Comparison of the Interference Effects on Somatosensory Evoked Potential from Tonic, Burst, and High-dose Spinal Cord Stimulations.

Spinal cord stimulations have been used widely to treat intractable neuropathic pain. The conventional spinal cord stimulation paradigm, the "tonic" type, suppresses excessive activation of wide dynamic range neurons in the dorsal horn via the collateral branch from the dorsal column. Therefore, preserved dorsal column function is an important prerequisite for tonic spinal cord stimulations.

Development of Quality of Life Questionnaire for Patients with Parkinson's Disease Undergoing STN-DBS.

In device-aided therapy (DAT) for Parkinson's disease (PD), factors such as device-related adverse effects, psychological and lifestyle changes, and specific disease progression can affect the quality of life (QoL) of patients with advanced PD. However, there is no existing QoL scale that includes the effects of therapeutic devices. From a semi-structured interview with patients with PD undergoing deep brain stimulation (DBS), we extracted the content of utterances that were thought to affect the QoL and created a draft questionnaire consisting of 113 items.

Effects of Medications and Subthalamic Nucleus-Deep Brain Stimulation on the Cutaneous Silent Period in Patients With Parkinson's Disease.

Objectives: We sought to evaluate whether the cutaneous silent period (CSP) could be an electrophysiological indicator reflective of the effects of therapy for Parkinson's disease (PD), including anti-PD medications or deep brain stimulation (DBS).

Material And Methods: We recorded the CSP in 43 patients with PD prior to and following the administration of medication during a pre-DBS evaluation (30 cases) and the "on" and "off" states of subthalamic nucleus DBS (13 cases). The CSP was elicited from the abductor pollicis brevis muscle by an electrical stimulation of the index finger that was 2, 4, and 15 times stronger than the sensory threshold (ST).

Diplopia associated with loop routing in deep brain stimulation: illustrative case.

Background: Deep brain stimulation (DBS) is a powerful surgical option for drug-resistant movement disorders; however, electromagnetic interference (EMI) from external sources poses a potential risk for implanted electronics.

Observations: A 61-year-old woman with Parkinson's disease originally had two implantable pulse generators (IPGs) for bilateral subthalamic DBS, which were then replaced with one dual-channel IPG routed in a loop. After the replacement surgery, with the same DBS programming as before the IPG replacement (bipolar setting for right, unipolar setting for left), the patient began to complain of transient paroxysmal diplopia.

Secondary Worsening Following DYT1 Dystonia Deep Brain Stimulation: A Multi-country Cohort.

: To reveal clinical characteristics of suboptimal responses to deep brain stimulation (DBS) in a multi-country DYT1 dystonia cohort. : In this multi-country multi-center retrospective study, we analyzed the clinical data of DYT1 patients who experienced suboptimal responses to DBS defined as <30% improvement in dystonia scales at the last follow-up compared with baseline. We used a literature-driven historical cohort of 112 DYT1 patients for comparison.

The effects of chronic subthalamic stimulation on nonmotor symptoms in advanced Parkinson's disease, revealed by an online questionnaire program.

Background: This study was designed to detect and assess the frequency and severity of nonmotor symptoms (NMSs) in advanced Parkinson's disease (PD) and to investigate the effects of subthalamic nucleus deep brain stimulation (STN-DBS) on NMSs.

Methods: We developed an online PC-based questionnaire program to assess NMSs in PD. Twenty-six PD patients who underwent bilateral STN-DBS were assessed.

Predictive Factors of Antiparkinsonian Drug Reduction after Subthalamic Stimulation for Parkinson's Disease.

Subthalamic nucleus deep brain stimulation (STN-DBS) improves motor symptoms in individuals with advanced Parkinson's disease (PD) and enables physicians to reduce doses of antiparkinsonian drugs. We investigated possible predictive factors for the successful reduction of antiparkinsonian drug dosage after STN-DBS. We evaluated 33 PD patients who underwent bilateral STN-DBS.

Fast modified Self-organizing Deformable Model: Geometrical feature-preserving mapping of organ models onto target surfaces with various shapes and topologies.

Background And Objective: This paper proposes a new method for mapping surface models of human organs onto target surfaces with the same genus as the organs.

Methods: In the proposed method, called modified Self-organizing Deformable Model (mSDM), the mapping problem is formulated as the minimization of an objective function which is defined as the weighted linear combination of four energy functions: model fitness, foldover-free, landmark mapping accuracy, and geometrical feature preservation. Further, we extend mSDM to speed up its processes, and call it Fast mSDM.

[Early Experience with the Vercise DBS System in the Treatment of Dystonic Tremor].

Six cases of dystonic tremor were treated with the Vercise deep brain stimulation(DBS)system, which has the multiple independent current control(MICC)technology. The mean preoperative score of Burke-Fahn-Marsden dystonia rating scale was 16.2±9.

Estimation of brain internal structures by deforming brain atlas using finite element method.

This paper presents a method for estimating the internal structures of a patient brain by deforming a standard brain atlas. Conventional deformation methods need several landmarks from the brain surface contour to fit the atlas to the patient brain shape. However, since the number and shapes of small sulci on the brain surface are different from each other, the determination of the accurate correspondence between small sulcus is difficult for experienced neurosurgeons.

Tolerance of early pallidal stimulation in pediatric generalized dystonia.

The authors report on 2 cases of pediatric generalized dystonia with a DYT1 mutation; the patients, an 11-year-old girl and a 9-year-old boy, underwent chronic, pallidal deep brain stimulation (DBS) of the globus pallidus internus (GPi). The dystonic postures in both cases showed dramatic improvements with pallidal DBS, but each patient's symptoms gradually recurred within a year, irrespective of exhaustive readjustments of the stimulation settings. After the recurrence of the dystonic symptoms, the DBS leads were replaced within the GPi in one patient (Case 1) and additional DBS leads were implanted into the bilateral subthalamic nuclei in the other patient (Case 2).

Short circuit in deep brain stimulation.

Object: The authors undertook this study to investigate the incidence, cause, and clinical influence of short circuits in patients treated with deep brain stimulation (DBS).

Methods: After the incidental identification of a short circuit during routine follow-up, the authors initiated a policy at their institution of routinely evaluating both therapeutic impedance and system impendence at every outpatient DBS follow-up visit, irrespective of the presence of symptoms suggesting possible system malfunction. This study represents a report of their findings after 1 year of this policy.

A simple but accurate method for histological reconstruction of the large-sized brain tissue of the human that is applicable to construction of digitized brain database.

Research on the human brain has undoubted significance, but our knowledge on its detailed morphology is still limited. We have developed a simple method for reconstruction of large-sized brain tissues of the human. Fixed brains were cut into blocks (maximum size 7 cm x 7 cm x 1 cm), embedded and postfixed in gelatin just one overnight before obtaining complete serial sections with a vibrating microtome.

Double lumbosacral lipomas of the dorsal and filar types associated with OEIS complex: case report.

A female baby was born at 37 weeks and 6 days gestation by vaginal delivery with omphalocele, exstrophy of the cloaca, and imperforate anus, indicating the presence of OEIS complex, a rare combination of defects consisting of omphalocele (O), exstrophy of the cloaca (E), imperforate anus (I), and spinal deformity (S), associated with lumbosacral lipoma. The most common associated spinal deformity is terminal myelocystocele, and spinal lipoma is rare. Constructive interference in steady-state magnetic resonance imaging clearly revealed double lipomas, a dorsal-type lipoma, located dorsal to the low-lying conus medullaris, and a filar-type lipoma, revealed by a thickened and fatty filum terminale.

Spectral analysis of field potential recordings by deep brain stimulation electrode for localization of subthalamic nucleus in patients with Parkinson's disease.

Aims: Spectral analysis of local field potential (LFP) recorded by deep brain stimulation (DBS) electrode around the subthalamic nucleus (STN) in patients with Parkinson's disease was performed.

Methods: The borders of the STN were determined by microelectrode recording. The most eligible trajectory for the sensorimotor area of the STN was used for LFP recording while advancing the DBS electrode.

[Intracerebral hemorrhage during multi-track microrecording of deep brain stimulation surgery: a report of three cases].

We described three cases with hemorrhagic complication during simultaneous multi-track microelectrode recording (MER) for stereotactic implantation of a subthalamic nucleus electrode. Although preoperative planning with gadolinium-enhanced T1-weighted MR images is recommended to prevent the occurrence of intracerebral hemorrhage, it should be noted that the danger from cerebral vasculatures is still underestimated. Multiple nonspecific white matter hyperintensities and asymptomatic lacunar infarcts may be suspected as potential risk factors, so, it is suggested that the number of MER penetrations should be restricted in such cases.

Subthalamic nucleus stimulation does not cause deterioration of preexisting hallucinations in Parkinson's disease patients.

Background: Among the neuropsychiatric symptoms in Parkinson's disease (PD) patients, hallucination can result from the disease itself or medical treatment. Hallucination associated with subthalamic nucleus stimulation (STN-DBS) has been reported; however, it is still unclear whether PD patients with a history of hallucination are appropriate candidates for STN-DBS or not.

Aims: We investigated the effect of STN-DBS on preexisting hallucination associated with advanced PD.

Holocord hydrosyringomyelia with terminal myelocystocele revealed by constructive interference in steady-state MR imaging.

We report an operated case with terminal myelocystocele and holocord hydrosyringomyelia (syrinx). The patient exhibited a subcutaneous mass at the right lumbosacral region with multiple anomalies including scoliosis and hyperdactylia of the right foot and systemic disease such as hydronephroureter. Neurological examination revealed palsy of the left diaphragm, and left upper and right lower limbs.

Detailed anatomy of intracranial venous anomalies associated with atretic parietal cephaloceles revealed by high-resolution 3D-CISS and high-field T2-weighted reversed MR images.

Purpose: The advancement of magnetic resonance (MR) imaging technology has revealed that intracranial venous anomalies, such as vertical embryonic positioning of the straight sinus (VEP of SS), are associated with atretic parietal cephaloceles. However, the precise anatomical relationships among the venous anomalies, superior sagittal sinus (SSS), cistern, and cephalocele have not been demonstrated. We compared the imaging features of conventional MR images and high-resolution 3-dimensional (3-D) MR images, such as Fourier-transformation-constructive interference in steady-state (CISS) images and T2-weighted reversed (T2R) images obtained on a 3-T MR machine.

Coexistence of a human tail and congenital dermal sinus associated with lumbosacral lipoma.

We present a female baby with a human tail associated with congenital dermal sinus (CDS) at the caudal site of the tail. Magnetic resonance (MR) images with constructive interference in steady-state (CISS) sequencing clearly demonstrated a lumbosacral lipoma of caudal type, contiguous with the dermal sinus tract and not with the human tail. At 3 months old, the tail was surgically removed.

Medial temporal lobe epilepsy associated with misplacement of a ventricular shunting catheter.

We report the case of a 35-year-old woman who developed right medial temporal lobe epilepsy associated with misplacement of a ventricular shunting catheter in the apex of the right temporal lobe. At 8 years of age, the patient had undergone total removal of a cerebellar astrocytoma and placement of a Torkildsen's ventriculo-cisternal shunt for obstructive hydrocephalus. Although the postoperative course was uneventful, she developed medically intractable psychomotor seizures with secondary generalization at 24 years of age.

Direct localization of subthalamic nucleus supplemented by single-track electrophysiological guidance in deep brain stimulation lead implantation: techniques and clinical results.

Background/aims: In subthalamic nucleus (STN) deep brain stimulation (DBS) lead implantation, it is still controversial whether it is more appropriate to employ indirect or direct methods in magnetic resonance imaging (MRI)-based tentative targeting and to select single- or multiple-track recording in electrophysiological definitive targeting. The efficacy of single-track electrophysiological recording through direct targeting was compared with the conventional indirect targeting methods in light of the identified STN thickness and clinical results.

Methods: The identified mean STN thickness, pre- and 6-month postoperative Unified Parkinson's Disease Rating Scale (UPDRS), dose change of L-dopa and dopaminergic agonists were compared in indirect (midcommissural point-based, 44 procedures) and direct (image-based, 44 procedures) targeting methods.

Assessment of contact location in subthalamic stimulation for Parkinson's disease by co-registration of computed tomography images.

Aims: To study the validity of a co-registration method for postimplantation computed tomography (CT) images for localizing the location of an intracranial deep brain stimulator.

Methods: Three-dimensional reconstruction images of postimplantation CTs were co-registered with preoperative CTs by stereotactic planning software and used to localize 18 leads in the subthalamic nuclei of 10 patients with Parkinson's disease. Our conventional method using superimposition of sagittal postimplantation magnetic resonance (MR) images were employed as a comparison.

Focal cortical dysplasia with calcification: a case report.

Case Report: Focal cortical dysplasia (FCD) with calcification is rare. We presented a 13-year-old epileptic patient with FCD and calcification in the left frontal lobe. At age 24, the FCD lesion and the surrounding epileptogenic cortex and underlying subcortex were removed after chronic subdural electrode recording.

Brain shift: an error factor during implantation of deep brain stimulation electrodes.

Object: The goal of this study was to focus on the tendency of brain shift during stereotactic neurosurgery and the shift's impact on the unilateral and bilateral implantation of electrodes for deep brain stimulation (DBS).

Methods: Eight unilateral and 10 bilateral DBS electrodes at 10 nuclei ventrales intermedii and 18 subthalamic nuclei were implanted in patients at Kaizuka Hospital with the aid of magnetic resonance (MR) imaging-guided and microelectrode-guided methods. Brain shift was assessed as changes in the 3D coordinates of the anterior and posterior commissures (AC and PC) with MR images before and immediately after the implantation surgery.