Societal return on investment may greatly exceed financial return on investment in neurotechnology-based therapies: A case study in epilepsy therapy development.

Background: This research study is an economic analysis of a neurotechnology-based translational research and development venture focused on the development of a therapy for patients with epilepsy. In the conceptualization, planning, financing, and execution of neurotechnology ventures, many factors come into play in determining value and ability to secure financing at each stage of the venture. Conventionally, these have included factors that determine the return on investment for the stakeholders of the venture, most notably the investors and the team members, the former investing hard earned capital, and the latter investing significant portions of their professional careers.

Neurovista: Concept to first-in-man: The war story behind launching a venture to treat epilepsy.

Many medical (and nonmedical) technologies are the fruit of years and even decades of work by dedicated members of startup companies and commitment of capital by their investors. The launching of a medical device venture is fraught with many risks, but the personal, societal, and potential financial rewards of developing therapies that improve the lives of others makes the risk and sacrifice worthwhile. The litany of risks and challenges can be daunting, and persistence is the key ingredient to every incremental iota of success achieved.

Neural State Monitoring in the Treatment of Epilepsy: Seizure Prediction-Conceptualization to First-In-Man Study.

This research study is part of a therapy development effort in which a novel approach was taken to develop an implantable electroencephalographic (EEG) based brain monitoring and seizure prediction system. Previous attempts to predict seizures by other groups had not been demonstrated to be statistically more successful than chance. The primary clinical findings from this group were published in a clinical paper; however much of the fundamental technology, including the strategy and techniques behind the development of the seizure advisory system have not been published.

Optimizations and Nuances in Neurosurgical Technique for the Minimization of Complications in Subdural Electrode Placement for Epilepsy Surgery.

Background: Surgical intervention is an important therapeutic option for patients with intractable epilepsy and a well-characterized epileptogenic focus. Invasive monitoring with subdural electrodes is an effective technique for localizing epileptogenic foci. Previous studies reported varying complication rates, and these may deter more widespread adoption.

Neurohistopathological findings at the electrode-tissue interface in long-term deep brain stimulation: systematic literature review, case report, and assessment of stimulation threshold safety.

Objectives: Despite the widespread use of deep brain stimulation (DBS) in the treatment of neurologic disorders for over a quarter of a century, there has not been a systematic review and analyses of cases in which long-term postmortem clinic-pathologic data have been collected demonstrating the effects of chronically implanted electrodes and electrical stimulation on human brain tissue. Our objective is to provide a comprehensive systematic review of the literature on clinicopathologic findings of DBS tissue-electrode interface (TEI) and to determine types and prevalences of neuropathological findings among electrode materials and stimulation parameters and to augment this with previously unpublished histopathological data, images, and analyses from a DBS case implanted for 12 years, providing the longest duration histopathological follow-up.

Materials And Methods: A Medline literature review identified DBS cases upon which postmortem clinicopathologic follow-up was performed with adequate characterization of TEI.

Chronic unlimited recording electrocorticography-guided resective epilepsy surgery: technology-enabled enhanced fidelity in seizure focus localization with improved surgical efficacy.

Object: Epilepsy surgery is at the cusp of a transformation due to the convergence of advancements in multiple technologies. Emerging neuromodulatory therapies offer the promise of functionally correcting neural instability and obviating the need for resective or ablative surgery in select cases. Chronic implanted neurological monitoring technology, delivered as part of a neuromodulatory therapeutic device or as a stand-alone monitoring system, offers the potential to monitor patients chronically in their normal ambulatory setting with outpatient medication regimens.

C4-C5 post-traumatic spondyloptosis with in situ fusion: systematic literature review and case report.

Study Design: A case report with systematic review of the literature.

Objective: To report a case of post-traumatic C4-C5 spondyloptosis without neurological deficit not associated with posterior element fractures and presenting in a delayed fashion with fusion in situ of C4 and C5 vertebral bodies influencing the management strategy.

Summary Of Background Data: Traumatic spondyloptosis of the subaxial cervical spine is typically associated with neurological injury.

Long-term deep brain stimulation for essential tremor: 12-year clinicopathologic follow-up.

We describe the clinical course and postmortem pathological findings in a patient with essential tremor (ET) treated with deep brain stimulation (DBS) for 12 years. This 75 year old woman had a 13-year history of progressive ET prior to implantation of bilateral quadripolar DBS electrodes in the region of her ventral intermediate thalamic nuclei in 1996, producing immediate relief of arm tremor. Histopathological examination of the brain, performed 12 years after the initial implantation, demonstrated electrode catheter tracts rimmed by 20-25 micron fibrous sheaths, with multinucleated giant cells and reactive gliosis.

Stimulation of sympathetic innervation in the upper gastrointestinal tract as a treatment for obesity.

Sympathetic activity and obesity have a reciprocal relationship. Firstly, hypothalamic obesity is associated with decreased sympathetic activity. Caffeine and ephedrine increase sympathetic activity and induce weight loss, of which 25% is due to increased metabolic rate and 75% is due to a reciprocally decreased food intake.

Severe coagulopathy following intraoperative use of topical thrombin.

This report describes a case of severe coagulopathy and bleeding related to the intraoperative use of topically applied thrombin. Commercial thrombin preparations contaminated with bovine factor V have been shown to stimulate the production of antibodies directed against factor V. These antibodies can cause coagulopathy.