Martina Bočková

Executive functions processed in the frontal and lateral temporal cortices: intracerebral study.

OBJECTIVE The study was designed to investigate the neurocognitive network in the frontal and lateral temporal cortices that is activated by the complex cognitive visuomotor tasks of letter writing. METHODS Eight epilepsy surgery candidates with implanted intracerebral depth electrodes performed two tasks involving the writing of single letters. The first task consisted of copying letters. In the second task, the patients were requested to write any other letter. The cognitive load of the second task was increased mainly by larger involvement of the executive functions. The task-related ERD/ERS of the alpha, beta and gamma rhythms was studied. RESULTS The alpha and beta ERD as the activational correlate of writing of single letters was found in the sensorimotor cortex, anterior cingulate, premotor, parietal cortices, SMA and the temporal pole. The alpha and beta ERD linked to the increased cognitive load was present moreover in the dorsolateral and ventrolateral prefrontal cortex, orbitofrontal cortex and surprisingly also the temporal neocortex. Gamma ERS was detected mostly in the left motor cortex. CONCLUSIONS Particularly the temporal neocortex was activated by the increased cognitive load. SIGNIFICANCE The lateral temporal cortex together with frontal areas forms a cognitive network processing executive functions.

Intracerebral ERD/ERS in voluntary movement and in cognitive visuomotor task.

In order to study cerebral activity related to preparation and execution of movement, evoked and induced brain electrical activities were compared to each other and to fMRI results in voluntary self-paced movements. Also, the event-related desynchronization and synchronization (ERD/ERS) were studied in complex movements with various degrees of cognitive load. The Bereitschaftspotential (BP) and alpha (8-12 Hz) and beta (16-24 Hz) ERD/ERS rhythms in self-paced simple movements were analyzed in 14 epilepsy surgery candidates. In previous studies, the cortical sources of BP were consistently displayed contralateral to the movement in the primary motor cortex and somatosensory cortex, and bilateral in the supplementary motor area (SMA) and in the cingulate cortex. There were also small and inconstant BP generators in the ipsilateral sensorimotor, premotor, and dorsolateral prefrontal cortex. Alpha and beta ERD/ERS were also observed in these cortical regions. The distribution of contacts showing ERD or ERS was larger than of those showing BP. In contrast to BP, ERD, and ERS frequently occurred in the orbitofrontal, lateral and mesial temporal cortices, and inferior parietal lobule. The spatial location of brain activation for self-paced repetitive movements, i.e., writing simple dots, was studied using event-related functional MRI (fMRI) in 10 healthy right-handed subjects. We observed significant activation in regions known to participate in motor control: contralateral to the movement in the primary sensorimotor and supramarginal cortices, the SMA and the underlying cingulate, and, to a lesser extent, the ipsilateral sensorimotor region. When the fMRI was compared with the map of the brain areas electrically active with self-paced movements (intracerebral recordings; Rektor et al., 1994, 1998, 2001b, c; Rektor, 2003), there was an evident overlap of most results. Nevertheless, the electrophysiological studies were more sensitive in uncovering small active areas, i.e., in the premotor and prefrontal cortices. The BP and the event-related hemodynamic changes were displayed in regions known to participate in motor control. The cortical occurrence of oscillatory activities in the alpha-beta range was clearly more widespread. Four epilepsy surgery candidates with implanted depth brain electrodes performed two visuomotor-cognitive tasks with cued complex movements: a simple task--copying randomly presented letters from the monitor; and a more complex task--writing a letter other than that which appears on the monitor. The second task demanded an increased cognitive load, i.e., of executive functions. Alpha and beta ERD/ERS rhythms were evaluated. Similar results for both tasks were found in the majority of the frontal contacts, i.e., in the SMA, anterior cingulate, premotor, and dorsolateral prefrontal cortices. The most frequent observed activity was ERD in the beta rhythm; alpha ERS and ERD were also present. Significant differences between the two tasks appeared in several frontal areas--in the dorsolateral and ventrolateral prefrontal and orbitofrontal cortices (BA 9, 45, 11), and in the temporal neocortex (BA 21). In several contacts localized in these areas, namely in the lateral temporal cortex, there were significant changes only with the complex task--mostly beta ERD. Although the fMRI results fit well with the map of the evoked activity (BP), several discrepant localizations were displayed when the BP was compared with the distribution of the oscillatory activity (ERD-ERS). The BP and hemodynamic changes are closely related to the motor control areas; ERD/ERS represent the broader physiological aspects of motor execution and control. The BP probably reflects regional activation, while the more widespread ERD/ERS may reflect the spread of task-relevant information across relevant areas. In the writing tasks, the spatial distribution of the alpha-beta ERD/ERS in the frontal and lateral temporal cortices was partially task dependent. The ERD/ERS occurred there predominantly in the more complex of the writing tasks. Some sites were only active in the task with the increased demand on executive functions. In the temporal neocortex only, the oscillatory, but not the evoked, activity was recorded in the self-paced movement. The temporal appearance of changes of oscillatory activities in the self-paced movement task as well as in the cued movement task with an increased load of executive functions raises the interesting question of the role of this region in cognitive-movement information processing.

Cognitive event-related potentials and oscillations in the subthalamic nucleus.

Background: The cognitive role of the subthalamic nucleus (STN) remains largely unknown. Methods/Results: A modified protocol with a dual task elicited local field event-related potentials (ERPs) within the STN. No generators of ERPs were elicited by the standard oddball protocol in the STN (at variance with recordings from the putamen, caudate and pallidum). Repetitive transcranial magnetic stimulation (rTMS) over the right inferior frontal cortex caused a shortening of latencies of ERPs in standard and dual protocols. No changes were observable after the rTMS over the dorsolateral prefrontal cortex and sham stimulation. In the STN, only the tasks with an increased demand on executive functions produced the α-/β-event-related desynchronization/synchronization in visuomotor tasks with single letters writing. Conclusion: Our results indicate a specific, task-related involvement of the STN in the cognitive activities. Cognitive processing in the STN is possibly processed via hyperdirect cortico-STN pathway. Certain effects of deep brain stimulation surgery on cognitive performance could be explained by a direct effect on ‘cognitive’ parts of the STN.

Involvement of the subthalamic nucleus in cognitive functions — A concept ☆

The involvement of the subthalamic nucleus (STN) in a broad spectrum of various non-motor functions - attention, executive functions, verbal learning and memory, verbal abstract reasoning, conflict resolution, and emotions - has been reported. The STN has an anatomically central position within the basal ganglia(BG)-thalamocortical motor, associative and limbic circuits. The STN might interfere with non-motor functions as an indirect modulator rather than a regulator. Mechanisms modulating the motor and non-motor functions might differ. The STN has been implicated in control of non-motor behaviors via the tuning of specific circuits depending on the task. The STN might modulate selected non-motor functions via contextual modulation of certain cortical areas. Based on intracerebral recordings, we proposed that the non-motor activities in the BG are organized in some way other than the well-known organization of the cortico-BG-thalamocortical circuits. These findings support the hypothesis of a cortico-STN bypass of the BG-thalamocortical circuitry under some circumstances. The exact role of the STN and the BG in non-motor functions remains an important and interesting challenge for future research.

The Role of Anterior Nuclei of the Thalamus: A Subcortical Gate in Memory Processing: An Intracerebral Recording Study.

Objective To study the involvement of the anterior nuclei of the thalamus (ANT) as compared to the involvement of the hippocampus in the processes of encoding and recognition during visual and verbal memory tasks. Methods We studied intracerebral recordings in patients with pharmacoresistent epilepsy who underwent deep brain stimulation (DBS) of the ANT with depth electrodes implanted bilaterally in the ANT and compared the results with epilepsy surgery candidates with depth electrodes implanted bilaterally in the hippocampus. We recorded the event-related potentials (ERPs) elicited by the visual and verbal memory encoding and recognition tasks. Results P300-like potentials were recorded in the hippocampus by visual and verbal memory encoding and recognition tasks and in the ANT by the visual encoding and visual and verbal recognition tasks. No significant ERPs were recorded during the verbal encoding task in the ANT. In the visual and verbal recognition tasks, the P300-like potentials in the ANT preceded the P300-like potentials in the hippocampus. Conclusions The ANT is a structure in the memory pathway that processes memory information before the hippocampus. We suggest that the ANT has a specific role in memory processes, especially memory recognition, and that memory disturbance should be considered in patients with ANT-DBS and in patients with ANT lesions. ANT is well positioned to serve as a subcortical gate for memory processing in cortical structures.

The role of brain shift, patient age, and Parkinson's disease duration in the difference between anatomical and electrophysiological targets for subthalamic stimulation

Abstract Introduction. Although microrecording is common in subthalamic stimulation, microelectrode monitoring prolongs surgical time and may increase the risk of haemorrhagic complications. The main reason for electrophysiological mapping is the discrepancy between the calculated anatomical and final electrophysiological targets. The aim of this paper is to describe the relationship between anatomical and electrophysiological targets defined as the best electrophysiological recordings from multiple parallel electrode tracts, explaining the target discrepancy with attention paid to the role of brain shift and patient- and disease-related factors. Materials and methods. Subthalamic electrodes were stereotactically implanted in 58 patients using microrecording by means of parallel electrodes at defined distances. The relationship between the final electrode placement to its anatomical trajectory and the relationship between the definitive electrodes implanted on the right and left sides were analysed, as was the influence of patient age, Parkinsons disease duration, and late motor complications duration. Results. Final electrode placement matched the anatomical trajectory in 53.4% of patients on the right side and 43.1% of patients on the left side. Electrode positions were symmetrical in 38.3% of patients. The analysis of left and right electrode positions does not prove a statistically significant prevalence of lateral and posterior final electrode trajectories as could be expected from lateral and posterior movements of the brain caused by brain shift, although there was some tendency for a larger percentage of lateral electrodes on the left side. Age, Parkinsons disease duration, and L-DOPA effect duration were not confirmed as responsible factors. Conclusions. The difference between anatomical trajectory and final electrode placement supports the use of functional microelectrode monitoring in subthalamic deep brain stimulation. Brain shift is not the only causative factor of the difference. The possible roles of age, Parkinsons disease duration, and late motor complications duration were also not confirmed by study results.

Complex motor-cognitive factors processed in the anterior nucleus of the thalamus: an intracerebral recording study.

Abstract Cognitive adverse effects were reported after the deep brain stimulation (DBS) of the anterior nucleus of the thalamus (AN) in epilepsy. As the AN may have an influence on widespread neocortical networks, we hypothesized that the AN, in addition to its participation in memory processing, may also participate in cognitive activities linked with the frontal neocortical structures. The aim of this study was to investigate whether the AN might participate in complex motor–cognitive activities. Three pharmacoresistant epilepsy patients implanted with AN–DBS electrodes performed two tasks involving the writing of single letters: (1) copying letters from a monitor; and (2) writing of any letter other than that appearing on the monitor. The cognitive load of the second task was increased. The task-related oscillatory changes and evoked potentials were assessed. Local event-related alpha and beta desynchronization were more expressed during the second task while the lower gamma synchronization decreased. The local field event-related potentials were elicited by the two tasks without any specific differences. The AN participates in cognitive networks processing complex motor–cognitive tasks. Attention should be paid to executive functions in subjects undergoing AN–DBS.

Learning curve in anatomo-electrophysiological correlations in subthalamic nucleus stimulation.

AIM Advances in neuroradiological planning techniques in deep brain stimulation have put the need for intraoperative electrophysiological monitoring into doubt. Moreover intraoperative monitoring prolongs surgical time and there is potential association between the use of microelectrodes and increased incidence of hemorrhagic complications. The aim of this study was to analyze the correlation between the anatomically planned trajectory and the final subthalamic electrode placement after electrophysiological monitoring in patients with Parkinsons disease and its change with the increasing experience of the surgical team. MATERIAL AND METHODS The trajectories of right (first implanted) and left electrodes were compared in the first 50 patients operated on (Group 1) and the next 50 patients (Group 2). RESULTS In Group 1, 52% of central trajectories were on the right and 38% on the left; in Group 2, the percentage of central trajectories was 76% on the right and 78% on the left; the difference was statistically significant (p=0.021 and 0.001). The difference in the percentage of posterior trajectories reflecting brain shift between the right and left sides was statistically insignificant in Groups 1 (26% and 28%, p=0.999) and 2 (18% and 12%, p=0.549). The percentage of bilateral central electrodes was 14% and 62% in Groups 1 and 2, respectively. CONCLUSION The correlation between anatomically planned trajectory and final electrode placement markedly improves with the number of patients. However the significant percentage of patients with final electrode trajectory differing from anatomically planned target supports the use of intraoperative monitoring.

ID 88 – Anterior thalamus in cognition: An intracerebral recording study

Objective To study the involvement of the anterior thalamic nuclei (ANT) in the cognitive processes. Methods We recorded the event-related potentials (ERPs) by visual and auditory memory encoding-recognition tasks by intracerebral recordings in patients with pharmacoresistent epilepsy who underwent the deep brain stimulation (DBS) surgery of the anterior thalamic nuclei with depth electrodes implanted bilaterally in the ANT. We compared the results with epilepsy-surgery candidates with depth electrodes implanted bilaterally in the hippocampus. Results In the ANT we recorded ERPs during the visual encoding and visual and auditory recognition tasks. No significant ERPs were recorded during the encoding phase by auditory stimuli in ANT. In hippocampus ERPs were recorded by visual and auditory memory encoding and recognition tasks. In the recognition tasks (visual and auditory) the ERPs in ANT preceded the ERPs in hippocampus. Conclusions ERPs are elicited by visual memory encoding and recognition, as well as by auditory recognition memory processes, but not by encoding auditory memory processing in the ANT. The ANT precedes the hippocampus in the memory recognition pathway. Key message ANT has a specific role in the memory processes, especially the memory recognition.

Subthalamic electrode implantation using the MicroDrive system and the importance of microrecording data.

OBJECTIVE The aim of the paper was to describe the relationship of the anatomical and electrophysiological target for the subthalamic electrode implantation in Parkinsons disease patients defined as the best electrophysiological recordings from multiple paralel electrodes tracts with a target discrepancy explanation. BACKGROUND Although microrecording is the standard in subthalamic stimulation, microelectrode monitoring prolongs surgical time and may increase the risk of haemorrhagic complications. The main purpose for the electrophysiological mapping is to overcome the discrepancy between the anatomical and electrophysiological targets. METHODS Subthalamic electrodes were stereotactically implanted in 58 patients using microrecording by means of parallel electrodes at defined distances. The relationship of the final electrode to the anatomical trajectory, the subthalamic nucleus electrical activity length, and the relationship of right and left electrodes were analysed. RESULTS The final electrode placement matched the anatomical trajectory in 53.4 % of patients on the right side, and 43.1 % of patients on the left side. The electrode position was symmetrical in 38.3 % of patients. The analysis of left and right electrode positions did not prove brain shift as the sole factor responsible for anatomy-functional discrepancy. Further, neither age, Parkinsons disease duration, or L-DOPA adverse effects were confirmed as responsible factors. CONCLUSIONS The difference between the anatomical trajectory and the final electrode placement underlined the need for functional microelectrode monitoring. Brain shift is not the only causative factor for the difference (Tab. 7, Ref. 27).