[In vivo investigation of human brain networks by using cortico-cortical evoked potentials]

A better understanding of seizure networks and the mechanisms underlying human higher cortical functions requires a detailed knowledge of neuronal connectivity. As it relates to higher cortical functions, such as language, in humans, studies performed in nonhuman primates are less relevant. By using subdural electrodes implanted for presurgical evaluation, we developed an in vivo electrical tract-tracing technique of cortico-cortical evoked potentials (CCEPs). Cortico-cortical connections could be traced by applying repetitive single-pulse electrical stimuli to a part of the cortices and recording evoked cortical potentials from adjacent and remote cortical regions by averaging electrocorticogram time-locked to stimulus onset. This technique has contributed to the understanding of human cortico-cortical networks involved in higher brain functions, such as language, praxis, and higher motor control. Establishing a CCEP connectivity map in the MNI standard space is also of academic importance, since a standardized CCEP connectivity map would provide a substantial reference for noninvasive network analyses. In addition to its importance in basic systems neuroscience, this method, in combination with conventional cortical mapping, could be used to clinically map functional brain systems by tracking cortico-cortical connections among functional cortical regions in individual patients. This approach may help identify the cortico-cortical network of a given function within the context of pathology and any resultant plasticity of brain systems. In relation to epileptogenicity, as CCEPs can be used as a measure of regional cortical excitability, stimulating the epileptic focus and recording CCEPs in adjacent areas could help evaluate cortical excitability at and around the focus.