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OPEN
received: 26 January 2016 accepted: 13 May 2016 Published: 06 June 2016
Synchrotron X-ray microtransections: a non invasive approach for epileptic seizures arising from eloquent cortical areas B. Pouyatos1,2,3, C. Nemoz4, T. Chabrol5, M. Potez2, E. Bräuer4, L. Renaud6,7, K. Pernet-Gallay1,2, F. Estève5, O. David1,2, P. Kahane1,2,8, J. A. Laissue9, A. Depaulis1,2 & R. Serduc5 Synchrotron-generated X-ray (SRX) microbeams deposit high radiation doses to submillimetric targets whilst minimizing irradiation of neighboring healthy tissue. We developed a new radiosurgical method which demonstrably transects cortical brain tissue without affecting adjacent regions. We made such image-guided SRX microtransections in the left somatosensory cortex in a rat model of generalized epilepsy using high radiation doses (820 Gy) in thin (200 μm) parallel slices of tissue. This procedure, targeting the brain volume from which seizures arose, altered the abnormal neuronal activities for at least 9 weeks, as evidenced by a decrease of seizure power and coherence between tissue slices in comparison to the contralateral cortex. The brain tissue located between transections stayed histologically normal, while the irradiated micro-slices remained devoid of myelin and neurons two months after irradiation. This pre-clinical proof of concept highlights the translational potential of noninvasive SRX transections for treating epilepsies that are not eligible for resective surgery. Surgical resections for intractable epilepsies have reached impressive success rates in recent years1,2. However, the management of seizures arising from eloquent cortical regions remains challenging due to high rates (up to 50%) of post-operative neurological deficits3–6. Non-resective procedures such as vagus nerve stimulation7, scheduled deep brain stimulation8 or closed-loop neurostimulation9, did not achieve seizure freedom in most cases. Multiple Subpial Transection (MST), developed by Morrell et al.10, is currently the most effective surgical technique applicable to eloquent cortex. Transections made with a special surgical knife at intervals of 5 mm interrupt horizontal intracortical fibers, while preserving vertical fibers. The procedure is based upon experimental evidence indicating that epileptogenic discharges require substantial side-to-side or horizontal interaction of cortical neurons11, whereas major functional properties of cortical tissue rely greatly on vertical fiber connections of the columnar units12. MST reduces synchronized discharges from the epileptic focus and limits their spread without impairing the function of the transected cortex13. However, MST is an invasive procedure that only reaches moderate rates of seizure freedom because of the limited access to deep cortical tissue/sulci14,15 and the risk of post-operative deficits, such as brain edema, infections, and bleeding16. Radiosurgery is an attractive alternative to surgical MST but radio-transections are currently unachievable with conventional radiosurgical devices and/or mega-voltage machines since their lateral dose profile does not provide the required sharp dose demarcations between irradiated and non-irradiated tissue slices17,18. Further, the transection procedure requires focused delivery of hectogray doses19, currently only achievable at 3rd generation synchrotron facilities. The assessment of the efficacy of synchrotron radiation for seizure management in rodents has been studied during the last few years using different methods and irradiation configurations20–23. The purpose of the present study was to perform a novel method of non-invasive cortical transections in epileptic rats using synchrotron x-rays (SRX) and to quantify the induced changes of normal and pathological electrical activities. To achieve 1
Inserm, U1216, F-38000 Grenoble, France. 2Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France. 3Synapcell S.A.S – Bâtiment Biopolis – 5 avenue du Grand Sablon, La Tronche, France. 4 ESRF, Grenoble, France. 5Univ. Grenoble Alpes, EA RSRM, F-38000 Grenoble, France. 6CNRS; CE2F PRIM UMS3537; Marseille, France. 7Aix Marseille Université; Centre d’Exploration Fonctionnelle et de Formation; France. 8CHU Grenoble Alpes, F-38000 Grenoble, France. 9University of Bern, Switzerland. Correspondence and requests for materials should be addressed to R.S. (email: [email protected]) Scientific Reports | 6:27250 | DOI: 10.1038/srep27250
1
www.nature.com/scientificreports/ this, we developed an innovative technique that focally cuts tissue within the cortex with micrometer precision. The synchrotron light was shaped into 50 μm-wide parallel microbeams characterized by extremely steep dose-gradients (about 200 hundred times steeper than conventional X-rays23. We arranged them spatially to achieve microtransections that aimed at “disconnecting” tissue slices from each other. The sensorimotor cortex of the GAERS rat, a validated model of generalized epilepsy21,24,25, was chosen as the target because it is non-resectable without functional deficit and produce frequent naturally-occurring highly-synchronized oscillations, i.e. Spike-Wave Discharges (SWDs). GAERS were chronically implanted with two symmetrical/longitudinal rows of five depth electrodes in both cortices (Fig. 1c). We chose to apply the transections mid-way between the electrodes of the left cortex only, to maintain the contralateral cortex as a control of the seizure stability across time. More precisely, four 200 μm-wide, 2 mm spaced, transections were delivered using submillimetric image-guidance (23) (Fig. 1a–d). Each transection was made by four 50 μm-wide and 2 mm-high microbeams with an entrance dose of 800 Gy each, sequentially delivered to the target through ports angled at 0°, 45°, 90° and −45°; Fig. 1a,b). Between each irradiation port, the animal was shifted laterally by 50 μm. The interlacement of the four microbeams resulted in a 200 μm wide prismatic octahedron with a diameter of 2 mm, exposed to 820 Gy (dose profile: Fig. 1e). This procedure was repeated 4 times at different antero-posterior coordinates.
Results
Synchrotron-generated microbeam induced sharp transections in rat brain. Figure 1f–t depicts
several aspects of the transection-induced damage in the brain two months after irradiation. Tissue necrosis was confined to the transection sites irradiated by the four interlaced microbeam paths. No tissue damages were observed between the transections. MR T1w images examination showed Gd-DOTA leakage confined to the 200 μm-wide transection sites while no diffusion was detected in the cortex of the contralateral hemisphere within the paths of non-interlaced 50 μm-wide microbeams (Fig. 1f). Brain sections (Fig. 1g,h) revealed tissue disintegration resulting in a sharp interruption of normal connections such as myelin sheaths within the transection sites (Fig. 1i,k). Conversely, the normal tissue structure, as well as myelin sheaths, were preserved in the paths of microbeams in the cortex of the contralateral hemisphere (Fig. 1j,l). Blood vessels were only interrupted at the four transections sites, but never in slices irradiated by a single microbeam (Fig. 1m,n). Neurons, astrocytes and oligodendrocytes were missing in both 200 μm- or 50 μm-wide irradiated tissue slices (Fig. 1o,p). Ultrastructurally, the neuropile was clearly damaged within the transection sites (Fig. 1q,s) while tissues located in between appeared normal (Fig. 1s,t). The transection gaps were filled with fibroblasts containing a developed rough endoplasmic reticulum and with extracellular matrix (Fig. 1q), including collagen fibrils. Edema was observed around capillaries near the transections, (Fig. 1s), but not in interjacent tissues (Fig. 1r). Numerous microglial cells were found in the transection sites, with phagocytosed neuronal and other cellular debris (Fig. 1q).
Synchrotron-generated transection reduces SWD power and coherence. Although microbeam
irradiations did induce a slight decrease in the number and duration of SWDs one week after irradiation (Table 1), values returned to baseline levels at subsequent post-irradiation times. This lack of effect of unilateral irradiation on seizure burden is in accordance with previous reports showing that bilateral manipulations are necessary to change the occurrence of seizures in this model26. However, from one week after transection, the power of the SWDs (6–8 Hz) recorded from the left electrodes in the irradiated left hemisphere was significantly reduced (Fig. 2a–d, p
OPEN
received: 26 January 2016 accepted: 13 May 2016 Published: 06 June 2016
Synchrotron X-ray microtransections: a non invasive approach for epileptic seizures arising from eloquent cortical areas B. Pouyatos1,2,3, C. Nemoz4, T. Chabrol5, M. Potez2, E. Bräuer4, L. Renaud6,7, K. Pernet-Gallay1,2, F. Estève5, O. David1,2, P. Kahane1,2,8, J. A. Laissue9, A. Depaulis1,2 & R. Serduc5 Synchrotron-generated X-ray (SRX) microbeams deposit high radiation doses to submillimetric targets whilst minimizing irradiation of neighboring healthy tissue. We developed a new radiosurgical method which demonstrably transects cortical brain tissue without affecting adjacent regions. We made such image-guided SRX microtransections in the left somatosensory cortex in a rat model of generalized epilepsy using high radiation doses (820 Gy) in thin (200 μm) parallel slices of tissue. This procedure, targeting the brain volume from which seizures arose, altered the abnormal neuronal activities for at least 9 weeks, as evidenced by a decrease of seizure power and coherence between tissue slices in comparison to the contralateral cortex. The brain tissue located between transections stayed histologically normal, while the irradiated micro-slices remained devoid of myelin and neurons two months after irradiation. This pre-clinical proof of concept highlights the translational potential of noninvasive SRX transections for treating epilepsies that are not eligible for resective surgery. Surgical resections for intractable epilepsies have reached impressive success rates in recent years1,2. However, the management of seizures arising from eloquent cortical regions remains challenging due to high rates (up to 50%) of post-operative neurological deficits3–6. Non-resective procedures such as vagus nerve stimulation7, scheduled deep brain stimulation8 or closed-loop neurostimulation9, did not achieve seizure freedom in most cases. Multiple Subpial Transection (MST), developed by Morrell et al.10, is currently the most effective surgical technique applicable to eloquent cortex. Transections made with a special surgical knife at intervals of 5 mm interrupt horizontal intracortical fibers, while preserving vertical fibers. The procedure is based upon experimental evidence indicating that epileptogenic discharges require substantial side-to-side or horizontal interaction of cortical neurons11, whereas major functional properties of cortical tissue rely greatly on vertical fiber connections of the columnar units12. MST reduces synchronized discharges from the epileptic focus and limits their spread without impairing the function of the transected cortex13. However, MST is an invasive procedure that only reaches moderate rates of seizure freedom because of the limited access to deep cortical tissue/sulci14,15 and the risk of post-operative deficits, such as brain edema, infections, and bleeding16. Radiosurgery is an attractive alternative to surgical MST but radio-transections are currently unachievable with conventional radiosurgical devices and/or mega-voltage machines since their lateral dose profile does not provide the required sharp dose demarcations between irradiated and non-irradiated tissue slices17,18. Further, the transection procedure requires focused delivery of hectogray doses19, currently only achievable at 3rd generation synchrotron facilities. The assessment of the efficacy of synchrotron radiation for seizure management in rodents has been studied during the last few years using different methods and irradiation configurations20–23. The purpose of the present study was to perform a novel method of non-invasive cortical transections in epileptic rats using synchrotron x-rays (SRX) and to quantify the induced changes of normal and pathological electrical activities. To achieve 1
Inserm, U1216, F-38000 Grenoble, France. 2Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France. 3Synapcell S.A.S – Bâtiment Biopolis – 5 avenue du Grand Sablon, La Tronche, France. 4 ESRF, Grenoble, France. 5Univ. Grenoble Alpes, EA RSRM, F-38000 Grenoble, France. 6CNRS; CE2F PRIM UMS3537; Marseille, France. 7Aix Marseille Université; Centre d’Exploration Fonctionnelle et de Formation; France. 8CHU Grenoble Alpes, F-38000 Grenoble, France. 9University of Bern, Switzerland. Correspondence and requests for materials should be addressed to R.S. (email: [email protected]) Scientific Reports | 6:27250 | DOI: 10.1038/srep27250
1
www.nature.com/scientificreports/ this, we developed an innovative technique that focally cuts tissue within the cortex with micrometer precision. The synchrotron light was shaped into 50 μm-wide parallel microbeams characterized by extremely steep dose-gradients (about 200 hundred times steeper than conventional X-rays23. We arranged them spatially to achieve microtransections that aimed at “disconnecting” tissue slices from each other. The sensorimotor cortex of the GAERS rat, a validated model of generalized epilepsy21,24,25, was chosen as the target because it is non-resectable without functional deficit and produce frequent naturally-occurring highly-synchronized oscillations, i.e. Spike-Wave Discharges (SWDs). GAERS were chronically implanted with two symmetrical/longitudinal rows of five depth electrodes in both cortices (Fig. 1c). We chose to apply the transections mid-way between the electrodes of the left cortex only, to maintain the contralateral cortex as a control of the seizure stability across time. More precisely, four 200 μm-wide, 2 mm spaced, transections were delivered using submillimetric image-guidance (23) (Fig. 1a–d). Each transection was made by four 50 μm-wide and 2 mm-high microbeams with an entrance dose of 800 Gy each, sequentially delivered to the target through ports angled at 0°, 45°, 90° and −45°; Fig. 1a,b). Between each irradiation port, the animal was shifted laterally by 50 μm. The interlacement of the four microbeams resulted in a 200 μm wide prismatic octahedron with a diameter of 2 mm, exposed to 820 Gy (dose profile: Fig. 1e). This procedure was repeated 4 times at different antero-posterior coordinates.
Results
Synchrotron-generated microbeam induced sharp transections in rat brain. Figure 1f–t depicts
several aspects of the transection-induced damage in the brain two months after irradiation. Tissue necrosis was confined to the transection sites irradiated by the four interlaced microbeam paths. No tissue damages were observed between the transections. MR T1w images examination showed Gd-DOTA leakage confined to the 200 μm-wide transection sites while no diffusion was detected in the cortex of the contralateral hemisphere within the paths of non-interlaced 50 μm-wide microbeams (Fig. 1f). Brain sections (Fig. 1g,h) revealed tissue disintegration resulting in a sharp interruption of normal connections such as myelin sheaths within the transection sites (Fig. 1i,k). Conversely, the normal tissue structure, as well as myelin sheaths, were preserved in the paths of microbeams in the cortex of the contralateral hemisphere (Fig. 1j,l). Blood vessels were only interrupted at the four transections sites, but never in slices irradiated by a single microbeam (Fig. 1m,n). Neurons, astrocytes and oligodendrocytes were missing in both 200 μm- or 50 μm-wide irradiated tissue slices (Fig. 1o,p). Ultrastructurally, the neuropile was clearly damaged within the transection sites (Fig. 1q,s) while tissues located in between appeared normal (Fig. 1s,t). The transection gaps were filled with fibroblasts containing a developed rough endoplasmic reticulum and with extracellular matrix (Fig. 1q), including collagen fibrils. Edema was observed around capillaries near the transections, (Fig. 1s), but not in interjacent tissues (Fig. 1r). Numerous microglial cells were found in the transection sites, with phagocytosed neuronal and other cellular debris (Fig. 1q).
Synchrotron-generated transection reduces SWD power and coherence. Although microbeam
irradiations did induce a slight decrease in the number and duration of SWDs one week after irradiation (Table 1), values returned to baseline levels at subsequent post-irradiation times. This lack of effect of unilateral irradiation on seizure burden is in accordance with previous reports showing that bilateral manipulations are necessary to change the occurrence of seizures in this model26. However, from one week after transection, the power of the SWDs (6–8 Hz) recorded from the left electrodes in the irradiated left hemisphere was significantly reduced (Fig. 2a–d, p
