Intraoperative DBS targeting of the globus pallidus internus by using motor evoked potentials.

Objectives: Target localization for deep brain stimulation (DBS) is a crucial step that influences the clinical benefit of the DBS procedure together with the reduction of side effects. In this work, we address the feasibility of DBS target localization in the globus pallidus internus (GPi) aided by intraoperative motor evoked potentials (MEP) with emphasis on the reduction of capsular side effects.

Material And Methods: Micro-macroelectrode recordings were performed intraoperatively on 20 patients that underwent DBS treatment of the GPi (GPi-DBS).

Additional effect of erenumab for patients with chronic migraine treated with onabotulinumtoxin A-real-world data from a preliminary cohort study.

Background: This preliminary retrospective cohort study investigates the potential additive prophylactic effect of erenumab, a fully human monoclonal antibody that blocks the calcitonin gene-related peptide receptor, in combination with ongoing onabotulinumtoxin A (onaBoNT-A) treatment in patients suffering from chronic migraine.

Methods: The study included 218 patients and investigated the effects of adding erenumab to the existing treatment regimen. The primary outcome was the MIDAS (Migraine Disability Assessment) score assessed 3 months after the introduction of erenumab.

The Use of Nitrosative Stress Molecules as Potential Diagnostic Biomarkers in Multiple Sclerosis.

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) of still unclear etiology. In recent years, the search for biomarkers facilitating its diagnosis, prognosis, therapy response, and other parameters has gained increasing attention. In this regard, in a previous meta-analysis comprising 22 studies, we found that MS is associated with higher nitrite/nitrate (NOx) levels in the cerebrospinal fluid (CSF) compared to patients with non-inflammatory other neurological diseases (NIOND).

Evidence for a Spoken Word Lexicon in the Auditory Ventral Stream.

The existence of a neural representation for whole words (i.e., a lexicon) is a common feature of many models of speech processing.

The Asymmetric Impact of COVID-19: A Novel Approach to Quantifying Financial Distress across Industries.

This paper assesses corporate financial distress in terms of liquidity and risk of insolvency due to the COVID-19 pandemic. We develop a novel multivariate approach to obtain monthly data on industry turnover, exploiting real time data to capture the atypical character of industry-specific disturbances. By combining the estimated set of industry revenue shocks with pre-pandemic financial statements, we quantify the impact of the pandemic on the risk of insolvency in the EU non-financial corporate sector.

Revascularization methods in patients with carotid stenosis and concomitant coronary heart disease.

A major feature of the atherosclerotic process is its systemic and progressive character. The plaque pathogenetic mechanisms, morphology, evolution, and predilection site (bifurcation zones) determine the frequent coincidence of carotid and coronary atherosclerosis in the same patient.The present overview chronologically traces the history, effectiveness, and benefit of surgical and continuously improving interventional carotid revascularization.

Large, calcified aneurysm of the left ventricle: Case report of an incidental finding.

The case is of an 88-year-old female patient with an accidental finding of a large, calcified aneurysm near the cardiac apex. Differential diagnoses can be made with false aneurysms and congenital diverticulums. Imaging modalities beneficial for diagnosing LVA are ultrasound, X-rays, CT, MRI, including PET/CT for oncology patients.

Toward therapeutic electrophysiology: beta-band suppression as a biomarker in chronic local field potential recordings.

Adaptive deep brain stimulation (aDBS) is a promising concept for feedback-based neurostimulation, with the potential of clinical implementation with the sensing-enabled Percept neurostimulator. We aim to characterize chronic electrophysiological activity during stimulation and to validate beta-band activity as a biomarker for bradykinesia. Subthalamic activity was recorded during stepwise stimulation amplitude increase OFF medication in 10 Parkinson's patients during rest and finger tapping.

Determinants of functional significance of coronary bifurcation lesions and clinical outcomes after physiology-guided treatment.

Objectives: To determine the rate of functionally significant (fractional flow reserve, FFR ≤ 0.80) coronary bifurcation stenoses that are considered anatomically significant based on angiographic estimation and to define predictors of functional significance of stenoses in main vessel and side branch.

Background: To date, the rate of functionally significant stenoses in angiographic significant coronary bifurcation stenoses has not been specifically determined.

Bifurcation functional significance score as predictor of mortality: a validating study.

Considerable progress has been made in the treatment of coronary bifurcation stenosis. Anatomical characteristics of the vessel and lesion, however, fail to give information about the functional significance of the bifurcation stenosis. To the best of our knowledge, there is no study that systematically establishes the baseline functional significance of coronary stenosis and its effect on procedural and clinical outcomes.

Altered motor cortical plasticity in patients with hepatic encephalopathy: A paired associative stimulation study.

Objective: Hepatic encephalopathy (HE) is a potentially reversible brain dysfunction caused by liver failure. Altered synaptic plasticity is supposed to play a major role in the pathophysiology of HE. Here, we used paired associative stimulation with an inter-stimulus interval of 25 ms (PAS25), a transcranial magnetic stimulation (TMS) protocol, to test synaptic plasticity of the motor cortex in patients with manifest HE.

Influence of High Pass Filter Settings on Motor Evoked Potentials.

Objective: Motor evoked potentials (MEP), obtained by transcranial magnetic stimulation (TMS) are a common tool in clinical research and diagnostic. Nevertheless, reports regarding the influence of filter settings on MEP are sparse. Here, we compared MEP amplitudes and signal to noise ratio (SNR) using multiple high pass filter (HPF) and notch filter settings.

Motor Evoked Potentials Improve Targeting in Deep Brain Stimulation Surgery.

Objectives: One of the main challenges posed by the surgical deep brain stimulation (DBS) procedure is the successful targeting of the structures of interest and avoidance of side effects, especially in asleep surgery. Here, intraoperative motor evoked potentials (MEPs) might serve as tool to identify the pyramidal tract. We hypothesized that intraoperative MEPs are useful to define the distance to the pyramidal tract and reduce the occurrence of postoperative capsular side effects.

[Deep brain stimulation for Parkinson's disease].

Deep brain stimulation is an established and evidence-based therapeutic option for the treatment of advanced Parkinson's disease. Main indication and inclusion criteria are the presence of idiopathic Parkinsonism with motor fluctuations and / or dyskinesias and / or with medication refractory tremor, a significant improvement of akinesia / rigidity in response to dopaminergic medication, the absence of relevant cognitive deficits and other significant comorbidities. DBS neurosurgery has a low risk of complications.

Impact of the number of conditioning pulses on motor cortex excitability: a transcranial magnetic stimulation study.

Conditioning transcranial magnetic stimulation (TMS) with subthreshold conditioning stimulus followed by supra-threshold test stimulus at inter-stimulus intervals (ISI) of 1-5 ms results in inhibition (SICI), while ISI at 10-15 ms results in facilitation (ICF). One concerning issue, applying ICF/SICI protocols on patients is the substantial protocol variability. Here, we hypothesized that increasing the number of CS could result in more robust ICF/SICI protocols.

The Importance of Cognitive Domains and the Returns to Schooling in South Africa: Evidence from Two Labor Surveys.

Numerous studies have considered the important role of cognition in estimating the returns to schooling. How cognitive abilities affect schooling may have important policy implications, especially in developing countries during periods of increasing educational attainment. Using two longitudinal labor surveys that collect direct proxy measures of cognitive skills, we study the importance of specific cognitive domains for the returns to schooling in two samples.

Directional Deep Brain Stimulation of the Thalamic Ventral Intermediate Area for Essential Tremor Increases Therapeutic Window.

Objectives: Deep brain stimulation (DBS) of the posterior subthalamic area (PSA) and the ventral intermediate thalamic nucleus (VIM) is a well-established therapy for essential tremor (ET), but it is frequently associated with side effects like dysarthria or gait ataxia. Directional DBS (dDBS) may be a way to activate fiber tracts more selectively. Is dDBS for ET superior to omnidirectional DBS (oDBS) regarding therapeutic window and clinically as effective as oDBS?

Materials And Methods: Ten patients with ET treated with PSA/VIM-DBS were recruited.

One- and 3-year outcomes of percutaneous bifurcation left main revascularization with modern drug-eluting stents: a systematic review and meta-analysis.

Aims: Optimal percutaneous coronary intervention (PCI) strategy for coronary left main (LM) bifurcation lesions remains controversial. We performed systematic review and meta-analysis comparing one and 3-year clinical outcomes of 1- and 2- stent strategies using modern drug eluting stents (DESs) for revascularization of LM bifurcation disease.

Methods: We systematically identified all investigations published between January 2015 and February 2020 comparing the use of single versus double-stent strategies for the revascularization of LM bifurcation lesions.

Ventricular arrhythmia risk prediction in repaired Tetralogy of Fallot using personalized computational cardiac models.

Background: Adults with repaired tetralogy of Fallot (rTOF) are at increased risk for ventricular tachycardia (VT) due to fibrotic remodeling of the myocardium. However, the current clinical guidelines for VT risk stratification and subsequent implantable cardioverter-defibrillator deployment for primary prevention of sudden cardiac death in rTOF remain inadequate.

Objective: The purpose of this study was to determine the feasibility of using an rTOF-specific virtual-heart approach to identify patients stratified incorrectly as being at low VT risk by current clinical criteria.

Characterizing Conduction Channels in Postinfarction Patients Using a Personalized Virtual Heart.

Patients with myocardial infarction have an abundance of conduction channels (CC); however, only a small subset of these CCs sustain ventricular tachycardia (VT). Identifying these critical CCs (CCCs) in the clinic so that they can be targeted by ablation remains a significant challenge. The objective of this study is to use a personalized virtual-heart approach to conduct a three-dimensional (3D) assessment of CCCs sustaining VTs of different morphologies in these patients, to investigate their 3D structural features, and to determine the optimal ablation strategy for each VT.

Cerebellar Involvement in DYT-THAP1 Dystonia.

DYT-THAP1 dystonia is known to present a variety of clinical symptoms. To the best of our knowledge, this is the first case with DYT-THAP 1 dystonia and clinical signs of cerebellar involvement studied with transcranial magnetic stimulation in vivo. We report a case of a 51-year-old male DYT-THAP1 mutation carrier with dystonia, who additionally developed ataxia 1.

Sensitivity of Ablation Targets Prediction to Electrophysiological Parameter Variability in Image-Based Computational Models of Ventricular Tachycardia in Post-infarction Patients.

Ventricular tachycardia (VT), which could lead to sudden cardiac death, occurs frequently in patients with myocardial infarction. Computational modeling has emerged as a powerful platform for the non-invasive investigation of lethal heart rhythm disorders in post-infarction patients and for guiding patient VT ablation. However, it remains unclear how VT dynamics and predicted ablation targets are influenced by inter-patient variability in action potential duration (APD) and conduction velocity (CV).