5s, range 5-69s) in the 10 data with a false recognition rate (FRR) of 0.08/d when the continuous predicted onset time reached 9s. When the predicted onset time reaches 19s, the three algorithm models can effectively reduce FRR, but at the same time, more underreporting will be generated. GTCs seizures can be detected through wrist signals, and it has good recognition effect and low FRR, which is conducive to the development of wearable epilepsy recognition devices.

The “Horizon 2020” is initiated by the European Union, and it advocates design-driven innovation. It is generally believed that design is an essential impetus for innovation, and naturally, design methods and tools are applied in the field of innovation. In innovation, one field is social innovation that refers to new ideas and solutions developed to cater to social needs. Evidences have shown that social innovation can be fully demonstrated through design, especially in systems thinking, prototype design and visualization. However, people express their concerns about limitations of design in this field.In this paper, having discussed specific case - NICE2035 Future Living Lab, the author proposed innovative design, methods and concepts of social innovation, and emphasized prototype design and infrastructure. Different from project design, social innovation methods, activities in implementation and social connection network built aimed to help stakeholders establish long-term relationships and obtain design opportunities. Moreover, it stressed that prototypes, as a design method and tool, should be open and displayed to more people, and to spread knowledge of a sustainable lifestyle.

Objective: : To identify prognostic factors and long-term seizure outcomes for patients with tuberous sclerosis complex (TSC) who underwent resective treatment for epilepsy. Methods: : We enrolled 81 patients with TSC who had undergone resective epilepsy surgery at Sanbo Brain Hospital, Capital Medical University, between April 2004 and June 2019. We estimated cumulative probability of remaining seizure-free and plotted survival curves. Variables were compared using Mann-Whitney U, Pearson's correlation, continuity correction, and Fisher's exact chi-square tests. Prognostic predictors were analysed using log-rank (Mantel-Cox) tests and Cox regression models. Results: : At the last follow-up, 48 (59.3%) patients were classified as International League Against Epilepsy Class 1 (including 14 patients who had seizures < 3 times postoperatively on the same or different day and were seizure-free at all other times). The estimated cumulative probability of remaining seizure-free postoperatively was 69.0% (95% confidence interval [CI] 58.8-79.2%), 61.9% (95% CI 51.1-72.7%), and 55.0% (95% CI 42.8-67.2%) at 2, 5, and 10 years, respectively. The mean time of remaining seizure-free was 7.24 +/- 0.634 years (95% CI 6.00-8.49); en bloc resection was an essential positive predictor of postoperative seizure freedom, as was age at seizure onset, regional interictal video-electroencephalography pattern, and temporal lobe surgery. The longer the seizure-free time, the less likely a relapse. Patients who postoperatively experienced seizures remained likely to recover. Conclusions: : We demonstrated the efficacy of surgical treatment for patients with TSC and intractable epilepsy. Detailed perioperative tests are a reliable predictor of postoperative seizure freedom.

Where and how the color perception formed in the human brain remains one of the most intriguing topics in vision science. Color selective neurons could be found along the visual hierarchy [[1]Xiao Y. Wang Y. Felleman D.J. A spatially organized representation of colour in macaque cortical area v2.Nature. 2003; 421: 535-539Crossref PubMed Scopus (198) Google Scholar,[2]Conway B.R. Tsao D.Y. Color-tuned neurons are spatially clustered according to color preference within alert macaque posterior inferior temporal cortex.Proc Natl Acad Sci. 2009; 106: 18034-18039Crossref PubMed Scopus (75) Google Scholar], but which level contributes directly to color perception and behaviorally correlated processing is still under debate. Lesion [[3]Damasio A. Yamada T. Damasio H. Corbett J. Mckee J. Central achromatopsia: Behavioral, anatomic, and physiologic aspects.Neurology. 1980; 31: 920-921Crossref Google Scholar] and functional magnetic resonance imaging [[4]Zeki S. Bartels A. The clinical and functional measurement of cortical (in) activity in the visual brain, with special reference to the two subdivisions (v4 and v4α) of the human colour centre.Philosophical Transactions Biological Sciences. 1999; 354: 1371-1382Crossref PubMed Scopus (66) Google Scholar,[5]Hadjikhani N. Liu A.K. Dale A.M. Cavanagh P. Tootell R.B.H. Retinotopy and color sensitivity in human visual cortical area V8.Nat Neurosci. 1998; 1: 235-241Crossref PubMed Scopus (423) Google Scholar] studies in human subjects suggested a group of color-selective areas in the ventral occipitotemporal cortex (VOTC), which labeled V4/V4α or V8, might be critical for color percepts. The intracranial electrical brain stimulation (EBS) could induce chromatic phosphenes in human VOTC, which also show color selectivity when activated by visual stimulus [[6]Murphey D.K. Yoshor D. Beauchamp M. Perception matches selectivity in the human anterior color center.Curr Biol. 2008; 18: 216-220Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar,[7]Schalk G. Kapeller C. Guger C. Ogawa H. Hiroshima S. Lafersousa R. et al.Facephenes and rainbows: causal evidence for functional and anatomical specificity of face and color processing in the human brain.Proc Natl Acad Sci. 2017; 114: 201713447Crossref Scopus (63) Google Scholar]. These evidence seem to suggest that color perception formed in the high-order visual cortex. Here we systematically examined a case of intracranial electrodes implanted patient who exhibited matched EBS induced color perception and visual stimulus induced color selectivity in her left dorsal V2, a part of the early visual cortex. The patient was 38-year-old right-handed women with 21 years history of the epileptic seizures secondary to left temporal pole arachnoid cyst. She had a history of conduct arachnoid cyst resection 20 years ago and anterior temporal lobectomy 10 years ago, but it did not effectively inhibit her epileptic seizures. Gradually, the patient's seizure deteriorated with frequency ranging from once to 10 times per month. Oral administration of lamotrigine was ineffective. According to self-reports, the patient's overall cognitive function was normal. Neuropsychological assessments showed that the full intelligence quotient and memory quotient was 123. All the experimental procedures were approved by the Ethics Committee of the Sanbo Hospital of Capital Medical University. Stereotactic electrodes were intracranially implanted for further epileptic zone evaluation. The stereo-electroencephalogram (sEEG) electrodes were manufactured by Huake Hengsheng Medical Technology Co Ltd, Beijing, China, with a diameter of 0.8 mm and multiple 2 mm long contacts that spaced 1.5 mm apart from each other. The reference electrode was placed on the forehead. On monitoring days, the impedance of all the recording electrode contacts were kept below 50 kΩ, and the contacts with impedances higher than this value were excluded from analyses. Video EEG monitor lasted for 21 days after implantation, and the lamotrigine dosage was gradually reduced during this period. The positions of each electrode contacts were identified using a post-implantation CT scan co-registered with the pre-implantation T1 image. An early visual area (V1 – V3) atlas was applied to the Freesurfer reconstructed brain anatomy, using the method developed by Benson and colleagues [[8]Benson N.C. Butt O.H. Brainard D.H. Aguirre G.K. Correction of distortion in flattened representations of the cortical surface allows prediction of v1-v3 functional organization from anatomy.PLoS Comput Biol. 2014; 10e1003538Crossref PubMed Scopus (103) Google Scholar]. During the EBS session, the patient was informed to sit at her hospital bed and fixate at a “+” on a 31.5-inches LCD monitor (view distance = 22 cm). Rectangular electrical pulses were delivered to pairs of adjacent contacts (frequency = 50 Hz, pulse width = 0.2 ms, duration = 5 s, amplitude = 1–6 mA). The amplitude was going up with a step of 1 mA until a certain phosphene was reported. The patient was asked to draw her visual percepts on the monitor immediately after the phosphene disappeared. The electrode X1 to X3 was localized on the dorsal part of V2 (Fig. 1A). The patient reported a chromatic phosphene in her right-bottom visual field when the contact pair X1-X2 was stimulated (Fig. 1D, left panels) while an achromatic phosphene with a similar location when the contact pair X2-X3 was stimulated (Fig. 1D, right panels). No phosphene was reported during sham trials randomly intermixed with stimulation trials. These results suggested that the neurons around X1, but not X2, have color preference. The day after the EBS session, visual evoked intracranial potentials to both chromatic (green-red, blue-yellow) and achromatic (black-white) stimuli were examined. The locations of the visual stimulus were specially designed to match the locations of electrically evoked phosphene (Fig. 1B). Forty trials for each condition were present, and the duration of a trial was 600 ms (ISI = 400 ms). Visual stimuli were flipped to the opponent color once at 300 ms. As shown in Fig. 1C and E, time-frequency analyses of the evoked potential illustrated a remarkable high-γ amplitude enhancement (100–250 Hz) evoked by the blue-yellow stimulus in X1 but not X2. For each electrode contact, a trial-level independent t-test on the averaged high-γ amplitudes between 100 and 800 ms was conducted (with Bonferroni adjustments). The results showed that, in X1, the high-γ evoked by blue-yellow stimulus was significantly larger than red-green [t (74) = 3.321, p = 0.001] and black-white [t (74) = 2.144, p = 0.035] stimuli (Fig. 1F). No significance was found in X2 (all p > 0.05). These results demonstrated color selectivity of X1 that was consistent with the EBS data. Consistent with the previous literature (Murphey et al., 2008; Schalk et al., 2017), we also found that the electrical stimulation on a contact pair (E2-E3), which location on the ventral occipitotemporal cortex (VOTC), could induce a chromatic phosphene (Supplementary Fig. 1B) (“a multicolor, porridge-like mess” according to the patient). To investigate the conduction direction between V2 and VOTC, cortico-cortical evoked potential (CCEP) were conducted (repetition = 20 times, pulse width = 0.2 ms, amplitude = 2, 4, 6 mA). The evoked responses are transferred to z-scores with respect to baseline in single-trial level. Significant evoked potentials were observed inE 2-E3 after X1-X2 stimulation onsets with a 58 ms averaged P1 latency (Supplementary Fig. 1C). No significant potential was observed in X1-X2 when E2-E3 was stimulated (Supplementary Fig. 1D). Although two previous studies have already suggested that EBS on human early visual cortex could effectively induce color perceptual [[9]Murphey D.K. Maunsell J. Yoshor D. Beauchamp M.S. Perceiving electrical stimulation of identified human visual areas.Proc Natl Acad Sci. 2009; 47: 5389-5393Crossref Scopus (85) Google Scholar,[10]Lee H.W. Hong S.B. Seo D.W. Tae W.S. Hong S.C. Mapping of functional organization in human visual cortex: electrical cortical stimulation.Neurology. 2000; 54: 849-854Crossref PubMed Scopus (152) Google Scholar], the current study has systematically measured the color preference in local neuron ensembles using both EBS and visual evoked potential within the same RF. On the other hand, as shown in Fig. 1D, the color preference in X1 was spatially organized in the local RF, which is consistent with the hue map in non-human primates’ V2 [[1]Xiao Y. Wang Y. Felleman D.J. A spatially organized representation of colour in macaque cortical area v2.Nature. 2003; 421: 535-539Crossref PubMed Scopus (198) Google Scholar]. Moreover, the unidirectional connectivity from V2 to VOTC may play a critical role in color awareness. This work was supported by the National Natural Science Foundation of China (no. 31700994, 81790654, 81790650). The following is the Supplementary data to this article: Download .docx (.17 MB) Help with docx files Multimedia component 1

Besides gelastic seizures, hypothalamic hamartoma (HH) is also noted for its susceptibility to remote secondary epileptogenesis. Although clinical observations have demonstrated its existence, and a three-stage theory has been proposed, how to determine whether a remote symptom is spontaneous or dependent on epileptic activities of HH is difficult in some cases. Herein, we report a case of new non-gelastic seizures in a 9-year-old female associated with a postoperatively remaining HH. Electrophysiological examinations and stereo-electroencephalography (SEEG) demonstrated seizure onsets with slow-wave and fast activities on the outside of the HH. By using computational methodologies to calculate the network dynamic effective connectivities, the importance of HH in the epileptic network was revealed. After SEEG-guided thermal coagulation of the remaining HH, the patient finally was seizure-free at the 2-year follow-up. This case showed the ability of computational methods to reveal information underlying complex SEEG signals, and further demonstrated the dependent-stage secondary epileptogenesis, which has been rarely reported.

The epileptic eye and head movements during epileptic seizures may be much more complicated than people originally understood, which can be ipsilateral or contralateral to the electroencephalography focus. Here, we describe a male patient with drug resistant focal seizures associated with a directional separation between head and eye movement before evolving into generalized tonic-clonic seizure. His contralateral head leading turning showed forced, sustained, and unnatural features companied by ipsilateral eye staring. Stereoeletroencephalography monitoring was performed, and 4 habitual seizures were recorded over 5 days. Three seizures showed left head leading turning and generalized tonic-clonic seizure, and only one showed dizziness and ringing in the ears. All the seizures showed that the ictal onset contacts were located in the posterior inferior temporal sulcus which borders on the anterolateral part of medial superior temporal area. The patient underwent a resection including temporooccipital region, and the histopathology showed focal cortical dysplasia type Ic. He has been seizure free for two years after operation. The scores of the intelligence and memory quotient improved half year after operation.

Objective: The diagnosis and treatment of insular and insulo-opercular epilepsy remain underexplored because the insula is covered by the insulo-opercular and a dense vascular curtain. Stereoelectro-encephalography (SEEG) is a reliable and recommended technique for locating the epileptic zone, especially in insular and insuloopercular regions (Isnard et al., 2000, 2004). Bipolar electro-coagulation with cortextomy is an alternative therapy for treating drug-resistant epilepsy and is more convenient and less likely to cause adverse complications. We report 20 patients with insular and insulo-opercular epilepsy diagnosed through SEEG who underwent surgical treatment via bipolar electro-coagulation with cortextomy. The outcomes and findings are presented as a retrospective analysis (Cui et al., 2012; Zhai et al., 2015). Method: We performed a retrospective analysis of 20 insular and insulo-opercular epilepsy patients. All patients involved in the analysis had undergone a comprehensive presurgical evaluation, including video electro-encephalographic recordings (at least 1 insultus), SEEG (at least 3 electrodes placed at insular depth), magnetic resonance imaging, positron emission tomography, and magneto-encephalography. All patients underwent bipolar electro-coagulation with cortextomy surgery. The follow-up time was over 24 months. Result: After bipolar electro-coagulation with cortextomy surgical treatment, 16 of the 20 patients (80.0%) were seizure free (Engel class I), and all patients achieved satisfactory seizure control (Engel class with a mean follow-up of 29.6 months (range, 24-39 months). Histopathological findings demonstrated focal cortical dysplasia in 14 patients (70.0%), neuro-damage in 3 patients (15.0%), ganglioglioma in 2 patients (10.0%), and gliosis in 1 patient (5.0%). Sixteen of the 20 patients reported no complications (80.0%), 3 exhibited temporary complications that recovered within 3 months (15.0%), and 1 patient experienced permanent complications (5.0%). Significance: Bipolar electro-coagulation with cortextomy of the insular and insulo-opercular cortex explored by SEEG findings can be performed safely and resulted in satisfactory seizure control.

Purpose: Individuals with traumatic brain injury (TBI) often experience difficulties in performing kitchen-related sequencing tasks due to cognitive deficits. The primary aim of this study is to examine the feasibility of a context-aware automatic prompting system in assisting individuals with TBI in multi-step cooking tasks. Method: Sixteen individuals with TBI participated in the study. A randomized cross-over design was used to compare the automatic prompting method with a conventional user-controlled method through a tablet device. Participant performance under each prompting method was assessed using the Performance Assessment of Self-Care Skills in terms of independence, safety, and adequacy. Subjective workload and qualitative feedback were also collected. Results: The automatic method, when compared with the user-controlled method, significantly decreased the amount of external assistance required by participants, received higher ratings in user perceived ease-of-use, and was considered less stressful for participants. However, the user-controlled method showed strengths in offering participants more flexibility in terms of controlling on the timing of prompts. Conclusions: The results provided insight into the potential benefits and user perceptions of a context-aware prompting system. The information could contribute to the future development of advanced prompting technology for people with cognitive impairments in completing sequential tasks.