Cortical Implication for Enhancement of Breathing
Abstract number :
2.407
Submission category :
18. Case Studies (case reports and small series less than 5 subjects will not be accepted)
Year :
2022
Submission ID :
2205120
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:28 AM
Authors :
Blanca Talavera De la Esperanza, MD – Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.; Chaitanya Ganne, MD – Clinical fellow, Neurology, Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.; Norma Hupp, R. EEG T – Data Manager, Neurology, Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.; Johnson Hampson, MSBME – Manager Biomedical Engineering, Neurology, Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.; John Mosher, PhD MS – Professor and Scientist Director, Neurology, Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.; Yash Vakilna, MS – Research fellow, Neurology, Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.; Sandipan Pati, MD – Associate Professor, Neurology, Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.; Jaison Hampson, MD – Research Scientist, Neurology, Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.; M. R. Sandhya Rani, PhD – Research Scientist, Neurology, Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.; Rabeha Noor, R. EEG T – EEG technologist, Neurology, 2. Epilepsy Monitoring Unit. Memorial Hermann Houston Medical Center, Houston, Texas, USA; Nitin Tandon, MD – Professor and Chair ad interim of Department of Neurosurgery, Neurosurgery, Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.; Samden Lhatoo, MD FRCP (Lon) – Executive Vice Chair, Neurology Director, Texas Comprehensive Epilepsy Program (TCEP) Co-Director, Texas Institute Of Restorative Neurotechnologies, Neurology, Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.; nuria Lacuey, MD PhD – Associate Professor, Neurology, Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.
This abstract has been invited to present during the Broadening Representation Inclusion and Diversity by Growing Equity (BRIDGE) poster session
Rationale: Cortical involvement in breathing is well described. 1-5 Direct cortical electrical stimulation studies (DCES) have found breathing suppression in limbic and paralimbic structures with stimulation frequencies that surpass normal breathing rates in humans.6-9 We aimed to identify suprapontine breathing modulation areas and specific stimulation paradigms involved in enhancement rather than suppression of breathing.
Methods: Thirty-five persons with epilepsy were prospectively and consecutively recruited from December 2020 to May 2022 from the Epilepsy Monitoring Unit of Memorial Hermann Houston Medical Center. Inclusion criteria were: a) ≥ 18 years old, b) drug-resistant PWE undergoing stereo- electroencephalography (SEEG) and, c) DCES for standard of care brain mapping was indicated. AAL2 atlas and iElectrodes were used with coregistered post-implantation computer tomography image and pre-implantation structural magnetic resonance imaging to localize cortical electrodes10-11. Saygin’s & Kliemann’s atlas for amygdalar subparcellation adapted in FreeSurfer was used for the identification of amygdala subnuclei12-13. DCES was carried out using lower (0.2-1 PPS) and higher (10-50 PPS) frequencies, different current intensities (1-10 mA), 0.1 msec pulse width, and 1-90 second stimulus trains. SEEG signal, three-channel electrocardiography, respiratory inductance plethysmography, pulse oximetry, airflow, and end-tidal CO2 capnography, were recorded during DCES sessions. Enhancement was defined as an increase in ≥20 % minute ventilation, obtained using percentage change in respiratory rate and tidal volume before and during stimulation.
Results: Reliable data were available in 18 subjects, 8 males (44%) and 10 females (66%), with a mean age of 32.9. We studied a total of 910 electrical stimulations, performed in 146 electrodes located in amygdala (AMY), hippocampus (HIP), anterior cingulate (including subgenual) (AC), anterior insula (AIN), orbitofrontal cortex (OF), postcentral gyrus (PG), temporal neocortex (TN), temporal pole (TP), and the centromedian nucleus of thalamus (TH). A total of 41 stimulations (table 1) showed enhancement of breathing in five locations: AMY (figure 1A), AC, AIN (figure 1B), TP, and TH. HIP, OF, and PG did not show enhacement of breathing. The majority of brain areas showing breathing enhancement did so with low-frequency stimulation (82%), except for anterior cingulate, which did so with high-frequency stimulation (69%).
Conclusions: Breathing enhancement with DCES is possible in specific brain structures, mainly using low-frequency paradigms. Nuclei of AMY, AC, AIN, TP, and CM of TH play a role in breathing enhancement and can potentially provide important targets for future neuromodulatory SUDEP prevention strategies.
Funding: CURE Epilepsy (IRB number: HSC- MS- 20- 1228) and National Institutes of Health (NIH)/National Institute of Neurological Disorders and Stroke (NINDS) (U01NS090407 and U01NS090405)
Case Studies (case reports and small series less than 5 subjects will not be accepted)