Epilepsy as a Dynamic Disease

439 Pages·2003·18.206 MB·English

by  J. Milton (auth.), Dr. John Milton, Dr. Peter Jung (eds.)

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John Milton Peter Iung (Eds.)
Epilepsy
as a Dynamic Disease
With 170 Figures, 24 Color Plates,
and 11Tables
Springer
Dr.John Milton
UniversityofChicago,DepartmentofNeurology
Chicago, IL60637,USA
e-mail:[email protected]
Dr.Peter lung
Ohio University, DepartmentofPhysicsandAstronomy
andInstituteforQuantitativeBiology
Athens,OH45701,USA
e-mail:[email protected]
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Includesbibliographicalreferencesandindex.ISBN3540427627(alk.paper)1.Epilepsy.2.Brainstimulation.3.
Convulsions.4.Electroencephalography.5.Electriccountershock.I.Milton.John,1950-II.lung,Peter,1957
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ISSN1618-7210
ISBN978-3-642-07665-7 ISBN978-3-662-05048-4(eBook)
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Preface
Since the time of Hippocrates, epilepsy has been felt to be related to an
imbalance in the regulatory activity of the brain; caused by either a relative
paucity of inhibition or an excess ofexcitation. Present-day readers will find
it hard to believe that only 125 years ago, the management of persons with
intractable seizures included confinement to life on a farm [1]. The peace
and quiet of country life was felt to be necessary to prevent the extremes
ofemotion and intellectual activity that predisposed to the convulsive state.
Following this rationalephysicians would advise patients to avoid intellectual
thought, extremes in hot and cold, wine, constipation, sex, and to lie in bed
with the head raised to assist the circulation of the brain!
Two developments that have had a major impact on the lives of people
with epilepsy are the discovery of anti-convulsant medications and the in
vention of the automobile. Anticonvulsant medications save lives and have
enabled peoplewith epilepsy to re-enter the main stream ofsociety. However,
the drug regulatory bodies have a very different definition for an effective
treatment from that of a typical person with epilepsy. Regulatory approval
requires that the treatment result in a statistically significant reduction in
seizure frequency. To the sufferer the only acceptable definition of a good
treatment is no seizures, i.e. the seizure frequency must become zero. Typ
ically the reduction in seizure frequency is not sufficient for patients with
epilepsy to be able to legally operate an automobile.Thus many occupations
remain unattainable;thesocial stigmaremains high.This limitation together
with the non-trivial cognitive side effects of anti-convulsant medications re
sults in a quality of life of people with epilepsy which is as dismal as those
suffering terminal cancer or the disabilities that accompany chronic medical
conditions [2,3].
There isan inherent illogicality tothe useofmedications to treat a parox
ysmal disorder such as epilepsy. Why should a person take medications ev
eryday to prevent an event which might occur once every six months? The
present day answer is that medications must be taken everyday since wecan
not predict on which day the seizure willoccur.However,recent research has
suggested that it may be possible to predict a seizure up to 30 min. before
it occurs (Chaps. 12 and 13). This observation suggests the feasibility of an
alternative therapeutic strategy. In this text we consider the possibility of
VI Preface
constructing an implantable device that would be capable ofdetecting when
a seizure occurs and then, at the appropriate time, delivering a carefully
honed stimulus designed to abort the seizure. Thus, very much in the spirit
of the implantable cardiac defibrillators, could a "brain defibrillator" be de
veloped to treat epilepsy? The advantage of this type of strategy is that the
treatment would be called upon only when needed.
The philosophy of this text is in the spirit of Herbert H. Jasper and his
colleagues innovative text, Basic Mechanisms of the Epilepsies which was
first published in 1969 [4]. Experts in epilepsy, bio-engineering, and dynam
ical systems theory have been brought together to discuss the treatment of
epilepsy. Each of these experts has been encouraged by us to do their best
to apply their knowledge to a topic that in many cases is unfamiliar to them
and for which there may be,in fact, little known.In the next section we give
an overview of the text so that the reader will better appreciate the flow of
the discussion. We anticipate that this text will be used by individuals with
as varied a background as the contributors. Thus wehave also included some
chapters that provide essential background to make the text self-contained.
The production of a working prototype of a "brain defibrillator" based
on principles of the nonlinear dynamics of neurons and neural populations
may seem far-fetched. However, we hope that in reading this text readers
will come to our realization that there is no obvious reason why working
prototypes of brain defibrillators do not already exist. On the other hand,
perhaps this book will make at least one reader angry enough at our naviete
to go to the laboratory, do the necessary experiments, and demonstrate to
us how it really should be done!
Chicago, Athens, John Milton
June 2002 Peter Jung
Contents
Roadmap XVII
1 Medically Intractable Epilepsy
J. Milton 1
1.1 Temporal Lobe Epilepsy. ................................... 1
1.2 Prevalence of MIE ......................................... 2
1.3 The Evolving Epileptic Syndrome 4
1.4 Lesional Epilepsy. ......................................... 5
1.5 Do Seizures Begat Seizures? 6
1.6 Neuronal Re-organization. .................................. 7
1.7 Epilepsy as a Learning Disorder " 11
1.8 Dynamical Aspects of Epilepsy " 13
1.9 Conclusions " 14
2 Insights into Seizure Propagation
from Axonal Conduction Times
J. Milton 15
2.1 Axonal Conduction Velocities ............................... 16
2.1.1 Unmyelinated Axons (Path 1) ........................ 16
2.1.2 Myelinated Axons (Path 2) 17
2.2 Human Seizure Propagation Rates........................... 19
2.3 Sub-cortical Mediated Spread (Path 3) ....................... 21
2.4 Discussion ................................................ 22
3 Dynamic Epileptic Systems Versus Static Epileptic Foci?
S.A. Chkhenkeli and J. Milton. ................................... 25
3.1 Failures of Epilepsy Surgery 25
3.2 Dynamic Epileptic Systems ................................. 26
3.3 Amygdalo-Hippocampal Interactions ......................... 28
3.4 Propagation Pathways ..................................... 30
3.5 Extratemporal Seizure Propagation .......................... 32
3.6 Inhibitory Mechanisms ..................................... 34
3.7 Conclusion ............................................... 35
VIII Contents
4 Neuroglia, the Other Brain Cells
P. Jung, A.H. Cornell-Bell, A. deGrauw, and R. Strawsburg .......... 37
4.0.1 Voltage-gated Na+ Channels in Astrocytes
and Action Potentials ............................... 38
4.0.2 Calcium Signaling in Glial Cells 39
4.1 Cluster Decomposition and Cluster Entropy of Ca2+ Waves..... 42
4.2 Calcium Signaling in Hyperexcitable Tissues .................. 44
4.2.1 Cultures of Human Nervous Tissue 45
4.3 Neuron-Glial Signaling ..................................... 47
4.4 Conclusions............................................... 49
5 The Electroencephalogram (EEG):
A Measure of Neural Synchrony
J.S. Ebersole and J. Milton ,...................... .... 51
5.1 Cortical Architecture 51
5.1.1 Laminar Organization ............................... 51
5.1.2 Columnar Organization.............................. 53
5.2 Generation of the EEG ..................................... 54
5.3 Neuronal Dipole Layers 56
5.4 Role of Glial Cells ......................................... 57
5.5 Epileptic Spikes ........................................... 57
5.6 Seizures .................................................. 60
5.7 Ictal EEG Patterns. ....................................... 62
5.8 Limitations of the EEG 64
5.9 Concluding Remarks ....................................... 67
6 Electrocorticographic Coherence Patterns
of Epileptic Seizures
V.L. Towle, F. Ahmad, M. Kohrman, K. Hecox, and S. Chkhenkeli .... 69
6.1 Lateral Coherence ......................................... 69
6.2 ECoG Recordings ,.......................... 71
6.3 Ictal Coherence 71
6.4 Interictal Coherence ....................................... 76
7 Synchronization
of Synaptically-Coupled Neural Oscillators
P.C. Bressloffand S. Coombes .................................... 83
7.1 Neural Oscillator Models ................................... 88
7.1.1 Conductance-based Models 88
7.1.2 Class I and Class II Excitability ...................... 90
7.1.3 Phase Resetting Curves...... .. .................. .... 92
7.1.4 Periodic Forcing:
Frequency-locking, Phase-locking and Synchronization ... 93
Contents IX
7.1.5 Integrate-and-fire Model ............................. 96
7.2 Mutual Synchronization in a Network
of Synaptically Coupled Oscillators .......................... 97
7.2.1 Network Model with Synaptic Coupling 97
7.2.2 Synchronization in the Weak Coupling Regime 99
7.2.3 Synchronization in the Strong Coupling Regime 105
7.3 Synaptically Generated Traveling Waves 110
8 Controlling Neural Synchrony
with Periodic and Aperiodic Stimuli
J.D. Hunter and .J. Milton 115
8.1 Arnold Tongue Diagrams 116
8.1.1 Entrainment Versus Synchrony 117
8.1.2 Synaptic Inputs 118
8.1.3 Epileptic Hippocampal Slices 119
8.2 Aperiodic Current Inputs 121
8.3 Rate-dependent Control of Neural Synchrony 123
8.4 Inhibitory Control of Neural Synchrony 124
8.5 Periodically Stimulated Inhibitory Networks 127
8.6 Discussion 129
9 Modeling Pattern Formation in Excitable Media:
The Legacy of Norbert Wiener
A.S. Mikhailov 131
9.1 Excitable Media 132
9.2 Spiral Waves Around Obstacles 134
9.3 Free Spiral Waves 136
9.4 Kinematics of Curved Waves with Open Ends 142
9.5 Complex Anisotropy 145
9.6 Resonances 148
9.7 Meandering 154
9.8 Fibrillation and Turbulence 159
9.9 Conclusions 163
10 Are Cardiac Waves Relevant
to Epileptic Wave Propagation?
A.T. Winfree 165
10.1 Introduction 165
10.2 Different Molecular Mechanisms of Propagation 166
10.3 Electrical Propagation Between Adjacent Cells 168
10.4 Chemical Propagation Between Adjacent Cells 175
10.5 Electrical Propagation in the Long-Range Fast-lane 176
10.6 An Alternative Description of Propagation in Complex Media 178
10.7 Electrical Stimulation of Excitable Tissues 186
X Contents
11 Pattern Formation in the Microbial World:
Dictyostelium Discoideum
H. Levine 189
11.1 Spiral Waves and Aggregation 189
11.2 Wavefield Evolution 194
11.2.1 Cell Streaming and Mound Formation 199
11.3 Cell Sorting and Tip Formation 206
11.4 Reprise 210
12 Predicting Epileptic Seizures
Robert Savit 213
12.1 Empiricism and Theory 214
12.2 Predicting Seizures 216
12.3 Simple Nonlinear Measures 218
12.4 Role of Non-stationarity and Non-autonomy 223
12.5 Non-autonomy and the Metaphase Space 225
12.6 Nonautonomy in Temporal Lobe Epilepsy 227
12.7 Conclusion 232
12.8 Prospective 233
12.9 Addendum 235
13 Comparison of Methods for Seizure Detection
K.K. Jerger, T.!. Netoff, J.T. Francis, T. Sauer, 1. Pecora,
S.L. Weinstein, S.J. Schiff 237
13.1 Methods for Seizure Prediction 238
13.1.1 Power Spectrum 238
13.1.2 Cross-correlation 239
13.1.3 Principal Components Analysis 239
13.1.4 Wavelets 240
13.1.5 Phase Correlation 240
13.1.6 Correlation Dimension 241
13.1.7 Mutual Prediction 242
13.2 Comparison of Seizure Detection Methods 242
13.3 Discussion 246
14 Direct Deep Brain Stimulation:
First Steps Towards the Feedback Control of Seizures
S.A. Chkhenkeli 249
14.1 Background 249
14.1.1 Stimulation of the Caudate Nucleus 249
14.1.2 Stimulation of the Dentate Nucleus 253
14.2 Clinical Experience 256
14.3 Feedback Control of Deep Brain Stimulation 257