Brain Advance Access published online on March 12, 2008
Brain, doi:10.1093/brain/awn044
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Short-term variations in response distribution to cortical stimulation
1Department of Neurology and 2Department of Neurosurgery, Johns Hopkins Medical Institutions, 3Zanvyl-Krieger Mind/Brain Institute, Johns Hopkins University, Baltimore, MD, USA, 4Department of Neurology, School of Medicine, Ewha Womans University and Ewha Medical Research Institute, Seoul, Korea, 5Group Health Center for Health Studies, Group Health Cooperative and 6Department of Biostatistics, University of Washington, Seattle, Washington, DC, USA
Correspondence to:
Ronald P. Lesser, MD, Department of Neurology, Johns Hopkins Medical Institutions, 2-147 Meyer Building, 600 North Wolfe Street, Baltimore, MD 21287-7247, USA E-mail: rl{at}jhmi.edu
Patterns of responses in the cerebral cortex can vary, and are influenced by pre-existing cortical function, but it is not known how rapidly these variations can occur in humans. We investigated how rapidly response patterns to electrical stimulation can vary in intact human brain. We also investigated whether the type of functional change occurring at a given location with stimulation would help predict the distribution of responses elsewhere over the cortex to stimulation at that given location. We did this by studying cortical afterdischarges following electrical stimulation of the cortex in awake humans undergoing evaluations for brain surgery. Response occurrence and location could change within seconds, both nearby to and distant from stimulation sites. Responses might occur at a given location during one trial but not the next. They could occur at electrodes adjacent or not adjacent to those directly stimulated or to other electrodes showing afterdischarges. The likelihood of an afterdischarge at an individual site after stimulation was predicted by spontaneous electroencephalographic activity at that specific site just prior to stimulation, but not by overall cortical activity. When stimulation at a site interrupted motor, sensory or language function, afterdischarges were more likely to occur at other sites where stimulation interrupted similar functions. These results show that widespread dynamic changes in cortical responses can occur in intact cortex within short periods of time, and that the distribution of these responses depends on local brain states and functional brain architecture at the time of stimulation. Similar rapid variations may occur during normal intracortical communication and may underlie changes in the cortical organization of function. Possibly these variations, and the occurrence and distribution of responses to cortical stimulation, could be predicted. If so, interventions such as stimulation might be used to alter spread of epileptogenic activity, accelerate learning or enhance cortical reorganization after brain injury.
Key Words: electrical stimulation; brain activation; brain circuits; cerebral electrophysiology; epileptiform EEG discharges
Abbreviations: fMRI, functional magnetic resonance imaging
Received October 16, 2007. Revised January 10, 2008. Accepted February 20, 2008.