Modulating Oscillations and Working Memory in Patients With Subdural Electrodes

Study Overview
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Brief Summary
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Purpose: To investigate whether rhythmic direct electrical stimulation (DES) causes entrainment of endogenous neural oscillatory activity and whether such activity improve cognition. Participants: Drug-resistant epilepsy patients undergoing epilepsy surgery cortical mapping with continuous electrocorticography (ECoG) with intracranial electrodes. Procedures (methods): Rhythmic electrical stimulation will be delivered via intracranial electrodes during routine extra-operative cortical mapping. Long-term ECoG, Pre-stimulation ECoG, peri-stimulation ECoG, and post-stimulation ECoG data will be analyzed to assess for entrainment of neural oscillations.

Detailed Description
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The aim of this study is to characterize the entrainment of endogenous neural oscillatory activity using direct electrical stimulation (DES) of the brain and understand the effects on cognition. In this study, the investigators will apply rhythmic DES to patients who are undergoing routine DES for cortical mapping as a part of their epilepsy surgery evaluation with the aim of entraining cortical neural oscillations at specific frequencies relevant to cognitive processing and neuropsychiatric disease. The investigators hypothesize that rhythmic DES within a naturally occurring oscillatory frequency will cause entrainment at that frequency (e.g. 10Hz rhythmic DES will entrain a 10 Hz alpha oscillation). Also, the investigators posit that rhythmic DES at the theta (5Hz), alpha(10Hz), and gamma (50Hz) frequencies will cause enhancement of neural oscillations in the gamma band. The study follows a within-participant crossover design. Participants will perform one of the tasks described below and each task consists of multiple trials of varying difficulty. Stimulation will be applied concurrently through electrodes implanted for clinical determination of seizure focus. Equal number of stimulation and sham trials will be pseudo-randomly interleaved to get a balanced design (balanced across trial difficulty and trial type). The investigators will apply electrical stimulation in the form of pulse trains. The applied electrical stimulation intensity, duration and frequency follow the parameters used for clinical assessments of language and seizure focus and fall below the clinically approved limits. The investigators will measure participants performance on a simple working memory task during the above-described cortical electrical stimulation protocol. Alternately, participants can perform a face recognition task.

Official Title
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Modulating Oscillations and Working Memory in Patients With Subdural Electrodes

Conditions
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Epilepsy, Working Memory

Intervention / Treatment
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* Device: Direct Cortical Stimulation
* Device: Direct Cortical Stimulation Sham


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: History of medically intractable epilepsy Capable of giving informed consent Aged 18 - 80 years, either sex Exclusion Criteria: Past or current history of other neurological illnesses including ischemic stroke, intracerebral hemorrhage, brain neoplasm. Major systemic illness Severe cognitive impairment defined as mini-mental state examination of less than 20 Severe psychiatric illness Excessive use of alcohol or other substances

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Non-Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Sham Comparator: Sham<br>Device: Direct Cortical Stimulation Sham. Trials in which stimulation is not applied. These trials are initiated using a generic trigger generator. | Device: Direct Cortical Stimulation Sham<br>* Sham trials where no electric pulse is delivered<br>|
| Active Comparator: Stimulation<br>Device: Direct Cortical Stimulation. 150 stimulations with stimulations lasting 5 seconds at different target electrodes at two target frequencies (e.g. 5 Hz and 10 Hz) 2 milliampere in amplitude (Pulse shape - Biphasic square pulse 200 microsecond in duration per phase). Stimulation will be applied concurrently with the task and stimulation trials will be randomly interleaved with sham trials. | Device: Direct Cortical Stimulation<br>* A train of periodic electrical pulses is delivered between two local electrodes implanted in the brain<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Working Memory Task Performance - Accuracy | In this task, a sequence of items (alphabets or numerals) is presented followed by a delay. Following this, a single item which may or may not have been in the sequence is presented and the subject will be asked to indicate whether the item was in the previously presented sequence. A total of 150 trials will be performed with randomly interleaved sham trials where no stimulation is applied. Accuracy will be quantified in percentage correct. | 1 Hour | 
| Working Memory Task Performance - Reaction Time | In this task, a sequence of items (alphabets or numerals) is presented followed by a delay. Following this, a single item which may or may not have been in the sequence is presented and the subject will be asked to indicate whether the item was in the previously presented sequence. A total of 150 trials will be performed with randomly interleaved sham trials where no stimulation is applied. Reaction times will be quantified in milliseconds. | 1 Hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intracranial EEG | Spectral analysis and functional connectivity analysis of electrophysiology data will be performed using methods like multi-taper fft, wavelets, phase locking, Granger causality etc. The measures will be compared between sham and stimulation trials to identify if stimulation enhances neuronal entrainment. The correlation between the measures described above and the task performance will also be estimated. | Intracranial EEG will be collected simultaneously when the participants perform the task. 1 Hour | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Facial recognition