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Direct electrical stimulation as an input gate into brain functional networks: principles, advantages and limitations

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Abstract

Background

While the fundamental and clinical contribution of direct electrical stimulation (DES) of the brain is now well acknowledged, its advantages and limitations have not been re-evaluated for a long time.

Method

Here, we critically review exactly what DES can tell us about cerebral function.

Results

First, we show that DES is highly sensitive for detecting the cortical and axonal eloquent structures. Moreover, DES also provides a unique opportunity to study brain connectivity, since each area responsive to stimulation is in fact an input gate into a large-scale network rather than an isolated discrete functional site. DES, however, also has a limitation: its specificity is suboptimal. Indeed, DES may lead to interpretations that a structure is crucial because of the induction of a transient functional response when stimulated, whereas (1) this effect is caused by the backward spreading of the electro-stimulation along the network to an essential area and/or (2) the stimulated region can be functionally compensated owing to long-term brain plasticity mechanisms.

Conclusion

In brief, although DES is still the gold standard for brain mapping, its combination with new methods such as perioperative neurofunctional imaging and biomathematical modeling is now mandatory, in order to clearly differentiate those networks that are actually indispensable to function from those that can be compensated.

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Acknowledgments

The authors thank Dr. Mélanie Pelegrini-Issac and Mrs. Judy Benson for helpful comments on the manuscript and English revision.

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Authors and Affiliations

  1. Unité 678, Inserm/UPMC, 91 boulevard de l’Hôpital, 75634, Paris Cedex 13, France

    Emmanuel Mandonnet

  2. Department of Neurosurgery, Klinikum Grosshadern, Marchioninistrasse 15, Ludwig Maximilian University of Munich, 81377, Munich, Germany

    Peter A. Winkler

  3. Department of Neurosurgery, Hôpital Gui de Chauliac, CHU de Montpellier, 80 avenue Augustin Fliche, 34295, Montpellier Cedex 5, France

    Hugues Duffau

  4. Department of Neurosurgery, Hôpital Lariboisière—Service de Neurochirurgie, 2 rue Ambroise Paré, 75010, Paris, France

    Emmanuel Mandonnet

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Mandonnet, E., Winkler, P.A. & Duffau, H. Direct electrical stimulation as an input gate into brain functional networks: principles, advantages and limitations. Acta Neurochir 152, 185–193 (2010). https://doi.org/10.1007/s00701-009-0469-0

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