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Biomedical subjects

Patrick Chauvel

Publications and source records attributed to Patrick Chauvel.

At least 19 recordsLinked to original sources

The dreamy state: hallucinations of autobiographic memory evoked by temporal lobe stimulations and seizures.

Using results from cortical stimulations, as well as the symptoms of spontaneous epileptic seizures recorded by stereoelectroencephalography we re-studied the phenomenon of the dreamy state, as described by Jackson (Jackson JH. Selected writings of John Hughlins Jackson. Vol 1. On epilepsy and epileptiform convulsions. Taylor J, editor. London: Hodder and Stoughton; 1931). A total of 15 sensations of déjà vécu, 35 visual hallucinations consisting of the image of a scene and 5 'feelings of strangeness' occurred. These were recorded during 40 stimulations in 16 subjects, and 15 seizures in 5 subjects. Forty-five per cent of dreamy states were evoked by stimulation of the amygdala, 37.5% by the hippocampus and 17.5% by the para-hippocampal gyrus. During both spontaneous and provoked dreamy state, the electrical discharge was localized within mesial temporal lobe structures, without involvement of the temporal neocortex. Early spread of the discharge to the temporal neocortex appeared to prevent the occurrence of the dreamy state. Semiological analysis showed a clinical continuity between déjà vécu and visual hallucinations, the latter often consisting of a personal memory that was 'relived' by the subject; such memories could be recent, distant or from childhood. With one exception, the particular memory evoked differed from one seizure to another, but were always drawn from the same period of the subject's life. Given the role of the amygdala and hippocampus in autobiographic memory, their pathological activation during seizures may trigger memory recall. This study of the dreamy state is in keeping with other evidence demonstrating the constant and central role of the amygdala and hippocampus (right as much as left) in the recall of recent and distant memories. It demonstrates the existence of large neural networks that produce recall of memories via activation of the hippocampus, amygdala and rhinal cortex.

Adolescent↗

Emotion induction after direct intracerebral stimulations of human amygdala.

Very few studies in humans have quantified the effect obtained after direct electrical stimulation of the amygdala, in terms of both emotional and physiological responses. We tested patients with drug-resistant partial epilepsies who were explored with intracerebral electrodes in the setting of presurgical evaluation. We assessed the effects of direct electric stimulations in either the right or the left amygdala on verbally self-reported emotions (Izard scale) and on psychophysiological markers of emotions by recording skin conductance responses (SCRs) and by measuring the electromyographic responses of the corrugator supercilii (EMGc). According to responses on Izard scales, electrical stimulations of the right amygdala induced negative emotions, especially fear and sadness. In contrast, stimulations of the left amygdala were able to induce either pleasant (happiness) or unpleasant (fear, anxiety, sadness) emotions. Unpleasant states induced by electrical stimulations were accompanied by an increase in EMGc activity. In addition, when emotional changes were reported after electrical stimulation, SCR amplitude for the positively valenced emotions was larger than for the negative ones. These findings provide direct in vivo evidence that the human amygdala is involved in emotional experiences and strengthen the hypothesis of a functional asymmetry of the amygdala for valence and arousal processing.

Adult↗

Epilepsy related to hypothalamic hamartomas: surgical management with special reference to gamma knife surgery.

OBJECTIVE: A large spectrum of surgical techniques can be proposed to young patients presenting with hypothalamic hamartomas (HH) associated with severe epilepsy. The aim of this report is to point on some clinical and anatomical parameters supposed to influence the choice of the surgical approach and to emphasize the specific role of radiosurgery. MATERIALS AND METHODS: We reviewed both our experience and the recent literature based on a Pubmed search. Lateral pterional, midline frontal through the lamina terminalis, transcallosal interforniceal approaches, endoscopic treatment through the foramen of Monro, disconnecting surgery, radiofrequency ablation, brachytherapy and gamma knife surgery (GKS) were all considered. Mortality, morbidity, and efficacy of each of these techniques were compared. Specific limits, difficulties, and constraints were taken into account. Our experience of radiosurgery is based on a prospective trial which enrolled 60 patients with HH and associated severe epilepsy between October 1999 and December 2005. RESULTS: Several surgical techniques can lead to a real reversal of the epileptic encephalopathy. The main factors for the decision-making process are the age, the size of the lesion and its anatomical type (according to our original classification), the severity of the epilepsy, and the severity of the cognitive/psychiatric comorbidity. In our prospective trial (GKS), 27 patients have a follow-up superior to 3 years. Among those, 59.2% have an excellent result with a dramatic behavioral and cognitive improvement and are completely seizure-free (37%) or have only rare non-disabling seizures (22.2%). No permanent neurological complication has been observed so far; three patients have presented a transient poïkilothermia. GKS is clearly the safer approach for these difficult patients. Young patients with severe epilepsy and comorbidity must be operated on using a curative approach as early as possible. Very large type VI or mixed type with a large component above the floor of the third ventricle must be disconnected and then the upper remnant can be ideally treated by GKS (staged surgery). Type V (rarely epileptic) and IV are frequently operable by disconnection. Type I HH deeply embedded in the hypothalamus are operated on by GKS efficiently and safely. Type II HH can be operated on either endoscopically or transcallosally or by GKS depending on the parents' choice and severity of epilepsy. In small type III HH, GKS is a safer procedure, due to the very close relationship to the fornix and mammillary bodies. In very large type III HH, transcallosal interforniceal approach is proposed but with significant risks especially concerning short-term memory. When the lesion is sufficiently small, GKS is globally offering the patient a rate of seizure cessation comparable to microsurgery with, however, a much lower risk (no neurological deficit reported till now). CONCLUSION: Our first results indicate that GKS is as effective as microsurgical resection and very much safer. GKS also allows avoiding the vascular risk related to radiofrequency lesioning or stimulation. The disadvantage of radiosurgery is its delayed action. Longer follow-up is mandatory for a reliable evaluation of the role of GKS. The early effect on subclinical discharges turns out to play a major role in the dramatic improvement of sleep quality, behavior, and developmental learning acceleration at school.

Epilepsy↗

The role of corticothalamic coupling in human temporal lobe epilepsy.

The EEG activity of the thalamus and temporal lobe structures (hippocampus, entorhinal cortex and neocortex) was obtained using intracerebral recordings (stereoelectroencephalography, SEEG) performed in patients with TLE seizures undergoing pre-surgical evaluation. Synchrony was studied using a statistical measure of SEEG signal interdependencies (non-linear correlation). The results demonstrated an overall increase of synchrony between the thalamus and temporal lobe structures during seizures. Moreover, although there was great inter-individual variability, we found that values from seizure onset period were significantly higher than values from the background period (P = 0.001). Values at the end of seizure were significantly higher than values from the seizure onset (P < 0.0001). Several indices were also defined in order to correlate some clinical features to the degree of coupling between cortical structures and the thalamus. In patients with mesial TLE seizures, a correlation was found between the degree of thalamocortical synchrony and the presence of an early loss of consciousness but not with other clinical parameters. In addition, surgical prognosis seemed better in patients with low values of thalamocortical couplings at the seizure onset. This report demonstrates that the thalamus and remote cortical structures synchronize their activity during TLE seizures and suggest that the extension of the epileptogenic network to the thalamus is a potential important factor determining surgical prognosis.

Adolescent↗

Evidence of functional connectivity between auditory cortical areas revealed by amplitude modulation sound processing.

The human auditory cortex includes several interconnected areas. A better understanding of the mechanisms involved in auditory cortical functions requires a detailed knowledge of neuronal connectivity between functional cortical regions. In human, it is difficult to track in vivo neuronal connectivity. We investigated the interarea connection in vivo in the auditory cortex using a method of directed coherence (DCOH) applied to depth auditory evoked potentials (AEPs). This paper presents simultaneous AEPs recordings from insular gyrus (IG), primary and secondary cortices (Heschl's gyrus and planum temporale), and associative areas (Brodmann area [BA] 22) with multilead intracerebral electrodes in response to sinusoidal modulated white noises in 4 epileptic patients who underwent invasive monitoring with depth electrodes for epilepsy surgery. DCOH allowed estimation of the causality between 2 signals recorded from different cortical sites. The results showed 1) a predominant auditory stream within the primary auditory cortex from the most medial region to the most lateral one whatever the modulation frequency, 2) unidirectional functional connection from the primary to secondary auditory cortex, 3) a major auditory propagation from the posterior areas to the anterior ones, particularly at 8, 16, and 32 Hz, and 4) a particular role of Heschl's sulcus dispatching information to the different auditory areas. These findings suggest that cortical processing of auditory information is performed in serial and parallel streams. Our data showed that the auditory propagation could not be associated to a unidirectional traveling wave but to a constant interaction between these areas that could reflect the large adaptive and plastic capacities of auditory cortex. The role of the IG is discussed.

Acoustic Stimulation↗

Large-scale expression study of human mesial temporal lobe epilepsy: evidence for dysregulation of the neurotransmission and complement systems in the entorhinal cortex.

Human mesial temporal lobe epilepsies (MTLE) are the most frequent form of partial epilepsies and display frequent pharmacoresistance. The molecular alterations underlying human MTLE remain poorly understood. A two-step transcriptional analysis consisting in cDNA microarray experiments followed by quantitative RT-PCR validations was performed. Because the entorhinal cortex (EC) plays an important role in the pathophysiology of the MTLE and usually discloses no detectable or little cell loss, resected EC and each corresponding lateral temporal neocortex (LTC) of MTLE patients were used as the source of disease-associated and control RNAs, respectively. Six genes encoding (i) a serotonin receptor (HTR2A) and a neuropeptide Y receptor type 1 (NPY1R), (ii) a protein (FHL2) associating with the KCNE1 (minK) potassium channel subunit and with presenilin-2 and (iii) three immune system-related proteins (C3, HLA-DR-gamma and CD99), were found consistently downregulated or upregulated in the EC of MTLE patients as compared with non-epileptic autopsy controls. Quantitative western blot analyses confirmed decreased expression of NPY1R in all eight MTLE patients tested. Immunohistochemistry experiments revealed the existence of a perivascular infiltration of C3 positive leucocytes and/or detected membrane attack complexes on a subset of neurons, within the EC of nine out of eleven MTLE patients. To summarize, a large-scale microarray expression study on the EC of MTLE patients led to the identification of six candidate genes for human MTLE pathophysiology. Altered expression of NPY1R and C3 was also demonstrated at the protein level. Overall, our data indicate that local dysregulation of the neurotransmission and complement systems in the EC is a frequent event in human MTLE.

Adult↗

Electric source imaging in frontal lobe epilepsy.

The objective of this study was to determine the validity of interictal spike (IIS) source localization in frontal lobe epilepsies (FLE) using stereoelectroencephalography as a validating method. Ten patients with drug-resistant FLE were studied with high-resolution EEG and stereoelectroencephalography. Sixty-four scalp channels, a realistic head model, and different algorithms were used. For each patient, the intracerebral interictal distribution was studied and classified into one of three groups: lateral, medial, and mixed (latero-medio-basal). Surface IIS were abundant or subcontinuous for 8 of 10 FLE patients. In lateral and medial groups, intracerebral interictal activities were accurately localized. In the mixed group, source localizations designated a part of the intracerebral interictal distribution. A high degree of source localization accuracy is obtained in FLE. False-positive results were never obtained, but the extent of interictal activity could be underestimated by source localization results. Geometrical and cytoarchitectonic characteristics of the generator appear crucial to explain why medial frontal IIS (anterior para-cingulate gyrus and anterior cingulate gyrus) may be localizable whereas only the lateral orbitofrontal IIS seems to be localizable.

Adolescent↗

Relationship between intracerebral gamma oscillations and slow potentials in the human sensorimotor cortex.

Changes in sensorimotor rhythms (mu, beta and gamma) and movement-related cortical potentials (MRCPs) are both generated principally by the contralateral sensorimotor areas during the execution of self-paced movement. They appear to reflect movement control mechanisms, which remain partially unclear. With the aim of better understanding their sources and significance, we recorded MRCPs and sensorimotor rhythms during and after self-paced movement using intracerebral electrodes in eight epileptic subjects investigated by stereoelectroencephalography. The results showed that: (i) there is a strong spatial relationship between the late components of movement--the so-called motor potential (MP) and post-movement complex (PMc)--and gamma event-related synchronization (ERS) within the 40-60 Hz band, as the MP/PMc always occurred in contacts displaying gamma ERS (the primary sensorimotor areas), whereas mu and beta reactivities were more diffuse; and (ii) MPs and PMc are both generated by the primary motor and somatosensory areas, but with distinct sources. Hence, this could mean that kinesthesic sensory afferences project to neurons other than those firing during the pyramidal tract volley. The PMc and low gamma ERS represent two electrophysiological facets of kinesthesic feedback from the joints and muscles involved in the movement to the sensorimotor cortex. It could be suggested that gamma oscillations within the 40-60 Hz band could serve to synchronize the activities of the various neuronal populations involved in control of the ongoing movement.

Action Potentials↗

Neural network underlying ictal humming demonstrated by very early SPECT: a case report.

We report the case of a 49-year-old right-handed woman with brief partial seizures in which the clinical semiology was marked by an early humming automatism. MRI fusion of the registered ictal and interictal single-photon emission computed tomography (SPECT) substraction exhibited a left neural network involving lateral temporal, inferior frontal, and inferior parietal cortices.

Automatism↗

Hemispheric lateralization of voice onset time (VOT) comparison between depth and scalp EEG recordings.

Auditory-evoked potential (AEP)s elicited to French-language voiced stop consonant (/ba/) and voiceless stop consonant (/pa/) were studied in non-language-impaired epileptic patients and non-epileptic volunteers. First, depth AEPs recorded from the primary auditory cortex during pre-surgical exploration and scalp AEPs recordings using high resolution EEG (HR EEG-64 channels scalp EEG) were compared in the same patients. Both methods indicated that the processing of voiced and voiceless consonants was based on a temporal auditory coding. /Ba/ elicited a first complex (N1) at the onset of voicing and a second component [release component (RC)] time-locked to release. This processing took place specifically in the left primary auditory cortex. Source modeling of the RC showed that a left-greater-than-right amplitude of source probes (SP) both in epileptic patients with left-hemispheric language dominance [established by means of invasive tests (WADA test) and/or clinical data] and right-handed non-epileptic subjects. Our data suggest that the processing of VOT is related to hemispheric dominance for language and that scalp-recorded AEPs may represent an effective, non-invasive method to establish hemispheric dominance for language in clinical settings. This procedure could complement existing methods and could help to detect the dissociation between receptive and expressive language sometimes observed in patients with epilepsy.

Acoustic Stimulation↗

Recollection of vivid memories after perirhinal region stimulations: synchronization in the theta range of spatially distributed brain areas.

Electrical stimulation of the temporal cortex in patients with epilepsy sometimes elicits experiential phenomena such as recollection of vivid memories. The neurophysiological substrate of such phenomena is poorly understood. Furthermore, the relation between the site of stimulation and the type of memory elicited has only recently started to be investigated. We investigated these issues in patient FGA who had intracerebral electrodes stereotaxically implanted in the right temporal lobe for investigation of drug-resistant epilepsy. We report the results of electrical stimulations of the perirhinal region. Two stimulations elicited experiential phenomena consisting of visual memories that belonged to FGA's past, but which were not related to any particular episode. These visual memories consisted of objects or of details of objects. These two stimulations were contrasted with other stimulations in the same subhippocampal region. Cross-correlation analysis of the depth-EEG signals filtered in frequency sub-bands revealed that experiential phenomena occurred only when the various brain structures involved in the after-discharge were synchronized in the theta range. These structures included the perirhinal region, the hippocampus, other limbic structures as well as a primary visual area. Our results suggest that recollection of vivid memory after electric stimulation of the cortex may rely on wide networks of brain areas that transiently synchronize. These results also highlight the role of the perirhinal region in human memory. Experiential phenomena are rarely obtained after brain stimulation. Replication of these results is thus required due to the small number of observations reported.

Adult↗

Acute alteration of emotional behaviour in epileptic seizures is related to transient desynchrony in emotion-regulation networks.

OBJECTIVE: During focal epileptic seizures, patients may express intense agitation, screaming and facial expressions of rage, fear or anger. The precise anatomical origin of such intense ictal emotional behaviour is not fully understood and the mechanisms by which the epileptic discharges provoke these phenomena are unknown. In the present study, we analysed the neurophysiological mechanisms underlying ictal emotional behaviour in 3 patients with frontal lobe epilepsies undergoing intracerebral recordings for presurgical evaluation. METHODS: We analyzed the interactions between regions forming 'emotional networks', before and during behavioural alterations. Intracerebral recordings (SEEG method) of seizures from 3 patients presenting with frontal lobe seizures were analyzed. A nonlinear measure of SEEG signal interdependencies was used to evaluate the functional couplings occurring between brain structures. RESULTS: We found that these intense emotional alterations were associated with a decrease of synchrony between signals recorded from the neural networks known to be involved in emotional processing, and in particular a loss of synchrony between the orbito-frontal cortex and the amygdala. This disruption of functional connections could then result in the disruption of emotional regulation leading to the release of altered behaviour, as observed in epileptic patients during seizures. CONCLUSIONS: We propose that the occurrence of intense ictal emotional behaviour disturbance in frontal lobe seizures is related to a disruption of the normal mechanisms of emotional regulation SIGNIFICANCE: These results provide some insight into our understanding of the pathophysiological processes involved in human partial epilepsies as well as in the interpretation of clinical semiology.

Adult↗

Intracerebral study of gamma rhythm reactivity in the sensorimotor cortex.

The generators and functional correlates of gamma oscillations within the sensorimotor cortex remain unclear. With the goal of locating the oscillations' sources precisely and then studying the relationship between oscillatory reactivity and ongoing movement, we recorded stereoelectroencephalograms with intracerebral electrodes in eight epileptic subjects awaiting surgical treatment. The sensorimotor cortex was free of lesions and was exhaustively explored with the electrodes. Subjects were asked to perform various self-paced movements contralateral to the exploration zone, brief and sustained, distal movements and a pointing movement. We used the event-related desynchronization method to quantify the reactivity of the 40-60-Hz band before, during and after the performance of movement. A very focused, event-related synchronization of gamma rhythms was found in all subjects. It was predominantly observed in the primary sensorimotor area and its distribution was consistent with the functional map established using electrical stimulations. Two different temporal patterns were observed, the event-related synchronization of gamma rhythms was related either to movement onset or to movement offset but was never recorded before movement. This observation suggests that gamma oscillations are more probably related to movement execution than to motor planning. The different patterns argue in favour of multiple functional roles; it has been shown that gamma oscillations may support the efferent drive to the muscles and here we show that they are also likely to be related to somatosensory integration. We therefore suggest that gamma oscillations in the 40-60-Hz band may support afferent sensory feedback to the sensorimotor cortex during the performance of movement.

Adolescent↗

Entorhinal cortex involvement in human mesial temporal lobe epilepsy: an electrophysiologic and volumetric study.

PURPOSE: Several studies have demonstrated diminution in the volume of entorhinal cortex (EC) ipsilateral to the pathologic side in patients with temporal lobe epilepsy (TLE). The relation between the degree of EC atrophy and the epileptogenicity of this structure has never been directly studied. The purpose of the study was to determine whether atrophy of the EC evaluated by the quantitative magnetic resonance imaging (MRI) method is correlated with the epileptogenicity of this structure in TLE. METHODS: Intracerebral recordings (SEEG method) of seizures from 11 patients with mesial TLE were analyzed. Seizures were classified according to patterns of onset: pattern 1 was the emergence of a low-frequency, high-amplitude rhythmic spiking followed by a tonic discharge, and pattern 2 was the emergence of a tonic discharge in the mesial structures. A nonlinear measure of SEEG signal interdependencies was used to evaluate the functional couplings occurring between hippocampus (Hip) and EC at seizure onset. MRI volumetric analysis was performed by using a T(1)-weighted three-dimensional gradient-echo sequence in TLE patients and 12 healthy subjects. RESULTS: Significant interactions between Hip and Ec were quantified at seizure onset. The EC was found to be the leader structure in most of the pattern 2 seizures. Volumetric measurements of EC demonstrated an atrophy in 63% of patients ipsilateral to the epileptic side. A significant correlation between the strength of EC-Hip coupling and the degree of atrophy was found. In addition, in those patients that had a normal EC volume, the EC was never the leader structure in Ec-Hip coupling. CONCLUSIONS: These results validate the potential role of volumetry to predict the epileptogenesis of the EC in patients with hippocampal sclerosis and MTLE.

Adolescent↗

Interictal to ictal transition in human temporal lobe epilepsy: insights from a computational model of intracerebral EEG.

In human partial epilepsies and in experimental models of chronic and/or acute epilepsy, the role of inhibition and the relationship between the inhibition and excitation and epileptogenesis has long been questioned. Besides experimental methods carried out either in vitro (human or animal tissue) or in vivo (animals), pathophysiologic mechanisms can be approached by direct recording of brain electrical activity in human epilepsy. Indeed, in some clinical presurgical investigation methods like stereoelectroencephalography, intracerebral electrodes are used in patients suffering from drug resistant epilepsy to directly record paroxysmal activities with excellent temporal resolution (in the order of 1 millisecond). The study of neurophysiologic mechanisms underlying such depth-EEG activities is crucial to progress in the understanding of the interictal to ictal transition. In this study, the authors relate electrophysiologic patterns typically observed during the transition from interictal to ictal activity in human mesial temporal lobe epilepsy (MTLE) to mechanisms (at a neuronal population level) involved in seizure generation through a computational model of EEG activity. Intracerebral EEG signals recorded from hippocampus in five patients with MTLE during four periods (during interictal activity, just before seizure onset, during seizure onset, and during ictal activity) were used to identify the three main parameters of a model of hippocampus EEG activity (related to excitation, slow dendritic inhibition and fast somatic inhibition). The identification procedure used optimization algorithms to minimize a spectral distance between real and simulated signals. Results demonstrated that the model generates very realistic signals for automatically identified parameters. They also showed that the transition from interictal to ictal activity cannot be simply explained by an increase in excitation and a decrease in inhibition but rather by time-varying ensemble interactions between pyramidal cells and local interneurons projecting to either their dendritic or perisomatic region (with slow and fast GABAA kinetics). Particularly, during preonset activity, an increasing dendritic GABAergic inhibition compensates a gradually increasing excitation up to a brutal drop at seizure onset when faster oscillations (beta and low gamma band, 15 to 40 Hz) are observed. These faster oscillations are then explained by the model feedback loop between pyramidal cells and interneurons targeting their perisomatic region. These findings obtained from model identification in human temporal lobe epilepsy are in agreement with some results obtained experimentally, either on animal models of epilepsy or on the human epileptic tissue.

Algorithms↗

Temporal envelope processing in the human left and right auditory cortices.

The goal of this study was to determine the temporal response properties of different auditory cortical areas in humans. This is achieved by recording the phase-locked neural activity to white noises modulated sinusoidally in amplitude (AM) at frequencies between 4 and 128 Hz, in the left and right cortices of 20 subjects. Phase-locked neural responses are recorded in four auditory cortical areas with intracerebral electrodes, and modulation transfer functions (MTFs) are computed from these responses. A number of MTFs are bandpass in shape, demonstrating a selective encoding of AM frequencies below 64 Hz in the auditory cortex. This result provides strong physiological support to the idea that the human auditory system decomposes the temporal envelope of sounds (such as speech) into its constituting AM components. Moreover, the results show a predominant response of cortical auditory areas to the lowest AM frequencies (4-16 Hz). This range matches the range of AM frequencies crucial for speech intelligibility, emphasizing therefore the role played by these initial stations of cortical processing in the analysis of speech. Finally, the results show differences in AM sensitivity across cortical areas and hemispheres, and provide a physiological foundation for claims of functional specialization of auditory areas based on previous population measures.

Acoustic Stimulation↗

Mining reproducible activation patterns in epileptic intracerebral EEG signals: application to interictal activity.

The study of interictal transient events may substantially complement the analysis of seizures in the presurgical evaluation of intractable epilepsy. A comprehensive methodology of quantifying reproducibility of activation patterns in intracerebral electroencephalography signals is presented. It may be applied to various forms of transient epileptic events under the assumption that a time of occurrence may be assigned to them. In this paper, the method is used on two different forms of interictal events (interictal spikes or sharpwaves and transient bursts of fast activity). The methodology is based on signal processing and data mining algorithms and proceeds in three steps: 1) detection of transient paroxysmal events (monochannel event); 2) identification of quasisynchronous transient paroxysmal events (multichannel events); and 3) automatic extraction of similar activation patterns. Results show that the methodology allows reproducible sequential activation sets to be identified from signals recorded in four patients. Potential advantages of the method are discussed with respect to other approaches.

Algorithms↗