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Devinsky, O.

Publications and source records attributed to Devinsky, O..

At least 19 recordsLinked to original sources

From Scalp to Source: Precise Phase Retrieval of Intracerebral Epileptic Sources Based on Surface EEG

Accurate phase tracking of deep-brain activity is critical for effective closed-loop and phase-locked neuromodulation therapies. However, direct access to deep neural phase through intracranial recordings remains clinically restrictive due to the invasiveness. Here we validate and clinically benchmark the Gabor-Nelson (GN) dipole estimation method for reconstructing deep-brain oscillatory phase from non-invasive scalp EEG. GN is a geometry-based, imaging-independent approach that offers computationally efficient dipole reconstruction and has rarely been applied to source-level phase estimation in human neuroscience. We compared GN with an established MRI-informed Inverse Solution (IS) method using a three-stage reconstruction pipeline consisting of dipole modeling, dimensionality reduction, and frequency-dependent phase-delay correction. Validation is performed using (i) cadaveric recordings, where known ground-truth seizure waveforms were replayed through implanted deep electrodes, and (ii) simultaneous scalp EEG and SEEG recordings in human patients, where pseudo-ground truth was approximated via the intracranial contacts. GN achieved phase accuracy and signal fidelity comparable to IS across both datasets despite requiring no anatomical imaging. In cadaver recordings, phase-corrected reconstruction correlations exceeded r > 0.91 and {Delta}{Phi} < 9{degrees} in mean phase error. In patient SEEG data, GN reached up to r {approx} 0.80 with phase offsets suitable for neuromodulatory timing. GN offers a viable, low-barrier, imaging-independent alternative to traditional inverse modeling for non-invasive seizure phase tracking. This framework opens pathways for scalable, phase-locked and closed-loop stimulation therapies in epilepsy and potentially other network-based brain disorders.

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PV interneuron-targeted CRISPRa rescue of SCN1A haploinsufficiency in Dravet syndrome

Dravet syndrome is a severe epileptic encephalopathy caused by SCN1A haploinsufficiency, which leads to reduced NaV1.1 expression in parvalbumin (PV)-expressing interneurons and disrupted excitatory-inhibitory balance in the brain. We developed an AAV-based CRISPR activation system (AAV9-E2-dCas9-VP64) to selectively upregulate SCN1A from its endogenous locus in PV interneurons. An in vitro saturating guide RNA (gRNA) screen across the human SCN1A promoter identified a lead guide with robust and highly specific engagement of the SCN1A locus. This lead gRNA was validated in human Dravet syndrome model GABAergic neurons, where dose-dependent and specific SCN1A upregulation was observed. Intracerebroventricular (ICV) administration in a mouse model of Dravet syndrome produced dose-dependent improvement in survival as well as reduced susceptibility to hyperthermia-induced seizures and increased NaV1.1 protein expression, with maintained PV interneuron selectivity and minimal off-target expression. In a study in juvenile cynomolgus macaques, MRI-guided ICV administration of the vector was well tolerated, achieved broad cortical biodistribution, and maintained strong detargeting of peripheral tissues, with substantially lower peripheral dCas9 expression relative to the brain. These results support PV interneuron-selective SCN1A gene modulation via CRISPR activation as a promising therapeutic strategy for Dravet syndrome. AAV9-E2-dCas9-VP64 (RT101) is currently in preclinical development and is being advanced toward evaluation in the clinic.

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Sex-related structural alterations across common epilepsies: a worldwide ENIGMA study

Epilepsy is characterized by widespread structural brain alterations extending beyond the epileptic zone, involving both cortical and subcortical regions. Importantly, the clinical manifestation of epilepsy, including seizure types, psychiatric comorbidities, and treatment responses, has been shown to differ between sexes. However, sex differences in structural alterations in epilepsy have been seldomly reported in neuroimaging studies, partly due to limited sample sizes and single-center designs. Here, we systematically investigated sex differences in common epilepsies and their related clinical variables using structural neuroimaging biomarkers in an international multi-center cohort of 1,253 epilepsy patients and 1,077 healthy controls. We studied cortical thickness and subcortical volume in two types of epilepsy: temporal lobe epilepsy (TLE) and genetic generalized epilepsy (GGE). Both male and female patients with TLE showed widespread cortical and subcortical thinning compared with controls. In GGE, when compared separately to controls, male patients showed only subtle structural alterations, whereas female patients exhibited more widespread structural alterations. Sex-stratified analyses revealed some variation in the extent and distribution of cortical thickness and subcortical volume alterations between male and female patients in both epilepsy cohorts. Yet, we did not find significant sex-by-diagnosis interaction effects in TLE and GGE. Similarly, no significant interaction effects were observed between sex and age of onset or disease duration in either patient group. Overall, although we observed some differences in regional cortical thickness and subcortical volume between male and female patients with epilepsy, we did not find significant sex-by-diagnosis interactions. Our findings indicate that sex differences in behavioral and clinical outcomes of epilepsy may involve biological or functional processes that require further investigation.

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Normalization accounts for temporal dynamics in human somatosensory cortex

Sensory processing is fundamentally shaped by stimulation history. For example, in visual cortex, neural responses are reduced for repeated or sustained stimuli (adaptation). These phenomena are well characterized and effectively modeled by divisive normalization. We asked whether these same computational principles govern somatosensory processing. We used fMRI (6 participants) and intracranial electroencephalography (iEEG, 2 participants) to measure responses to time-varying vibrotactile stimuli in human somatosensory cortex. Stimuli consisted of single- and paired-pulses with durations and interstimulus intervals ranging from 0.05 to 1.2 s. We extracted BOLD time courses to capture neural response amplitudes, and high-frequency iEEG broadband envelopes to capture fast neural dynamics. In both experiments, we observed pronounced sub-additive temporal summation. Responses to longer or repeated stimuli were consistently lower than predicted by linear integration. Computational modeling revealed that divisive normalization models outperformed linear models in cross-validated accuracy across both datasets. These results demonstrate that somatosensory temporal dynamics closely mirror those in the visual system. Our findings suggest that the nervous system employs similar computational principles across modalities to encode sensory information across time. Significance statementHow the brain integrates sensory information over time is a fundamental question in neuroscience. While nonlinear temporal integration is well documented in visual cortex, it has not been extensively mapped in the human somatosensory system. By combining fMRI with intracranial EEG in humans, we demonstrate that somatosensory responses to tactile stimulation exhibit subadditive temporal summation. This nonlinearity is accurately captured by a divisive normalization model, matching observations in the visual system. Our results suggest that normalization is a canonical computation shared across different modalities to manage temporal dynamics, providing a unified framework for understanding how the brain encodes dynamic sensory stimuli.

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Prediction of Stimulation-Defined Eloquent Cortex Using Graph-Theoretical Connectivity from Electrocorticography During Presurgical Mapping

Background and ObjectivesElectrical stimulation mapping (ESM) is the clinical gold standard for identifying eloquent cortex during presurgical evaluation but is time-intensive, constrained by incomplete cortical sampling, and limited by patient tolerance. We investigated whether features derived from electrocorticography (ECoG), including functional connectivity measures, can provide complementary information for identifying functionally critical cortex and examined how predictive performance varies across functional domains, behavioral tasks, and data quantity. MethodsFourteen patients undergoing intracranial monitoring for epilepsy surgery performed speech production tasks while ECoG was recorded independently of stimulation mapping. Graph-theoretic functional connectivity features derived from high-gamma activity (70-150 Hz), combined with anatomical region encoding, were used to train machine learning classifiers, and predictive performance was evaluated using leave-one-subject-out validation with ESM-defined functional deficits used as ground-truth outcomes. ResultsFourteen patients were included. Performance differed across functional domains, with motor-critical electrodes identified with the highest accuracy (ROC-AUC 0.929 {+/-} 0.061; PR-AUC 0.755 {+/-} 0.191), followed by speech arrest (ROC-AUC 0.793 {+/-} 0.103; PR-AUC 0.550 {+/-} 0.196), whereas language-critical electrodes were more difficult to robustly predict (ROC-AUC 0.761 {+/-} 0.160; PR-AUC 0.385 {+/-} 0.167). Additional signal-derived features provided limited benefit beyond anatomical and connectivity features. Performance also varied across tasks and with the number of available trials, with motor prediction remaining stable across trial counts and speech arrest prediction improving with increasing trial counts up to approximately 10 trials before plateauing. In addition, evaluation at the level of stimulation pairs increased sensitivity, with only modest changes in overall performance. DiscussionGraph-theoretic connectivity analysis of ECoG provides complementary information for identifying stimulation-defined functional criticality and supports presurgical mapping. Differences in predictive performance across functional domains likely reflect underlying neuro-physiologic organization, with connectivity providing the clearest improvement for speech arrest prediction. Combined-label prediction strategies increased sensitivity at the expense of specificity, reflecting a clinically relevant tradeoff between broad detection of critical cortex and precise localization. These findings suggest that connectivity-informed approaches may help guide task selection and improve mapping efficiency while complementing electrical stimulation mapping.

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Neural Dynamics of Automatic Speech Production

Speech is a defining human behavior, and this ability depends critically on speech motor cortex. While the ventral precentral and postcentral gyri are classically regarded as chiefly articulatory and somatosensory regions, a growing body of literature challenges this simplification. Most prior research, however, has examined cued or structured speech production tasks, neglecting the automatic, overlearned speech commonly utilized in clinical assessment. Consequently, the neural dynamics and precise timing of cortical recruitment during automatic speech remain poorly understood. Here, we present intracranial electrocorticography (ECoG) recordings from the left perisylvian cortex in participants performing automatic speech such as counting and recitation of overlearned sequences. We investigate neural dynamics using encoding (multivariate temporal response function) and decoding (deep neural network speech synthesis) models. We show that automatic speech engages a distributed network across superior temporal, precentral, and post-central cortices, characterized by attenuated pre-articulatory activity and weaker frontal encoding. Furthermore, two complementary decoding strategies reveal that speech motor cortex represents a mixture of feedforward and feedback signals, with a subset of sites exhibiting exclusively feed-forward dynamics. These results delineate the spatiotemporal cortical organization of automatic speech and establish that the speech motor cortex supports more complex dynamics than purely feedforward control.

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Multiple task-demands flexibly optimize neural geometry in human ventral temporal cortex

A hallmark of human intelligence is the ability to perform multiple tasks immediately upon instruction. Yet, the neural processes that implement such flexibility remain unclear. Using intracranial electrophysiology in epilepsy patients, we examined how representational geometries evolve as participants switched among three tasks - individuation, categorization, and conceptualization - on a trial-by-trial basis. Although tasks differed in the required representational geometries, neural representations across cortex were not immediately optimized following task cues. Instead, task-tailored geometries emerged gradually over successive stimulus repetitions within a trial. Ventral temporal cortex was the only region to exhibit task-specific adjustments for all three tasks, dynamically transforming within- and between-category distances in line with task demands. Importantly, these gradual representational changes were behaviorally relevant, predicting trial-level performance. Our results show that behavioral flexibility is supported by incremental, task-dependent refinement of representational geometry already within sensory cortex - far earlier in the processing hierarchy than previously thought.

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Decoding state specific connectivity during speech production and perception

Understanding how dynamic brain networks support language perception and production is central to cognitive neuroscience. A vast network based literature has employed functional connectivity (FC), primarily using resting-state and task-based fMRI. However, methodological limitations have hindered this approach in language processing, particularly during speech production. Here, we address this gap by employing a large cohort of electrocorticographic (ECoG) patients (N=42) to investigate the networks driving speech perception and production. We acquired data while patients were engaged in a controlled battery of speech production tasks focusing on five cognitive states (auditory perception, picture perception, reading perception, speech production, and baseline). Using linear classifiers we were able to robustly decode cognitive states from single-trial FC (i.e. Pearson correlations) of the neural activity patterns, achieving a mean accuracy of 64.4%. These classifiers revealed distinct network signatures underlying auditory and visual perception as well as speech production via stable network connectivity. Importantly, the network signatures included both regions with robust local neural activity and those with minimal or no detectable activation. Such signatures indicate that even low-activity regions contribute critically to differentiating cognitive states. Our findings underscore the significance of functional connectivity analysis as a complementary dimension to investigating local neural activity, and suggest that the functional networks supporting speech extend beyond the most metabolically active regions.

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Cannabidiol dampens propagation of hippocampal hyperactivity and differentially modulates feedforward and feedback inhibition

Cannabidiol (CBD) decreases seizures in patients with severe pediatric-onset epilepsies including Dravet, Lennox-Gastaut, and Tuberous Sclerosis syndromes. However, the effects of CBD on neuronal activity and circuits remain obscure. In the mouse hippocampus, we found that CBD causes a GPR55-independent decrease in CA1 pyramidal neuron firing frequency and a GPR55-dependent reduction in CA3 to CA1 hippocampal activity propagation. CBD-mediated decrease in high-frequency activity was mimicked by GPR55 antagonism and prevented by GPR55 deletion and blockade of GABAergic transmission. Dampening high-frequency activity was accompanied by increased recruitment of parvalbumin+ (PV)-INs and reduced recruitment of somatostatin+ (SST)-INs, leveraging the inhibitory subcircuit to limit propagation of hyperactivity. CBD-induced attenuation of high frequency spike propagation was mimicked by pharmacological enhancement and optogenetic engagement of PV-INs. Such increased on-demand recruitment of PV-INs dampened propagation of high-frequency activity to hippocampal CA1 similarly to CBD. We predict that CBD potentially curbs propagation and perpetuation of seizure activity via these mechanisms.

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Frontal cortex organization supporting audiovisual processing during naturalistic viewing

AbstractOur brains dynamically adapt to a multisensory world by orchestrating diverse inputs across sensory streams. This process engages multiple brain regions, but it remains unclear how audiovisual stimuli are represented and evolve over time, especially in naturalistic scenarios. Here, we employed a movie-viewing paradigm to explore this question. We recorded intracranial electrocorticography (iEEG) to measure brain activity in 19 participants watching a short multilingual movie. Using unsupervised clustering and supervised encoding models, we identified a robust modality-specific gradient in the frontal cortex, wherein the ventral division primarily processes auditory information and the dorsal division processes visual inputs. Further, we found that this cortical organization dynamically changed, adapting to different movie contexts. This result potentially reflects flexible audiovisual-resource assignment to construct a coherent percept of the movie. Leveraging behavioral ratings, we found that the frontal cortex is the primary site in this modality assignment process. Together, our findings shed new light on the functional architecture of the frontal cortex underlying flexible multisensory representation and integration in natural contexts.

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Neural and Computational Mechanisms Underlying One-shot Perceptual Learning in Humans

The ability to quickly learn and generalize is one of the brains most impressive feats and recreating it remains a major challenge for modern artificial intelligence research. One of the most mysterious one-shot learning abilities displayed by humans is one-shot perceptual learning, whereby a single viewing experience drastically alters visual perception in a long-lasting manner. Where in the brain one-shot perceptual learning occurs and what mechanisms support it remain enigmatic. Combining psychophysics, 7T fMRI, and intracranial recordings, we identify high-level visual cortex as the most likely neural substrate wherein neural plasticity supports one-shot perceptual learning. We further develop a novel deep neural network model incorporating top-down feedback into a vision transformer, which recapitulates and predicts human behavior. The prior knowledge learnt by this model is highly similar to the neural code in the human high-level visual cortex. These results reveal the neurocomputational mechanisms underlying one-shot perceptual learning in humans.

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The "Podcast" ECoG dataset for modeling neural activity during natural language comprehension

Naturalistic electrocorticography (ECoG) data are a rare but essential resource for studying the brains linguistic capabilities. ECoG offers a high temporal resolution suitable for investigating processes at multiple temporal timescales and frequency bands. It also provides broad spatial coverage, often along critical language areas. Here, we share a dataset of nine ECoG participants with 1,330 electrodes listening to a 30-minute audio podcast. The richness of this naturalistic stimulus can be used for various research endeavors, from auditory perception to semantic integration. In addition to the neural data, we extract linguistic features of the stimulus ranging from phonetic information to large language model word embeddings. We use these linguistic features in encoding models that relate stimulus properties to neural activity. Finally, we provide detailed tutorials for preprocessing raw data, extracting stimulus features, and running encoding analyses that can serve as a pedagogical resource or a springboard for new research.

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Fast-timescale hippocampal processes bridge between slowly unfurling neocortical states during memory search

Prior behavioral work showed that event structure supports our ability to search through continuous naturalistic memories. We hypothesized that, neurally, this memory search process involves a division of labor between slowly unfurling neocortical states representing event knowledge and fast hippocampal-neocortical communication supporting retrieval of new information at transitions between events. In a sample of ten intracranial EEG patients we tracked slow neural state-patterns as patients viewed a movie and then searched their memories in a structured naturalistic interview. As patients answered questions ("after A, when does B happen next?"), state-patterns from movie-viewing were reinstated in neocortex. During the critical memory-search period, states unfurled in a forward direction, realizing a trajectory from A to B in memory. Punctate moments of state-transition during memory-search were marked by low-frequency power decreases in cortex and preceded by power decreases in hippocampus that correlated with reinstatement. Connectivity-analysis revealed information-flow from hippocampus to cortex underpinning state-transitions.

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Associations between epilepsy-related polygenic risk and brain morphology in childhood

AO_SCPLOWBSTRACTC_SCPLOWTemporal lobe epilepsy with hippocampal sclerosis (TLE-HS) is associated with a complex genetic architecture, but the translation from genetic risk factors to brain vulnerability remains unclear. Here, we examined associations between epilepsy-related polygenic risk scores for HS (PRS-HS) and brain structure in a large sample of neurotypical children, and correlated these signatures with case-control findings in in multicentric cohorts of patients with TLE-HS. Imaging-genetic analyses revealed PRS-related cortical thinning in temporo-parietal and fronto-central regions, strongly anchored to distinct functional and structural network epicentres. Compared to disease-related effects derived from epilepsy case-control cohorts, structural correlates of PRS-HS mirrored atrophy and epicentre patterns in patients with TLE-HS. By identifying a potential pathway between genetic vulnerability and disease mechanisms, our findings provide new insights into the genetic underpinnings of structural alterations in TLE-HS and highlight potential imaging-genetic biomarkers for early risk stratification and personalized interventions.

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Non-vectorial Integration of Intersectional Short-Pulse Stimulation Enables Enhanced Deep Brain Modulation and Effective Seizure Control

Transcranial electrical stimulation (TES) holds promise to treat neurological disorders, but its efficacy is limited by poor spatial focality and depth of penetration. Here, we examined the potential utility of Intersectional Short-Pulse (ISP) stimulation of deeper brain penetration. Using computational modeling and in vivo patch-clamp recordings in rats, we demonstrate that neurons integrate ISP-induced electric fields in a non-vectorial manner. This mechanism allows ISP to overcome some limits of conventional TES, achieving spatially limited stimulation across cortical and subcortical structures. In a rat model of temporal lobe epilepsy, closed-loop ISP stimulation significantly outperformed conventional TES in reducing seizure duration and severity. ISP reduced hippocampal seizure duration by 49% and 41% compared to sham stimulation and conventional TES and significantly reduced motor seizure severity. Our findings demonstrate that ISP stimulation can rapidly terminate hippocampal seizures, offering a potential new approach for non-invasive neuromodulation with applications across diverse neurologic and psychiatric disorders.

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From single words to sentence production: Shared cortical representations but distinct temporal dynamics

Sentence production is the uniquely human ability to transform complex thoughts into strings of words. Despite the importance of this process, language production research has primarily focused on single words. However, it remains a largely untested assumption that the principles of word production generalize to more naturalistic utterances like sentences. Here, we investigate this using high-resolution neurosurgical recordings (ECoG) and an overt production experiment where patients produced six words in isolation (picture naming) and in sentences (scene description). We trained machine learning classifiers to identify the unique brain activity patterns for each word during picture naming, and used these patterns to decode which words patients were processing while they produced sentences. Our findings confirm that words share cortical representations across tasks, but reveal a division of labor within the language network. In sensorimotor cortex, words were consistently activated in the order in which they were said in the sentence. However, in inferior and middle frontal gyri (IFG and MFG), the order in which words were processed depended on the syntactic structure of the sentence. Deeper analysis of this pattern revealed a spatial code for representing a words position in the sentence, with subjects selectively encoded in IFG and objects in MFG. Finally, we argue that the processes we observe in prefrontal cortex may impose a subtle pressure on language evolution, explaining why nearly all the worlds languages position subjects before objects.

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Temporal integration in human auditory cortex is predominantly yoked to absolute time, not structure duration

Sound structures such as phonemes and words have highly variable durations. Thus, there is a fundamental difference between integrating across absolute time (e.g., 100 ms) vs. sound structure (e.g., phonemes). Auditory and cognitive models have traditionally cast neural integration in terms of time and structure, respectively, but the extent to which cortical computations reflect time or structure remains unknown. To answer this question, we rescaled the duration of all speech structures using time stretching/compression and measured integration windows in the human auditory cortex using a new experimental/computational method applied to spatiotemporally precise intracranial recordings. We observed significantly longer integration windows for stretched speech, but this lengthening was very small ([~]5%) relative to the change in structure durations, even in non-primary regions strongly implicated in speech-specific processing. These findings demonstrate that time-yoked computations dominate throughout the human auditory cortex, placing important constraints on neurocomputational models of structure processing.

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Information-making processes in the speaker's brain drive human conversations forward

Natural human conversation is driven by the exchange of information-rich messages that surprise the listener and deviate from predictable context. While extensive research has characterized how the brain processes unexpected linguistic input during comprehension, the neural mechanisms underlying the generation of such information by the speaker remain poorly understood. In this study, we hypothesize that the speakers brain actively creates information through extra neural computation, transforming internal thoughts into novel, meaningful linguistic outputs. Utilizing a unique 24/7 dataset of continuous electrocorticography (ECoG) comprising approximately 100 hours of spontaneous natural conversations, we contrast the neural basis of speech production and comprehension within the same participants. Behaviorally, we find that speakers take longer pausing for an additional 100-150 milliseconds before producing information-rich, improbable words, even when controlling for word identity and frequency. Neurally, we provide converging evidence for a previously unreported process: generating information-rich words elicits significantly stronger neural activity (ERP) and enhanced neural encoding and decoding in language-related areas starting 100-500 ms before articulation. This pattern contrasts sharply with speech comprehension, where enhanced neural activity for predictable words occurs before onset, while responses to improbable words emerge only after onset as prediction errors. Furthermore, we demonstrate that large language models (LLMs) mirror this biological process, requiring deeper internal computation across layers to generate improbable versus probable words. Together, these results reveal that the speakers brain is not merely a transmission channel but an active generator of information, recruiting extra neural resources to create novel content that diverges from listener expectations.

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