Ann Clin Neurophysiol.  2021 Oct;23(2):69-81. 10.14253/acn.2021.23.2.69.

New approach of using cortico-cortical evoked potential for functional brain evaluation

• Jo H
• Kim D
• Song J
• Seo DW

• KMID: 2521884
• DOI: http://doi.org/10.14253/acn.2021.23.2.69

Abstract

Cortico-cortical evoked potential (CCEP) mapping is a rapidly developing method for visualizing the brain network and estimating cortical excitability. The CCEP comprises the early N1 component the occurs at 10-30 ms poststimulation, indicating anatomic connectivity, and the late N2 component that appears at < 200 ms poststimulation, suggesting long-lasting effective connectivity. A later component at 200-1,000 ms poststimulation can also appear as a delayed response in some studied areas. Such delayed responses occur in areas with changed excitability, such as an epileptogenic zone. CCEP mapping has been used to examine the brain connections causally in functional systems such as the language, auditory, and visual systems as well as in anatomic regions including the frontoparietal neocortices and hippocampal limbic areas. Task-based CCEPs can be used to measure behavior. In addition to evaluations of the brain connectome, single-pulse electrical stimulation (SPES) can reflect cortical excitability, and so it could be used to predict a seizure onset zone. CCEP brain mapping and SPES investigations could be applied both extraoperatively and intraoperatively. These underused electrophysiologic tools in basic and clinical neuroscience might be powerful methods for providing insight into measures of brain connectivity and dynamics. Analyses of CCEPs might enable us to identify causal relationships between brain areas during cortical processing, and to develop a new paradigm of effective therapeutic neuromodulation in the future.

Figure

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  Fig. 1. Cortico-cortical evoked potentials (CCEP) recorded using subdural electrodes in right frontal areas. (A) 3-D rendered functional magnetic resonance imaging images showing the locations of all electrodes on the right cerebral hemisphere. (B) Schematic drawing of the number of electrodes on a plate. The stimulation site (I25 and I26, red arrows) and recording electrodes (B10, short arrow; B6, long arrow) are shown. (C) CCEP recordings from the B10 electrode demonstrating an early N1 response on both a graph of the averaged power spectral density (dotted squares) and a line graph (arrow). (D) CCEP recordings from the B06 electrode displaying an early N1 response (thin arrow) and a late N2 response (thick arrow) that are also evident on the power-spectral-density graph at the corresponding times (dotted squares).

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  Fig. 2. Responses to single-pulse electrical stimulation at electrodes in the right midcingulate cortex during stereo-electroencephalography (EEG). (A) Schematic drawing of the entry points of all electrodes on the right lateral cerebral surface. (B) Surface-rendered functional magnetic resonance imaging image showing the exit point on the right medial surface of each electrode. (C) EEG demonstrating the early response (thin arrow) and delayed responses (thick arrow) at electrodes R7-3, R7-4, and R7-5 after applying stimulation (arrowhead) via electrode R5-4 (reference stimulating electrode on the left-hemisphere electrode).

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