Cortical hot spots and labyrinths: why cortical neuromodulation for episodic XXXX should be personalized.

@entity2795 @entity2704 @entity1 @entity308
Stimulation protocols for medical devices should be rationally designed. For episodic @entity2795 we outline model-based design strategies toward preventive and acute therapies using stereotactic cortical neuromodulation. To this end, we regard a localized @entity308 ( @entity308 ) wave segment as a central element in @entity2704 pathophysiology. To describe nucleation and propagation features of the @entity308 wave segment, we define the new concepts of cortical hot spots and labyrinths, respectively. In particular, we firstly focus exclusively on curvature-induced dynamical properties by studying a generic reaction-diffusion model of @entity308 on the folded cortical surface. This surface is described with increasing level of details, including finally personalized simulations using @entity1 's magnetic resonance imaging (MRI) scanner readings. At this stage, the only relevant factor that can modulate nucleation and propagation paths is the Gaussian curvature, which has the advantage of being rather readily accessible by MRI. We conclude with discussing further anatomical factors, such as areal, laminar, and cellular heterogeneity, that in addition to and in relation to Gaussian curvature determine the generalized concept of cortical hot spots and labyrinths as target structures for neuromodulation. Our numerical simulations suggest that these target structures are like fingerprints, they are individual features of each @entity2704 sufferer. The goal in the future will be to provide individualized neural tissue simulations. These simulations should predict the clinical data and therefore can also serve as a test bed for exploring stereotactic cortical neuromodulation.
