Structural network-specific effect of extreme capsule stimulation for drug-resistant focal epilepsy

作者：Yueyang Cheng, Di Wang, Xiaohua Zhang, Guangyuan Jin, Di Wu, Qiao Wang, Jialin Du, Lei Qi, Cuiping Xu, Zichen Qiao, Xiaopeng Wang, Junliang Ge, Siyi Wang, Hao Yan, Xueyuan Wang, Huaqiang Zhang, Tao Yu, Yuping Wang, Fang‐Cheng Yeh, Guoguang Zhao, Liankun Ren · 发表于：Brain · 年份：2025 · DOI：10.1093/brain/awaf097 · 被引用次数：6 · 研究领域：Neurological disorders and treatments、EEG and Brain-Computer Interfaces、Epilepsy research and treatment

Treatment for drug-resistant epilepsy in poor candidates for resection surgeries remains challenging. The prevailing deep brain stimulation of subcortical nuclei is effective but exhibits heterogeneous efficacy and unpredictable side effects. Therefore, the investigation of novel deep brain stimulation targets is of paramount importance. Here, we focused on the unique structure known as the extreme capsule (EC), which is a 'butterfly'-like structure passing through the uncinate fasciculus, the inferior fronto-occipital fasciculus and the convergence of the short association fibres connecting to the insula. We investigated the modulatory effect of EC stimulation in 11 drug-resistant epilepsy patients (mean age, 28 years; eight males and three females) who underwent stereo-electroencephalography as part of presurgical evaluation. One electrode was extended to the EC ipsilateral to the presumed seizure onset zone. Structural connectivity to the EC derived from structural human connectome data (n = 1065) was estimated to compare with the effective connectivity to the EC using single-pulse stimulation at 1 Hz during the resting state. To assess the modulatory effect of EC stimulation, we used stepwise incremental stimulation ranging from 5 to 145 Hz in a cyclical pattern. We evaluated how neural activity across distributed cortical areas synchronized with EC stimulation frequencies, in addition to the changes in interictal epileptiform discharges and ripples during the stimulation...