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Seo Y, Chang KW, Lee J, Kong C, Shin J, Chang JW, Na YC, Chang WS. Optimal timing for drug delivery into the hippocampus by focused ultrasound: A comparison of hydrophilic and lipophilic compounds. Heliyon 2024; 10:e29480. [PMID: 38644896 PMCID: PMC11033133 DOI: 10.1016/j.heliyon.2024.e29480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 04/23/2024] Open
Abstract
Aims Previous studies have reported that focused ultrasound (FUS) helps modulate the blood-brain barrier (BBB). These studies have generally used the paracellular pathway owing to tight junction proteins (TJPs) regulation. However, BBB transport pathways also include diffusion and transcytosis. Few studies have examined transcellular transport across endothelial cells. We supposed that increased BBB permeability caused by FUS may affect transcytosis. We investigated drug delivery through transcytosis and paracellular transport to the brain after BBB modulation using FUS. Main methods FUS and microbubbles were applied to the hippocampus of rats, and were euthanized at 1, 4, 24, and 48 h after sonication. To investigate paracellular transport, we analyzed TJPs, including zona occludens-1 (ZO-1) and occludin. We also investigated caveola-mediated transcytosis by analyzing caveola formation and major facilitator superfamily domain-containing 2a (Mfsd2a) levels, which inhibit caveola vesicle formation. Key findings One hour after FUS, ZO-1 and occludin expression was the lowest and gradually increased over time, returning to baseline 24 h after FUS treatment. Compared with that of TJPs, caveola formation started to increase 1 h after FUS treatment and peaked at 4 h after FUS treatment before returning to baseline by 48 h after FUS treatment. Decreased Mfsd2a levels were observed at 1 h and 4 h after FUS treatment, indicating increased caveola formation. Significance FUS induces BBB permeability changes and regulates both paracellular transport and caveola-mediated transcytosis. However, a time difference was observed between these two mechanisms. Hence, when delivering drugs into the brain after FUS, the optimal drug administration timing should be determined by the mechanism by which each drug passes through the BBB.
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Affiliation(s)
- Younghee Seo
- Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Won Chang
- Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Chanho Kong
- Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jaewoo Shin
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation (K-MEDI Hub), Daegu, 41061, South Korea
| | - Jin Woo Chang
- Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Cheol Na
- Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurosurgery, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon Metropolitan City, South Korea
| | - Won Seok Chang
- Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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Kwon YW, Ahn DB, Park YG, Kim E, Lee DH, Kim SW, Lee KH, Kim WY, Hong YM, Koh CS, Jung HH, Chang JW, Lee SY, Park JU. Power-integrated, wireless neural recording systems on the cranium using a direct printing method for deep-brain analysis. Sci Adv 2024; 10:eadn3784. [PMID: 38569040 PMCID: PMC10990281 DOI: 10.1126/sciadv.adn3784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/27/2024] [Indexed: 04/05/2024]
Abstract
Conventional power-integrated wireless neural recording devices suffer from bulky, rigid batteries in head-mounted configurations, hindering the precise interpretation of the subject's natural behaviors. These power sources also pose risks of material leakage and overheating. We present the direct printing of a power-integrated wireless neural recording system that seamlessly conforms to the cranium. A quasi-solid-state Zn-ion microbattery was 3D-printed as a built-in power source geometrically synchronized to the shape of a mouse skull. Soft deep-brain neural probes, interconnections, and auxiliary electronics were also printed using liquid metals on the cranium with high resolutions. In vivo studies using mice demonstrated the reliability and biocompatibility of this wireless neural recording system, enabling the monitoring of neural activities across extensive brain regions without notable heat generation. This all-printed neural interface system revolutionizes brain research, providing bio-conformable, customizable configurations for improved data quality and naturalistic experimentation.
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Affiliation(s)
- Yong Won Kwon
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul 03722, Republic of Korea
| | - David B. Ahn
- Department of Energy and Chemical Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan 44919, Republic of Korea
| | - Young-Geun Park
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul 03722, Republic of Korea
| | - Enji Kim
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul 03722, Republic of Korea
| | - Dong Ha Lee
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul 03722, Republic of Korea
| | - Sang-Woo Kim
- Department of Energy and Chemical Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan 44919, Republic of Korea
| | - Kwon-Hyung Lee
- Ulsan Advanced Energy Technology R&D Center, Korea Institute of Energy Research (KIER), Ulsan 44776, Republic of Korea
| | - Won-Yeong Kim
- Department of Chemical and Biomolecular Engineering, Yonsei University, Seoul 03772, Republic of Korea
| | - Yeon-Mi Hong
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul 03722, Republic of Korea
| | - Chin Su Koh
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Sang-Young Lee
- Department of Chemical and Biomolecular Engineering, Yonsei University, Seoul 03772, Republic of Korea
| | - Jang-Ung Park
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul 03722, Republic of Korea
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Graduate Program of Nano Biomedical Engineering (NanoBME), Advanced Science Institute, Yonsei University, Seoul 03722, Republic of Korea
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Slavin KV, Régis JM, Hodaie M, Doshi PK, Blomstedt P, Chang JW. Letter: Functional Neurosurgery-A Neglected Aspect of Global Neurosurgery: Call to Action. Neurosurgery 2024; 94:e55-e56. [PMID: 38265211 DOI: 10.1227/neu.0000000000002850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/22/2023] [Indexed: 01/25/2024] Open
Affiliation(s)
- Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
- Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago , Illinois , USA
| | - Jean M Régis
- Aix Marseille University, Neurochirurgie Fonctionnelle & Stéréotaxique Hôpital d'adulte de la Timone, Marseille , France
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto , ON , Canada
| | - Paresh K Doshi
- Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai , Maharastra , India
| | - Patric Blomstedt
- Department of Clinical Neuroscience, Umeå University, Umeå , Sweden
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul , Republic of Korea
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Lee Y, Kim S, Cho YK, Kong C, Chang JW, Jun SB. Amygdala electrical stimulation for operant conditioning in rat navigation. Biomed Eng Lett 2024; 14:291-306. [PMID: 38374898 PMCID: PMC10874353 DOI: 10.1007/s13534-023-00336-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/12/2023] [Accepted: 11/17/2023] [Indexed: 02/21/2024] Open
Abstract
There have been several attempts to navigate the locomotion of animals by neuromodulation. The most common method is animal training with electrical brain stimulation for directional cues and rewards; the basic principle is to activate dopamine-mediated neural reward pathways such as the medial forebrain bundle (MFB) when the animal correctly follows the external commands. In this study, the amygdala, which is the brain region responsible for fear modulation, was targeted for punishment training. The brain regions of MFB, amygdala, and barrel cortex were electrically stimulated for reward, punishment, and directional cues, respectively. Electrical stimulation was applied to the amygdala of rats when they failed to follow directional commands. First, two different amygdala regions, i.e., basolateral amygdala (BLA) and central amygdala (CeA), were stimulated and compared in terms of behavior responses, success and correction rates for training, and gene expression for learning and memory. Then, the training was performed in three groups: group R (MFB stimulation for reward), group P (BLA stimulation for punishment), and group RP (both MFB and BLA stimulation for reward and punishment). In group P, after the training, RNA sequencing was conducted to detect gene expression and demonstrate the effect of punishment learning. Group P showed higher success rates than group R, and group RP exhibited the most effective locomotion control among the three groups. Gene expression results imply that BLA stimulation can be more effective as a punishment in the learning process than CeA stimulation. We developed a new method to navigate rat locomotion behaviors by applying amygdala stimulation.
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Affiliation(s)
- Youjin Lee
- Department of Electronic and Electrical Engineering, Ewha Womans University, Seoul, 03760 Republic of Korea
- Graduate Program in Smart Factory, Ewha Womans University, Seoul, 03760 Republic of Korea
| | - Soonyoung Kim
- Department of Electrical and Computer Engineering, Rice University, Houston, TX 77005 USA
| | - Yoon Kyung Cho
- Department of Electronic and Electrical Engineering, Ewha Womans University, Seoul, 03760 Republic of Korea
| | - Chanho Kong
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, 03722 Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, 03722 Republic of Korea
- Brain Korea 21 PLUS Project for Medical Science and Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722 Republic of Korea
| | - Sang Beom Jun
- Department of Electronic and Electrical Engineering, Ewha Womans University, Seoul, 03760 Republic of Korea
- Graduate Program in Smart Factory, Ewha Womans University, Seoul, 03760 Republic of Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, 03760 Republic of Korea
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Park M, Koh CS, Chang H, Kim TJ, Mun W, Chang JW, Jung HH. Low-frequency (5-Hz) stimulation of ventrolateral periaqueductal gray modulates the descending serotonergic system in the peripheral neuropathic pain. Pain 2024:00006396-990000000-00536. [PMID: 38422490 DOI: 10.1097/j.pain.0000000000003185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/15/2023] [Indexed: 03/02/2024]
Abstract
ABSTRACT Neuropathic pain is a type of chronic pain that entails severe prolonged sensory dysfunctions caused by a lesion of the somatosensory system. Many of those suffering from the condition do not experience significant improvement with existing medications, resulting in various side effects. In this study, Sprague-Dawley male rats were used, and long-term deep brain stimulation of the ventrolateral periaqueductal gray was conducted in a rat model of spared nerve injury. We found that 5-Hz deep brain stimulation effectively modulated mechanical allodynia and induced neuronal activation in the rostral ventromedial medulla, restoring impaired descending serotonergic system. At the spinal level, glial cells were still activated but only the 5-HT1a receptor in the spinal cord was activated, implying its inhibitory role in mechanical allodynia. This study found that peripheral neuropathy caused dysfunction in the descending serotonergic system, and prolonged stimulation of ventrolateral periaqueductal gray can modulate the pathway in an efficient manner. This work would provide new opportunities for the development of targeted and effective treatments for this debilitating disease, possibly giving us lower chances of side effects from repeated high-frequency stimulation or long-term use of medication.
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Affiliation(s)
- Minkyung Park
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chin Su Koh
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Heesue Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Jun Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wonki Mun
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Park YG, Kwon YW, Koh CS, Kim E, Lee DH, Kim S, Mun J, Hong YM, Lee S, Kim JY, Lee JH, Jung HH, Cheon J, Chang JW, Park JU. In-vivo integration of soft neural probes through high-resolution printing of liquid electronics on the cranium. Nat Commun 2024; 15:1772. [PMID: 38413568 PMCID: PMC10899244 DOI: 10.1038/s41467-024-45768-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/01/2024] [Indexed: 02/29/2024] Open
Abstract
Current soft neural probes are still operated by bulky, rigid electronics mounted to a body, which deteriorate the integrity of the device to biological systems and restrict the free behavior of a subject. We report a soft, conformable neural interface system that can monitor the single-unit activities of neurons with long-term stability. The system implements soft neural probes in the brain, and their subsidiary electronics which are directly printed on the cranial surface. The high-resolution printing of liquid metals forms soft neural probes with a cellular-scale diameter and adaptable lengths. Also, the printing of liquid metal-based circuits and interconnections along the curvature of the cranium enables the conformal integration of electronics to the body, and the cranial circuit delivers neural signals to a smartphone wirelessly. In the in-vivo studies using mice, the system demonstrates long-term recording (33 weeks) of neural activities in arbitrary brain regions. In T-maze behavioral tests, the system shows the behavior-induced activation of neurons in multiple brain regions.
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Affiliation(s)
- Young-Geun Park
- Department of Materials Science and Engineering, Yonsei University, Seoul, 03722, South Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul, 03722, South Korea
| | - Yong Won Kwon
- Department of Materials Science and Engineering, Yonsei University, Seoul, 03722, South Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul, 03722, South Korea
| | - Chin Su Koh
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Enji Kim
- Department of Materials Science and Engineering, Yonsei University, Seoul, 03722, South Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul, 03722, South Korea
| | - Dong Ha Lee
- Department of Materials Science and Engineering, Yonsei University, Seoul, 03722, South Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul, 03722, South Korea
| | - Sumin Kim
- Department of Materials Science and Engineering, Yonsei University, Seoul, 03722, South Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul, 03722, South Korea
| | - Jongmin Mun
- Department of Statistics and Data Science, Yonsei University, Seoul, 03722, South Korea
| | - Yeon-Mi Hong
- Department of Materials Science and Engineering, Yonsei University, Seoul, 03722, South Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul, 03722, South Korea
| | - Sanghoon Lee
- Department of Materials Science and Engineering, Yonsei University, Seoul, 03722, South Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul, 03722, South Korea
| | - Ju-Young Kim
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul, 03722, South Korea
- Graduate Program of Nano Biomedical Engineering (NanoBME), Advanced Science Institute, Yonsei University, Seoul, 03722, South Korea
| | - Jae-Hyun Lee
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul, 03722, South Korea
- Graduate Program of Nano Biomedical Engineering (NanoBME), Advanced Science Institute, Yonsei University, Seoul, 03722, South Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, 03722, South Korea.
| | - Jinwoo Cheon
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul, 03722, South Korea.
- Graduate Program of Nano Biomedical Engineering (NanoBME), Advanced Science Institute, Yonsei University, Seoul, 03722, South Korea.
- Department of Chemistry, Yonsei University, Seoul, 03722, South Korea.
| | - Jin Woo Chang
- Department of Neurosurgery, Korea University Anam Hospital, Seoul, 02841, South Korea.
| | - Jang-Ung Park
- Department of Materials Science and Engineering, Yonsei University, Seoul, 03722, South Korea.
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul, 03722, South Korea.
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, 03722, South Korea.
- Graduate Program of Nano Biomedical Engineering (NanoBME), Advanced Science Institute, Yonsei University, Seoul, 03722, South Korea.
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Ahn SH, Koh CS, Park M, Jun SB, Chang JW, Kim SJ, Jung HH, Jeong J. Liquid Crystal Polymer-Based Miniaturized Fully Implantable Deep Brain Stimulator. Polymers (Basel) 2023; 15:4439. [PMID: 38006163 PMCID: PMC10675735 DOI: 10.3390/polym15224439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/22/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
A significant challenge in improving the deep brain stimulation (DBS) system is the miniaturization of the device, aiming to integrate both the stimulator and the electrode into a compact unit with a wireless charging capability to reduce invasiveness. We present a miniaturized, fully implantable, and battery-free DBS system designed for rats, using a liquid crystal polymer (LCP), a biocompatible and long-term reliable material. The system integrates the simulator circuit, the receiver coil, and a 20 mm long depth-type microelectrode array in a dome-shaped LCP package that is 13 mm in diameter and 5 mm in height. Wireless powering and control via an inductive link enable device miniaturization, allowing for full implantation and, thus, the free behavior of untethered animals. The eight-channel stimulation electrode array was microfabricated on an LCP substrate to form a multilayered system substrate, which was monolithically encapsulated by a domed LCP lid using a specialized spot-welding process. The device functionality was validated via an in vivo animal experiment using a neuropathic pain model in rats. This experiment demonstrated an increase in the mechanical withdrawal threshold of the rats with microelectrical stimulation delivered using the fully implanted device, highlighting the effectiveness of the system.
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Affiliation(s)
- Seung-Hee Ahn
- Department of Electrical and Computer Engineering, College of Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Chin Su Koh
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Minkyung Park
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sang Beom Jun
- Department of Electronic and Electrical Engineering, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sung June Kim
- Department of Electrical and Computer Engineering, College of Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Joonsoo Jeong
- School of Biomedical Convergence Engineering, Pusan National University, Yangsan 50612, Republic of Korea
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Park M, Woo HN, Koh CS, Chang H, Kim JH, Park K, Chang JW, Lee H, Jung HH. A Single Injection of rAAV-shmTOR in Peripheral Nerve Persistently Attenuates Nerve Injury-Induced Mechanical Allodynia. Int J Mol Sci 2023; 24:15918. [PMID: 37958901 PMCID: PMC10649356 DOI: 10.3390/ijms242115918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Activation of mammalian target of rapamycin (mTOR) has been known as one of the contributing factors in nociceptive sensitization after peripheral injury. Its activation followed by the phosphorylation of downstream effectors causes hyperexcitability of primary sensory neurons in the dorsal root ganglion. We investigated whether a single injection of rAAV-shmTOR would effectively downregulate both complexes of mTOR in the long-term and glial activation as well. Male SD rats were categorized into shmTOR (n = 29), shCON (n = 23), SNI (n = 13), and Normal (n = 8) groups. Treatment groups were injected with rAAV-shmTOR or rAAV-shCON, respectively. DRG tissues and sciatic nerve were harvested for Western blot and immunohistochemical analyses. Peripheral sensitization was gradually attenuated in the shmTOR group, and it reached a peak on PID 21. Western blot analysis showed that both p-mTORC1 and p-mTORC2 were downregulated in the DRG compared to shCON and SNI groups. We also found decreased expression of phosphorylated p38 and microglial activation in the DRG. We first attempted a therapeutic strategy for neuropathic pain with a low dose of AAV injection by interfering with the mTOR signaling pathway, suggesting its potential application in pain treatment.
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Affiliation(s)
- Minkyung Park
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (M.P.); (C.S.K.); (H.C.); (J.W.C.)
- Brain Korea 21 PLUS Project for Medical Science and Brain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Ha-Na Woo
- Department of Biochemistry & Molecular Biology, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
- Bio-Medical Institute of Technology, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
| | - Chin Su Koh
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (M.P.); (C.S.K.); (H.C.); (J.W.C.)
| | - Heesue Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (M.P.); (C.S.K.); (H.C.); (J.W.C.)
| | - Ji Hyun Kim
- Bio-Medical Institute of Technology, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
- Department of Microbiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul 05505, Republic of Korea
| | - Keerang Park
- Cedmogen Co., Ltd., Cheongju 28644, Republic of Korea;
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (M.P.); (C.S.K.); (H.C.); (J.W.C.)
- Brain Korea 21 PLUS Project for Medical Science and Brain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Heuiran Lee
- Bio-Medical Institute of Technology, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
- Department of Microbiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul 05505, Republic of Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (M.P.); (C.S.K.); (H.C.); (J.W.C.)
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Lee J, Chang KW, Jung HH, Kim D, Chang JW, Song DH. One-year outcomes of deep brain stimulation in refractory Tourette syndrome. Psychiatry Clin Neurosci 2023; 77:605-612. [PMID: 37565663 DOI: 10.1111/pcn.13584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023]
Abstract
AIM Deep brain stimulation (DBS) is one option for treating refractory Tourette syndrome (TS); however, it remains unclear which preoperative factors are predictive of DBS outcomes. This study investigated the efficacy of DBS targeting the anteromedial globus pallidus internus and evaluated predisposing factors affecting the outcomes of DBS in a single center in Korea. METHOD Twenty patients who had undergone DBS for refractory TS were reviewed retrospectively. Tic symptoms were followed up at 3-month intervals for up to 1 year after surgery. The Yale Global Tic Severity Scale was used to evaluate preoperative/postoperative tic symptoms. Scores from the Yale-Brown Obsessive Compulsive Scale, Beck Depression Inventory-II, and Beck Anxiety Inventory were also evaluated. RESULTS Patients with refractory TS achieved improvement in tic symptoms within 1 year after DBS. Initial responders who achieved a 35% reduction in Yale Global Tic Severity Scale total score within the first 3 months after DBS showed larger treatment effects during 1-year follow-up. Although no clinical or demographic factors were predictive of initial responses, patients with serious self-injurious behaviors tended to show delayed responses. CONCLUSION This is the first study to our knowledge to report the DBS outcomes of 20 patients with TS in a single center in Asia. Our study supports the efficacy of DBS targeting anteromedial globus pallidus internus in refractory TS with no evident serious adverse events. Initial responses after DBS seem to be a predictor of long-term outcomes after surgery.
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Affiliation(s)
- Junghan Lee
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Won Chang
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Ho Jung
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dre Kim
- Iian Psychiatric Clinic, Sejong, Republic of Korea
| | - Jin Woo Chang
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong-Ho Song
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Park JY, Park J, Baek J, Chang JW, Kim YG, Chang WS. Long-term results on the suppression of secondary brain injury by early administered low-dose baclofen in a traumatic brain injury mouse model. Sci Rep 2023; 13:18563. [PMID: 37903976 PMCID: PMC10616194 DOI: 10.1038/s41598-023-45600-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/21/2023] [Indexed: 11/01/2023] Open
Abstract
Secondary injury from traumatic brain injury (TBI) perpetuates cerebral damages through varied ways. Attenuating neuroinflammation, which is a key feature of TBI, is important for long-term prognosis of its patients. Baclofen, a muscle relaxant, has shown promise in reducing excessive inflammation in other neurologic disorders. However, its effectiveness in TBI remains ambiguous. Thus, our study aimed to investigate whether early administration of baclofen could elicit potential therapeutic effects by diminishing exaggerated neuroinflammation in TBI mice. In this study, 80 C57BL/6 mice were used, of which 69 mice received controlled cortical impact. The mice were divided into six groups (11-16 mice each). Baclofen, administered at dose of 0.05, 0.2 and 1 mg/kg, was injected intraperitoneally a day after TBI for 3 consecutive weeks. 3 weeks after completing the treatments, the mice were assessed histologically. The results showed that mice treated with baclofen exhibited a significantly lower volume of lesion tissue than TBI mice with normal saline. Baclofen also reduced activated glial cells with neurotoxic immune molecules and inhibited apoptotic cells. Significant recovery was observed and sustained for 6 weeks at the 0.2 mg/kg dose in the modified neurological severity score. Furthermore, memory impairment was recovered with low-doses of baclofen in the Y-maze. Our findings demonstrate that early administration of low dose baclofen can regulate neuroinflammation, prevent cell death, and improve TBI motor and cognitive abnormalities.
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Affiliation(s)
- Ji Young Park
- Department of Neurosurgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Junwon Park
- Department of Neurosurgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jiwon Baek
- Department of Neurosurgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Brain Korea 21 PLUS Project for Medical Science and Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Goo Kim
- Department of Neurosurgery, Ewha Womans University School of Medicine, Ewha Womans University Mokdong Hospital, Mok 5-dong, Yangcheon-gu, Seoul, 07985, Republic of Korea.
| | - Won Seok Chang
- Department of Neurosurgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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11
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Boo YJ, Kim DW, Park JY, Kim BS, Chang JW, Kang JI, Kim SJ. Altered prefrontal beta oscillatory activity during removal of information from working memory in obsessive-compulsive disorder. BMC Psychiatry 2023; 23:645. [PMID: 37667294 PMCID: PMC10478376 DOI: 10.1186/s12888-023-05149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is related to working memory impairment. Since patients with OCD have difficulty controlling their obsessive thoughts, removal of irrelevant information might be important in the pathophysiology of OCD. However, little is known about brain activity during the removal of information from working memory in patients with OCD. Our goal was to explore potential deficits in inhibitory function related to working memory processes in patients with OCD. METHODS Sixteen OCD patients and 20 healthy controls (HCs) were recruited. We compared in prefrontal alpha and beta band activity derived from magnetoencephalography (MEG) between patients with OCD and HCs during multiple phases of information processing associated with working memory, especially in post-trial period of the visuospatial working memory task (the delayed matching-to-sample task), which is presumed to be related to the information removal process of working memory. RESULTS Prefrontal post-trial beta power change (presumed to occur at high levels during the post-trial period) exhibited significant reductions in patients with OCD compared to HCs. In addition, the post-trial beta power change was negatively correlated with Obsessive-Compulsive Inventory-Revised total scores in patients with OCD. CONCLUSIONS These findings suggest that impairment in the removal of information from working memory might be a key mechanism underlying the inability of OCD patients to rid themselves of their obsessions.
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Affiliation(s)
- Young Jun Boo
- Department of Psychiatry, Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Do-Won Kim
- Department of Biomedical Engineering, College of Engineering Sciences, Chonnam National University, 50 Daehak-ro, Yeosu, Republic of Korea
- School of Healthcare and Biomedical Engineering, College of Engineering Sciences, Chonnam National University, 50 Daehak-ro, Yeosu, Republic of Korea
| | - Jin Young Park
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Bong Soo Kim
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee In Kang
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
| | - Se Joo Kim
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
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12
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Kong C, Ahn JW, Kim S, Park JY, Na YC, Chang JW, Chung S, Chang WS. Long-lasting restoration of memory function and hippocampal synaptic plasticity by focused ultrasound in Alzheimer's disease. Brain Stimul 2023; 16:857-866. [PMID: 37211337 DOI: 10.1016/j.brs.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/06/2023] [Accepted: 05/17/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Focused ultrasound (FUS) is a medical technology that non-invasively stimulates the brain and has been applied in thermal ablation, blood-brain barrier (BBB) opening, and neuromodulation. In recent years, numerous experiences and indications for the use of FUS in clinical and preclinical studies have rapidly expanded. Focused ultrasound-mediated BBB opening induces cognitive enhancement and neurogenesis; however, the underlying mechanisms have not been elucidated. METHODS Here, we investigate the effects of FUS-mediated BBB opening on hippocampal long-term potentiation (LTP) and cognitive function in a 5xFAD mouse model of Alzheimer's disease (AD). We applied FUS with microbubble to the hippocampus and LTP was measured 6 weeks after BBB opening using FUS. Field recordings were made with a concentric bipolar electrode positioned in the CA1 region using an extracellular glass pipette filled with artificial cerebrospinal fluid. Morris water maze and Y-maze was performed to test cognitive function. RESULTS Our results demonstrated that FUS-mediated BBB opening has a significant impact on increasing LTP at Schaffer collateral - CA1 synapses and rescues cognitive dysfunction and working memory. These effects persisted for up to 7 weeks post-treatment. Also, FUS-mediated BBB opening in the hippocampus increased PKA phosphorylation. CONCLUSION Therefore, it could be a promising treatment for neurodegenerative diseases as it remarkably increases LTP, thereby improving working memory.
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Affiliation(s)
- Chanho Kong
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Woong Ahn
- Department of Physiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sohyun Kim
- Department of Physiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Young Park
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Cheol Na
- Department of Neurosurgery, Catholic Kwandong University College of Medicine, International St Mary's Hospital, Incheon, Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seungsoo Chung
- Department of Physiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Won Seok Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
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13
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Park J, Kong C, Shin J, Park JY, Na YC, Han SH, Chang JW, Song SH, Chang WS. Combined Effects of Focused Ultrasound and Photodynamic Treatment for Malignant Brain Tumors Using C6 Glioma Rat Model. Yonsei Med J 2023; 64:233-242. [PMID: 36996894 PMCID: PMC10067799 DOI: 10.3349/ymj.2022.0422] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE Glioblastoma (GBM) is an intractable disease for which various treatments have been attempted, but with little effect. This study aimed to measure the effect of photodynamic therapy (PDT) and sonodynamic therapy (SDT), which are currently being used to treat brain tumors, as well as sono-photodynamic therapy (SPDT), which is the combination of these two. MATERIALS AND METHODS Four groups of Sprague-Dawley rats were injected with C6 glioma cells in a cortical region and treated with PDT, SDT, and SPDT. Gd-MRI was monitored weekly and 18F-FDG-PET the day before and 1 week after the treatment. The acoustic power used during sonication was 5.5 W/cm² using a 0.5-MHz single-element transducer. The 633-nm laser was illuminated at 100 J/cm². Oxidative stress and apoptosis markers were evaluated 3 days after treatment using immunohistochemistry (IHC): 4-HNE, 8-OhdG, and Caspase-3. RESULTS A decrease in tumor volume was observed in MRI imaging 12 days after the treatment in the PDT group (p<0.05), but the SDT group showed a slight increase compared to the 5-Ala group. The high expression rates of reactive oxygen species-related factors, such as 8-OhdG (p<0.001) and Caspase-3 (p<0.001), were observed in the SPDT group compared to other groups in IHC. CONCLUSION Our findings show that light with sensitizers can inhibit GBM growth, but not ultrasound. Although SPDT did not show the combined effect in MRI, high oxidative stress was observed in IHC. Further studies are needed to investigate the safety parameters to apply ultrasound in GBM.
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Affiliation(s)
- Junwon Park
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chanho Kong
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jaewoo Shin
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Young Park
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Cheol Na
- Department of Neurosurgery, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Korea
| | - Seung Hee Han
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyun Song
- Department of Electronics Engineering, Sookmyung Women's University, Seoul, Korea.
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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14
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Cosgrove GR, Lipsman N, Lozano AM, Chang JW, Halpern C, Ghanouni P, Eisenberg H, Fishman P, Taira T, Schwartz ML, McDannold N, Hayes M, Ro S, Shah B, Gwinn R, Santini VE, Hynynen K, Elias WJ. Magnetic resonance imaging-guided focused ultrasound thalamotomy for essential tremor: 5-year follow-up results. J Neurosurg 2023; 138:1028-1033. [PMID: 35932269 PMCID: PMC10193464 DOI: 10.3171/2022.6.jns212483] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 06/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate, at 4 and 5 years posttreatment, the long-term safety and efficacy of unilateral MRI-guided focused ultrasound (MRgFUS) thalamotomy for medication-refractory essential tremor in a cohort of patients from a prospective, controlled, multicenter clinical trial. METHODS Outcomes per the Clinical Rating Scale for Tremor (CRST), including postural tremor scores (CRST Part A), combined hand tremor/motor scores (CRST Parts A and B), and functional disability scores (CRST Part C), were measured by a qualified neurologist. The Quality of Life in Essential Tremor Questionnaire (QUEST) was used to assess quality of life. CRST and QUEST scores at 48 and 60 months post-MRgFUS were compared to those at baseline to assess treatment efficacy and durability. All adverse events (AEs) were reported. RESULTS Forty-five and 40 patients completed the 4- and 5-year follow-ups, respectively. CRST scores for postural tremor (Part A) for the treated hand remained significantly improved by 73.3% and 73.1% from baseline at both 48 and 60 months posttreatment, respectively (both p < 0.0001). Combined hand tremor/motor scores (Parts A and B) also improved by 49.5% and 40.4% (p < 0.0001) at each respective time point. Functional disability scores (Part C) increased slightly over time but remained significantly improved through the 5 years (p < 0.0001). Similarly, QUEST scores remained significantly improved from baseline at year 4 (p < 0.0001) and year 5 (p < 0.0003). All previously reported AEs remained mild or moderate, and no new AEs were reported. CONCLUSIONS Unilateral MRgFUS thalamotomy demonstrates sustained and significant tremor improvement at 5 years with an overall improvement in quality-of-life measures and without any progressive or delayed complications. Clinical trial registration no.: NCT01827904 (ClinicalTrials.gov).
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Affiliation(s)
| | | | - Andres M. Lozano
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | | | - Pejman Ghanouni
- Radiology, Stanford University School of Medicine, Stanford, California
| | | | - Paul Fishman
- Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | | | - Nathan McDannold
- Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Susie Ro
- Neurology, Swedish Neuroscience Center, Seattle, Washington; and
| | - Binit Shah
- Neurology, University of Virginia School of Medicine, Charlottesville, Virginia
| | | | | | - Kullervo Hynynen
- Radiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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15
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Chang JG, Kim DW, Jung HH, Chang WS, Kim CH, Kim SJ, Chang JW. Evaluation of changes in neural oscillation after bilateral capsulotomy in treatment refractory obsessive-compulsive disorder using magnetoencephalogram. Asian J Psychiatr 2023; 82:103473. [PMID: 36706511 DOI: 10.1016/j.ajp.2023.103473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
Bilateral thermal capsulotomy with magnetic resonance-guided focused ultrasound (MRgFUS-capsulotomy) is a promising treatment option for treatment-refractory obsessive-compulsive disorder (OCD). Herein, we investigated the effects of bilateral thermal capsulotomy with MRgFUS on neural oscillations in treatment-refractory OCD patients. Eight patients underwent resting-state MEG with repeated recordings before and 1 and 6 months after MRgFUS-capsulotomy, and the oscillatory power and phase coherence over the entire cortical sensor area were measured. After MRgFUS-capsulotomy, the high beta band power in the fronto-central and temporal areas decreased at 1 month and remained stable for 6 months. Cortical connectivity of the high beta band gradually decreased over the entire cortical area during the following 6 months. At 1 month, improvement in anxiety and depression symptoms was significantly correlated with changes in high beta band power in both the frontotemporal and temporal areas. The treatment effect of MRgFUS-capsulotomy may be attributed to the cortical high beta band. Our results provide an advanced understanding of the neural mechanisms underlying MRgFUS-capsulotomy and other neuromodulatory interventions for treatment-refractory OCD.
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Affiliation(s)
- Jhin Goo Chang
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, the Republic of Korea.
| | - Do-Won Kim
- School of Healthcare and Biomedical Engineering, Chonnam National University, Yeosu, the Republic of Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, the Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, the Republic of Korea
| | - Chan-Hyung Kim
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, the Republic of Korea
| | - Se Joo Kim
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, the Republic of Korea.
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, the Republic of Korea.
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16
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Seo Y, Han S, Song BW, Chang JW, Na YC, Chang WS. Endogenous Neural Stem Cell Activation after Low-Intensity Focused Ultrasound-Induced Blood–Brain Barrier Modulation. Int J Mol Sci 2023; 24:ijms24065712. [PMID: 36982785 PMCID: PMC10056062 DOI: 10.3390/ijms24065712] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Endogenous neural stem cells (eNSCs) in the adult brain, which have the potential to self-renew and differentiate into functional, tissue-appropriate cell types, have raised new expectations for neurological disease therapy. Low-intensity focused ultrasound (LIFUS)-induced blood–brain barrier modulation has been reported to promote neurogenesis. Although these studies have reported improved behavioral performance and enhanced expression of brain biomarkers after LIFUS, indicating increased neurogenesis, the precise mechanism remains unclear. In this study, we evaluated eNSC activation as a mechanism for neurogenesis after LIFUS-induced blood–brain barrier modulation. We evaluated the specific eNSC markers, Sox-2 and nestin, to confirm the activation of eNSCs. We also performed 3′-deoxy-3′[18F] fluoro-L-thymidine positron emission tomography ([18F] FLT-PET) to evaluate the activation of eNSCs. The expression of Sox-2 and nestin was significantly upregulated 1 week after LIFUS. After 1 week, the upregulated expression decreased sequentially; after 4 weeks, the upregulated expression returned to that of the control group. [18F] FLT-PET images also showed higher stem cell activity after 1 week. The results of this study indicated that LIFUS could activate eNSCs and induce adult neurogenesis. These results show that LIFUS may be useful as an effective treatment for patients with neurological damage or neurological disorders in clinical settings.
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Affiliation(s)
- Younghee Seo
- Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine, Seodaemun-gu, Seoul 03722, Republic of Korea
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Sangheon Han
- Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Byeong-Wook Song
- Department for Medical Science, College of Medicine, Catholic Kwandong University, Gangwon-do, Gangneung City 25601, Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine, Seodaemun-gu, Seoul 03722, Republic of Korea
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Young Cheol Na
- Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine, Seodaemun-gu, Seoul 03722, Republic of Korea
- Department of Neurosurgery, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Seo-gu, Incheon Metropolitan City 22711, Republic of Korea
- Correspondence: (Y.C.N.); (W.S.C.)
| | - Won Seok Chang
- Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine, Seodaemun-gu, Seoul 03722, Republic of Korea
- Correspondence: (Y.C.N.); (W.S.C.)
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17
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Chang KW, Hong SW, Chang WS, Jung HH, Chang JW. Characteristics of Focused Ultrasound Mediated Blood-Brain Barrier Opening in Magnetic Resonance Images. J Korean Neurosurg Soc 2023; 66:172-182. [PMID: 36537034 PMCID: PMC10009247 DOI: 10.3340/jkns.2022.0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The blood-brain barrier (BBB) is an obstacle for molecules to pass through from blood to the brain. Focused ultrasound is a new method which temporarily opens the BBB, which makes pharmaceutical delivery or removal of neurodegenerative proteins possible. This study was demonstrated to review our BBB opening procedure with magnetic resonance guided images and find specific patterns in the BBB opening. METHODS In this study, we reviewed the procedures and results of two clinical studies on BBB opening using focused ultrasound regarding its safety and clinical efficacy. Magnetic resonance images were also reviewed to discover any specific findings. RESULTS Two clinical trials showed clinical benefits. All clinical trials demonstrated safe BBB opening, with no specific side effects. Magnetic resonance imaging showed temporary T1 contrast enhancement in the sonication area, verifying the BBB opening. Several low-signal intensity spots were observed in the T2 susceptibility-weighted angiography images, which were also reversible and temporary. Although these spots can be considered as microbleeding, evidence suggests these are not ordinary microbleeding but an indicator for adequate BBB opening. CONCLUSION Magnetic resonance images proved safe and efficient BBB opening in humans, using focused ultrasound.
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Affiliation(s)
- Kyung Won Chang
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Woo Hong
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Won Seok Chang
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ho Jung
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Woo Chang
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
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18
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Krishna V, Fishman PS, Eisenberg HM, Kaplitt M, Baltuch G, Chang JW, Chang WC, Martinez Fernandez R, Del Alamo M, Halpern CH, Ghanouni P, Eleopra R, Cosgrove R, Guridi J, Gwinn R, Khemani P, Lozano AM, McDannold N, Fasano A, Constantinescu M, Schlesinger I, Dalvi A, Elias WJ. Trial of Globus Pallidus Focused Ultrasound Ablation in Parkinson's Disease. N Engl J Med 2023; 388:683-693. [PMID: 36812432 DOI: 10.1056/nejmoa2202721] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Unilateral focused ultrasound ablation of the internal segment of globus pallidus has reduced motor symptoms of Parkinson's disease in open-label studies. METHODS We randomly assigned, in a 3:1 ratio, patients with Parkinson's disease and dyskinesias or motor fluctuations and motor impairment in the off-medication state to undergo either focused ultrasound ablation opposite the most symptomatic side of the body or a sham procedure. The primary outcome was a response at 3 months, defined as a decrease of at least 3 points from baseline either in the score on the Movement Disorders Society-Unified Parkinson's Disease Rating Scale, part III (MDS-UPDRS III), for the treated side in the off-medication state or in the score on the Unified Dyskinesia Rating Scale (UDysRS) in the on-medication state. Secondary outcomes included changes from baseline to month 3 in the scores on various parts of the MDS-UPDRS. After the 3-month blinded phase, an open-label phase lasted until 12 months. RESULTS Of 94 patients, 69 were assigned to undergo ultrasound ablation (active treatment) and 25 to undergo the sham procedure (control); 65 patients and 22 patients, respectively, completed the primary-outcome assessment. In the active-treatment group, 45 patients (69%) had a response, as compared with 7 (32%) in the control group (difference, 37 percentage points; 95% confidence interval, 15 to 60; P = 0.003). Of the patients in the active-treatment group who had a response, 19 met the MDS-UPDRS III criterion only, 8 met the UDysRS criterion only, and 18 met both criteria. Results for secondary outcomes were generally in the same direction as those for the primary outcome. Of the 39 patients in the active-treatment group who had had a response at 3 months and who were assessed at 12 months, 30 continued to have a response. Pallidotomy-related adverse events in the active-treatment group included dysarthria, gait disturbance, loss of taste, visual disturbance, and facial weakness. CONCLUSIONS Unilateral pallidal ultrasound ablation resulted in a higher percentage of patients who had improved motor function or reduced dyskinesia than a sham procedure over a period of 3 months but was associated with adverse events. Longer and larger trials are required to determine the effect and safety of this technique in persons with Parkinson's disease. (Funded by Insightec; ClinicalTrials.gov number, NCT03319485.).
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Affiliation(s)
- Vibhor Krishna
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Paul S Fishman
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Howard M Eisenberg
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Michael Kaplitt
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Gordon Baltuch
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Jin Woo Chang
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Wei-Chieh Chang
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Raul Martinez Fernandez
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Marta Del Alamo
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Casey H Halpern
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Pejman Ghanouni
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Roberto Eleopra
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Rees Cosgrove
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Jorge Guridi
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Ryder Gwinn
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Pravin Khemani
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Andres M Lozano
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Nathan McDannold
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Alfonso Fasano
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Marius Constantinescu
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Ilana Schlesinger
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - Arif Dalvi
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
| | - W Jeff Elias
- From the University of North Carolina, Chapel Hill (V.K.); University of Maryland, Baltimore (P.S.F., H.M.E.); Cornell University (M.K.) and Columbia University (G.B.) - both in New York; Yonsei University, Seoul (J.W.C.); Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan (W.-C.C.); Centro Integral de Neurociencias Abarca Campal-HM Puerta Del Sur, Madrid (R.M.F., M.A.), and Clínica Universidad de Navarra, Pamplona (J.G.) - both in Spain; University of Pennsylvania, Philadelphia (C.H.H.); Stanford University, Stanford, CA (P.G.); Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy (R.E.); Harvard University, Boston (R.C., N.M.); Swedish Hospital, Seattle (R.G., P.K.); University of Toronto, Toronto (A.M.L., A.F.); Rambam Health Care Campus, Haifa, Israel (M.C., I.S.); Palm Beach Neuroscience Institute, Boynton Beach, FL (A.D.); and University of Virginia, Charlottesville (W.J.E.)
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Schulder M, Mishra A, Mammis A, Horn A, Boutet A, Blomstedt P, Chabardes S, Flouty O, Lozano AM, Neimat JS, Ponce F, Starr PA, Krauss JK, Hariz M, Chang JW. Advances in Technical Aspects of Deep Brain Stimulation Surgery. Stereotact Funct Neurosurg 2023; 101:112-134. [PMID: 36809747 PMCID: PMC10184879 DOI: 10.1159/000529040] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/19/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Deep brain stimulation has become an established technology for the treatment of patients with a wide variety of conditions, including movement disorders, psychiatric disorders, epilepsy, and pain. Surgery for implantation of DBS devices has enhanced our understanding of human physiology, which in turn has led to advances in DBS technology. Our group has previously published on these advances, proposed future developments, and examined evolving indications for DBS. SUMMARY The crucial roles of structural MR imaging pre-, intra-, and post-DBS procedure in target visualization and confirmation of targeting are described, with discussion of new MR sequences and higher field strength MRI enabling direct visualization of brain targets. The incorporation of functional and connectivity imaging in procedural workup and their contribution to anatomical modelling is reviewed. Various tools for targeting and implanting electrodes, including frame-based, frameless, and robot-assisted, are surveyed, and their pros and cons are described. Updates on brain atlases and various software used for planning target coordinates and trajectories are presented. The pros and cons of asleep versus awake surgery are discussed. The role and value of microelectrode recording and local field potentials are described, as well as the role of intraoperative stimulation. Technical aspects of novel electrode designs and implantable pulse generators are presented and compared.
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Affiliation(s)
- Michael Schulder
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Akash Mishra
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA,
| | - Antonios Mammis
- Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Andres Horn
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,MGH Neurosurgery and Center for Neurotechnology and Neurorecovery (CNTR), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, Universität zu Berlin, Berlin, Germany
| | - Alexandre Boutet
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Patric Blomstedt
- Department of Clinical Neuroscience, University of Umea, Umea, Sweden
| | - Stephan Chabardes
- Department of Neurosurgery, Grenoble-Alpes University Hospital, Grenoble, France
| | - Oliver Flouty
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Joseph S Neimat
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Francisco Ponce
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
| | - Marwan Hariz
- Department of Clinical Neuroscience, University of Umea, Umea, Sweden.,UCL-Queen Square Institute of Neurology, London, UK
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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20
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Pae C, Kim MJ, Chang WS, Jung HH, Chang KW, Eo J, Park HJ, Chang JW. Differences in intrinsic functional networks in patients with essential tremor who had good and poor long-term responses after thalamotomy performed using MR-guided ultrasound. J Neurosurg 2023; 138:318-328. [PMID: 35901685 DOI: 10.3171/2022.5.jns22324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Thalamotomy at the nucleus ventralis intermedius using MR-guided focused ultrasound has been an effective treatment method for essential tremor (ET). However, this is not true for all cases, even for successful ablation. How the brain differs in patients with ET between those with long-term good and poor outcomes is not clear. To analyze the functional connectivity difference between patients in whom thalamotomy was effective and those in whom thalamotomy was ineffective and its prognostic role in ET treatment, the authors evaluated preoperative resting-state functional MRI in thalamotomy-treated patients. METHODS Preoperative resting-state functional MRI data in 85 patients with ET, who were experiencing tremor relief at the time of treatment and were followed up for a minimum of 6 months after the procedure, were collected for the study. The authors conducted a graph independent component analysis of the functional connectivity matrices of tremor-related networks. The patients were divided into thalamotomy-effective and thalamotomy-ineffective groups (thalamotomy-effective group, ≥ 50% motor symptom reduction; thalamotomy-ineffective group, < 50% motor symptom reduction at 6 months after treatment) and the authors compared network components between groups. RESULTS Seventy-two (84.7%) of the 85 patients showed ≥ 50% tremor reduction from baseline at 6 months after thalamotomy. The network analysis shows significant suppression of functional network components with connections between the areas of the cerebellum and the basal ganglia and thalamus, but enhancement of those between the premotor cortex and supplementary motor area in the noneffective group compared to the effective group. CONCLUSIONS The present study demonstrates that patients in the noneffective group have suppressed functional subnetworks in the cerebellum and subcortex regions and have enhanced functional subnetworks among motor-sensory cortical networks compared to the thalamotomy-effective group. Therefore, the authors suggest that the functional connectivity pattern might be a possible predictive factor for outcomes of MR-guided focused ultrasound thalamotomy.
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Affiliation(s)
- Chongwon Pae
- 1Center for Systems and Translational Brain Sciences, Institute of Human Complexity and Systems Science, Yonsei University, Seoul.,2Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul.,8Department of Psychiatry, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Myung Ji Kim
- 3Department of Neurosurgery, Korea University College of Medicine, Korea University Medical Center, Ansan Hospital, Gyeonggi-do
| | - Won Seok Chang
- 4Department of Neurosurgery, Yonsei University College of Medicine, Seoul.,5Center for Innovative Functional Neurosurgery, Brain Research Institute, Seoul
| | - Hyun Ho Jung
- 4Department of Neurosurgery, Yonsei University College of Medicine, Seoul.,5Center for Innovative Functional Neurosurgery, Brain Research Institute, Seoul
| | - Kyung Won Chang
- 4Department of Neurosurgery, Yonsei University College of Medicine, Seoul
| | - Jinseok Eo
- 1Center for Systems and Translational Brain Sciences, Institute of Human Complexity and Systems Science, Yonsei University, Seoul.,2Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul.,6Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul
| | - Hae-Jeong Park
- 1Center for Systems and Translational Brain Sciences, Institute of Human Complexity and Systems Science, Yonsei University, Seoul.,2Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul.,6Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul.,7Department of Cognitive Science, Yonsei University, Seoul; and
| | - Jin Woo Chang
- 4Department of Neurosurgery, Yonsei University College of Medicine, Seoul.,5Center for Innovative Functional Neurosurgery, Brain Research Institute, Seoul
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Kim MJ, Jung HH, Kim YB, Chang JH, Chang JW, Park KY, Chang WS. Comparison of Single-Session, Neoadjuvant, and Adjuvant Embolization Gamma Knife Radiosurgery for Arteriovenous Malformation. Neurosurgery 2022; 92:986-997. [PMID: 36700732 DOI: 10.1227/neu.0000000000002308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/14/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The purpose of intracranial arteriovenous malformations (AVMs) treatment is to prevent bleeding or subsequent hemorrhage with complete obliteration. For large, difficult-to-treat AVMs, multimodal approaches including surgery, endovascular embolization, and gamma knife radiosurgery (GKRS) are frequently used. OBJECTIVE To analyze the outcomes of AVMs treated with single-session, neoadjuvant, and adjuvant embolization GKRS. METHODS We retrospectively reviewed a database of 453 patients with AVMs who underwent GKRS between January 2007 and December 2017 at our facility. The obliteration rate, incidence of latent period bleeding, cyst formation, and radiation-induced changes were compared among the 3 groups, neoadjuvant-embolized, adjuvant-embolized, nonembolized group. In addition, the variables predicting AVM obliteration and complications were investigated. RESULTS A total of 228 patients were enrolled in this study. The neoadjuvant-embolized, adjuvant-embolized, and nonembolized groups comprised 29 (12.7%), 19 (8.3%), and 180 (78.9%) patients, respectively. Significant differences were detected among the 3 groups in the history of previous hemorrhage and the presence of aneurysms ( P < .0001). Multivariate Cox regression analyses revealed a significant inverse correlation between neoadjuvant embolization and obliteration occurring 36 months after GKRS (hazard ratio, 0.326; P = .006). CONCLUSION GKRS with either neoadjuvant or adjuvant embolization is a beneficial approach for the treatment of AVMs with highly complex angioarchitectures that are at risk for hemorrhage during the latency period. Embolization before GKRS may be a negative predictive factor for late-stage obliteration (>36 months). To confirm our conclusions, further studies involving a larger number of patients and continuous follow-up are necessary.
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Affiliation(s)
- Myung Ji Kim
- Department of Neurosurgery, Korea University College of Medicine, Korea University Ansan Hospital, Gyeonggi-do, Republic of Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Keun Young Park
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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22
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Kong C, Yang EJ, Shin J, Park J, Kim SH, Park SW, Chang WS, Lee CH, Kim H, Kim HS, Chang JW. Enhanced delivery of a low dose of aducanumab via FUS in 5×FAD mice, an AD model. Transl Neurodegener 2022; 11:57. [PMID: 36575534 PMCID: PMC9793531 DOI: 10.1186/s40035-022-00333-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/08/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Aducanumab (Adu), which is a human IgG1 monoclonal antibody that targets oligomer and fibril forms of beta-amyloid, has been reported to reduce amyloid pathology and improve impaired cognition after administration of a high dose (10 mg/kg) of the drug in Alzheimer's disease (AD) clinical trials. The purpose of this study was to investigate the effects of a lower dose of Adu (3 mg/kg) with enhanced delivery via focused ultrasound (FUS) in an AD mouse model. METHODS The FUS with microbubbles opened the blood-brain barrier (BBB) of the hippocampus for the delivery of Adu. The combined therapy of FUS and Adu was performed three times in total and each treatment was performed biweekly. Y-maze test, Brdu labeling, and immunohistochemical experimental methods were employed in this study. In addition, RNA sequencing and ingenuity pathway analysis were employed to investigate gene expression profiles in the hippocampi of experimental animals. RESULTS The FUS-mediated BBB opening markedly increased the delivery of Adu into the brain by approximately 8.1 times in the brains. The combined treatment induced significantly less cognitive decline and decreased the level of amyloid plaques in the hippocampi of the 5×FAD mice compared with Adu or FUS alone. Combined treatment with FUS and Adu activated phagocytic microglia and increased the number of astrocytes associated with amyloid plaques in the hippocampi of 5×FAD mice. Furthermore, RNA sequencing identified that 4 enriched canonical pathways including phagosome formation, neuroinflammation signaling, CREB signaling and reelin signaling were altered in the hippocami of 5×FAD mice receiving the combined treatment. CONCLUSION In conclusion, the enhanced delivery of a low dose of Adu (3 mg/kg) via FUS decreases amyloid deposits and attenuates cognitive function deficits. FUS-mediated BBB opening increases adult hippocampal neurogenesis as well as drug delivery. We present an AD treatment strategy through the synergistic effect of the combined therapy of FUS and Adu.
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Affiliation(s)
- Chanho Kong
- Department of Neurosurgery, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Eun-Jeong Yang
- Department of Pharmacology, College of Medicine, Seoul National University, 103 Daehakro, Jongro-Gu, Seoul, Republic of Korea
- Neuroscience Research Center, College of Medicine, Seoul National University, 103 Daehakro, Jongro-Gu, Seoul, Republic of Korea
| | - Jaewoo Shin
- Department of Neurosurgery, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Junwon Park
- Department of Neurosurgery, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Si-Hyun Kim
- Department of Pharmacology, College of Medicine, Seoul National University, 103 Daehakro, Jongro-Gu, Seoul, Republic of Korea
- Neuroscience Research Center, College of Medicine, Seoul National University, 103 Daehakro, Jongro-Gu, Seoul, Republic of Korea
| | - Seong-Wook Park
- Department of Pharmacology, College of Medicine, Seoul National University, 103 Daehakro, Jongro-Gu, Seoul, Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Chang-Han Lee
- Department of Pharmacology, College of Medicine, Seoul National University, 103 Daehakro, Jongro-Gu, Seoul, Republic of Korea
- Department of Biomedical Sciences, College of Medicine, Seoul National University, 103 Daehakro, Jongro-Gu, Seoul, Republic of Korea
| | - Hyunju Kim
- Department of Pharmacology, College of Medicine, Seoul National University, 103 Daehakro, Jongro-Gu, Seoul, Republic of Korea.
- Neuroscience Research Center, College of Medicine, Seoul National University, 103 Daehakro, Jongro-Gu, Seoul, Republic of Korea.
| | - Hye-Sun Kim
- Department of Biomedical Sciences, College of Medicine, Seoul National University, 103 Daehakro, Jongro-Gu, Seoul, Republic of Korea.
- Bundang Hospital, Seoul National University College of Medicine, Bundang-Gu, Sungnam, Republic of Korea.
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea.
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23
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Jung IH, Chang KW, Park SH, Jung HH, Chang JH, Chang JW, Chang WS. Pseudoprogression and peritumoral edema due to intratumoral necrosis after Gamma knife radiosurgery for meningioma. Sci Rep 2022; 12:13663. [PMID: 35953695 PMCID: PMC9372131 DOI: 10.1038/s41598-022-17813-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/01/2022] [Indexed: 11/09/2022] Open
Abstract
Peritumoral cerebral edema is reported to be a side effect that can occur after stereotactic radiosurgery. We aimed to determine whether intratumoral necrosis (ITN) is a risk factor for peritumoral edema (PTE) when gamma knife radiosurgery (GKRS) is performed in patients with meningioma. In addition, we propose the concept of pseudoprogression: a temporary volume expansion that can occur after GKRS in the natural course of meningioma with ITN. This retrospective study included 127 patients who underwent GKRS for convexity meningioma between January 2019 and December 2020. Risk factors for PTE and ITN were investigated using logistic regression analysis. Analysis of variance was used to determine whether changes in tumor volume were statistically significant. After GKRS, ITN was observed in 34 (26.8%) patients, and PTE was observed in 10 (7.9%) patients. When postoperative ITN occurred after GKRS, the incidence of postoperative PTE was 18.970-fold (p = 0.009) greater. When a 70% dose volume ≥ 1 cc was used, the possibility of ITN was 5.892-fold (p < 0.001) higher. On average, meningiomas with ITN increased in volume by 128.5% at 6 months after GKRS and then decreased to 94.6% at 12 months. When performing GKRS in meningioma, a 70% dose volume ≥ 1 cc is a risk factor for ITN. At 6 months after GKRS, meningiomas with ITN may experience a transient volume expansion and PTE, which are characteristics of pseudoprogression. These characteristics typically improve at 12 months following GKRS.
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Affiliation(s)
- In-Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.,Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.,Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Kyung Won Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - So Hee Park
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
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Abstract
Microvascular decompression is the gold standard for the treatment of trigeminal neuralgia (TN). However, percutaneous techniques still play a role in treating patients with TN and offer several important advantages and efficiency in obtaining immediate pain relief, which is also durable in a less invasive and safe manner. Patients' preference for a less invasive method can influence the procedure they will undergo. Neurovascular conflict is not always a prerequisite for patients with TN. In addition, recurrence and failure of the previous procedure can influence the decision to follow the treatment. Therefore, indications for percutaneous procedures for TN persist when patients experience idiopathic and episodic sharp shooting pain. In this review, we provide an overview of percutaneous procedures for TN and its outcome and complication.
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Affiliation(s)
- Kyung Won Chang
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ho Jung
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Woo Chang
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
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Lee M, Woo J, Chang JW, Park J. Paper‐MAP: A Novel Tool for Super‐resolution Imaging of Pathological Tissues by Rapidly Tissue Expansion and Clearing. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r4309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mirae Lee
- Department of NeurosurgeryGraduate School of Medical Science, Brain Korea 21 ProjectYonsei University College of MedicineSeoul
| | - Jiwon Woo
- Department of NeurosurgeryGraduate School of Medical ScienceYonsei University College of MedicineSeoul
| | - Jin Woo Chang
- Department of NeurosurgeryGraduate School of Medical Science, Brain Korea 21 ProjectYonsei University College of MedicineSeoul
| | - Jeong‐Yoon Park
- Department of NeurosurgeryGraduate School of Medical Science, Brain Korea 21 ProjectYonsei University College of MedicineSeoul
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Jung IH, Chang KW, Park SH, Chang WS, Jung HH, Chang JW. Complications After Deep Brain Stimulation: A 21-Year Experience in 426 Patients. Front Aging Neurosci 2022; 14:819730. [PMID: 35462695 PMCID: PMC9022472 DOI: 10.3389/fnagi.2022.819730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDeep brain stimulation is an established treatment for movement disorders such as Parkinson’s disease, essential tremor, and dystonia. However, various complications that occur after deep brain stimulation are a major concern for patients and neurosurgeons.ObjectiveThis study aimed to analyze various complications that occur after deep brain stimulation.MethodsWe reviewed the medical records of patients with a movement disorder who underwent bilateral deep brain stimulation between 2000 and 2020. Among them, patients requiring revision surgery were analyzed.ResultsA total of 426 patients underwent bilateral deep brain stimulation for a movement disorder. The primary disease was Parkinson’s disease in 315 patients, followed by dystonia in 71 patients and essential tremor in 40 patients. Twenty-six (6.1%) patients had complications requiring revision surgery; the most common complication was infection (12 patients, 2.8%).ConclusionVarious complications may occur after deep brain stimulation, and patient prognosis should be improved by reducing complications.
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Affiliation(s)
- In-Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Kyung Won Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - So Hee Park
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
- *Correspondence: Jin Woo Chang,
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Park SH, Jung IH, Chang KW, Oh MK, Chang JW, Kim SH, Kang HC, Kim HD, Chang WS. Epidural grid, a new methodology of invasive intracranial EEG monitoring: A technical note and experience of a single center. Epilepsy Res 2022; 182:106912. [PMID: 35339854 DOI: 10.1016/j.eplepsyres.2022.106912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/10/2022] [Accepted: 03/17/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Subdural grid monitoring (SDG) has the advantage to provide continuous coverage over a larger area of cortex, direct visualization of electrode location and functional mapping. However, SDG can cause direct irritation of the cortex or postoperative headaches due to cerebrospinal fluid (CSF) leakage. Epidural grid monitoring (EDG) without opening the dura is thought to reduce the possibility of these complications. We report our experience with EDG. METHODS We described our surgical technique of EDG in invasive intracranial electroencephalography (iEEG) monitoring. A retrospective review of 30 patients who underwent grid placement of iEEG between March 2019 and December 2020 was performed to compare SDG and EDG. RESULTS Of the 30 patients, 10 patients underwent SDG and 20 patients underwent EDG. There was no difference in age between SDG and EDG groups (p = 0.13). Also, there was no difference in the number of grid electrodes, craniotomy size, number of electrodes per craniotomy area and postoperative complication rate (p = 0.32, 0.84, 0.58 and 0.40). However, the maximum number of electrodes that have been undermined from the bone margin was much higher in SDG group (SDG 4.6 ± 2.2 vs. EDG 2.0 ± 0.9; p = 0.001). The demand for postoperative analgesics was significantly lower in EDG group (SDG 13.4 ± 9.1 vs. EDG 4.1 ± 4.3; p = 0.012); and the demand for postoperative antiemetics also tended to be low (SDG 4.6 ± 3.6 vs. EDG 1.8 ± 1.6; p = 0.078). CONCLUSIONS There was no significant difference in craniotomy and electrode insertion between the two groups; however, the EDG group showed less postoperative headache and nausea. Though not in direct contact with the cortex, the quality of the electrophysiological signal received through the electrode in EDG is comparable to that of the SDG. The EDG enables to detect the onset of seizure and delineate the epileptogenic zone sufficiently. Moreover, functional mapping is possible with EDG. Therefore, EDG has the sufficient potential to replace SDG for monitoring of the lateral surface of brain.
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Affiliation(s)
- So Hee Park
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Won Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Maeng Keun Oh
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Hee Kim
- Department of Pediatric, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hoon-Chul Kang
- Department of Pediatric, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Heung Dong Kim
- Department of Pediatric, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Chang KW, Kim MJ, Park SH, Chang WS, Jung HH, Chang JW. Dual Pallidal and Thalamic Deep Brain Stimulation for Complex Ipsilateral Dystonia. Yonsei Med J 2022; 63:166-172. [PMID: 35083902 PMCID: PMC8819405 DOI: 10.3349/ymj.2022.63.2.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/07/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Globus pallidus pars interna (GPi) has become an established target for deep brain stimulation (DBS) in dystonia. Previous studies suggest that targeting the ventralis oralis (Vo) complex nucleus improves dystonic tremor or even focal dystonia. Research has also demonstrated that multi-target DBS shows some benefits over single target DBS. In this study, we reviewed patients who had undergone unilateral DBS targeting the GPi and Vo. MATERIALS AND METHODS Five patients diagnosed with medically refractory upper extremity dystonia (focal or segmental) underwent DBS. Two DBS electrodes each were inserted unilaterally targeting the ipsilateral GPi and Vo. Clinical outcomes were evaluated using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Disability Rating Scale. RESULTS BFMDRS scores decreased by 55% at 1-month, 56% at 3-month, 59% at 6-month, and 64% at 12-month follow up. Disability Rating Scale scores decreased 41% at 1-month, 47% at 3-month, 50% at 6-month, and 60% at 12-month follow up. At 1 month after surgery, stimulating both targets improved clinical scores better than targeting GPi or Vo alone. CONCLUSION Unilateral thalamic and pallidal dual electrode DBS may be as effective or even superior to DBS of a single target for dystonia. Although the number of patients was small, our results reflected favorable clinical outcomes.
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Affiliation(s)
- Kyung Won Chang
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Ji Kim
- Department of Neurosurgery, Korea University College of Medicine, Seoul, Korea
| | - So Hee Park
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Won Seok Chang
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ho Jung
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Woo Chang
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
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Yun S, Koh CS, Seo J, Shim S, Park M, Jung HH, Eom K, Chang JW, Kim SJ. A Fully Implantable Miniaturized Liquid Crystal Polymer (LCP)-Based Spinal Cord Stimulator for Pain Control. Sensors (Basel) 2022; 22:s22020501. [PMID: 35062462 PMCID: PMC8778878 DOI: 10.3390/s22020501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 05/09/2023]
Abstract
Spinal cord stimulation is a therapy to treat the severe neuropathic pain by suppressing the pain signal via electrical stimulation of the spinal cord. The conventional metal packaged and battery-operated implantable pulse generator (IPG) produces electrical pulses to stimulate the spinal cord. Despite its stable operation after implantation, the implantation site is limited due to its bulky size and heavy weight. Wireless communications including wireless power charging is also restricted, which is mainly attributed to the electromagnetic shielding of the metal package. To overcome these limitations, here, we developed a fully implantable miniaturized spinal cord stimulator based on a biocompatible liquid crystal polymer (LCP). The fabrication of electrode arrays in the LCP substrate and monolithically encapsulating the circuitries using LCP packaging reduces the weight (0.4 g) and the size (the width, length, and thickness are 25.3, 9.3, and 1.9 mm, respectively). An inductive link was utilized to wirelessly transfer the power and the data to implanted circuitries to generate the stimulus pulse. Prior to implantation of the device, operation of the pulse generator was evaluated, and characteristics of stimulation electrode such as an electrochemical impedance spectroscopy (EIS) were measured. The LCP-based spinal cord stimulator was implanted into the spared nerve injury rat model. The degree of pain suppression upon spinal cord stimulation was assessed via the Von Frey test where the mechanical stimulation threshold was evaluated by monitoring the paw withdrawal responses. With no spinal cord stimulation, the mechanical stimulation threshold was observed as 1.47 ± 0.623 g, whereas the stimulation threshold was increased to 12.7 ± 4.00 g after spinal cord stimulation, confirming the efficacy of pain suppression via electrical stimulation of the spinal cord. This LCP-based spinal cord stimulator opens new avenues for the development of a miniaturized but still effective spinal cord stimulator.
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Affiliation(s)
- Seunghyeon Yun
- Department of Electrical and Computer Engineering, College of Engineering, Seoul National University, Seoul 08826, Korea; (S.Y.); (J.S.); (S.S.); (S.J.K.)
| | - Chin Su Koh
- Department of Neurosurgery, College of Medicine, Yonsei University, Seoul 03722, Korea; (C.S.K.); (M.P.); (H.H.J.)
| | - Jungmin Seo
- Department of Electrical and Computer Engineering, College of Engineering, Seoul National University, Seoul 08826, Korea; (S.Y.); (J.S.); (S.S.); (S.J.K.)
| | - Shinyong Shim
- Department of Electrical and Computer Engineering, College of Engineering, Seoul National University, Seoul 08826, Korea; (S.Y.); (J.S.); (S.S.); (S.J.K.)
| | - Minkyung Park
- Department of Neurosurgery, College of Medicine, Yonsei University, Seoul 03722, Korea; (C.S.K.); (M.P.); (H.H.J.)
| | - Hyun Ho Jung
- Department of Neurosurgery, College of Medicine, Yonsei University, Seoul 03722, Korea; (C.S.K.); (M.P.); (H.H.J.)
| | - Kyungsik Eom
- Department of Electronics Engineering, College of Engineering, Pusan National University, Busan 46241, Korea
- Correspondence: (K.E.); (J.W.C.)
| | - Jin Woo Chang
- Department of Neurosurgery, College of Medicine, Yonsei University, Seoul 03722, Korea; (C.S.K.); (M.P.); (H.H.J.)
- Correspondence: (K.E.); (J.W.C.)
| | - Sung June Kim
- Department of Electrical and Computer Engineering, College of Engineering, Seoul National University, Seoul 08826, Korea; (S.Y.); (J.S.); (S.S.); (S.J.K.)
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Kong C, Park SH, Shin J, Baek HG, Park J, Na YC, Chang WS, Chang JW. Factors Associated with Energy Efficiency of Focused Ultrasound Through the Skull: A Study of 3D-Printed Skull Phantoms and Its Comparison with Clinical Experiences. Front Bioeng Biotechnol 2021; 9:783048. [PMID: 34957077 PMCID: PMC8708563 DOI: 10.3389/fbioe.2021.783048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022] Open
Abstract
While focused ultrasound (FUS) is non-invasive, the ultrasound energy is attenuated by the skull which results in differences in energy efficiency among patients. In this study, we investigated the effect of skull variables on the energy efficiency of FUS. The thickness and density of the skull and proportion of the trabecular bone were selected as factors that could affect ultrasound energy transmittance. Sixteen 3D-printed skull models were designed and fabricated to reflect the three factors. The energy of each phantom was measured using an ultrasonic sound field energy measurement system. The thickness and proportion of trabecular bone affected the attenuation of transmitted energy. There was no difference in the density of the trabecular bone. In clinical data, the trabecular bone ratio showed a significantly greater correlation with dose/delivered energy than that of thickness and the skull density ratio. Currently, for clinical non-thermal FUS, the data are not sufficient, but we believe that the results of this study will be helpful in selecting patients and appropriate parameters for FUS treatment.
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Affiliation(s)
- Chanho Kong
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - So Hee Park
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jaewoo Shin
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hee Gyu Baek
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, South Korea
| | - Juyoung Park
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, South Korea
| | - Young Cheol Na
- Department of Neurosurgery, Catholic Kwandong University College of Medicine, International St Mary's Hospital, Incheon, South Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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Jung HH, Koh CS, Park M, Kim JH, Woo HN, Lee H, Chang JW. Microglial deactivation by adeno-associated virus expressing small-hairpin GCH1 has protective effects against neuropathic pain development in a spinothalamic tract-lesion model. CNS Neurosci Ther 2021; 28:36-45. [PMID: 34845843 PMCID: PMC8673712 DOI: 10.1111/cns.13751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022] Open
Abstract
AIMS Neuropathic pain after spinal cord injury is one of the most difficult clinical problems after the loss of mobility, and pharmacological or neuromodulation therapy showed limited efficacy. In this study, we examine the possibility of pain modulation by a recombinant adeno-associated virus (rAAV) encoding small-hairpin RNA against GCH1 (rAAV-shGCH1) in a spinal cord injury model in which neuropathic pain was induced by a spinothalamic tract (STT) lesion. METHODS Micro-electric lesioning was used to damage the left STT in rats (n = 32), and either rAAV-shGCH1 (n = 19) or rAAV control (n = 6) was injected into the dorsal horn of the rats at the same time. On postoperative days 3, 7, and 14, we evaluated neuropathic pain using a behavioral test and microglial activation by immunohistochemical staining. RESULTS A pain modulation effect of shGCH1 was observed from postoperative days 3 to 14. The mechanical withdrawal threshold was 13.0 ± 0.95 in the shGCH1 group, 4.3 ± 1.37 in the control group, and 3.49 ± 0.85 in sham on postoperative day 3 (p < 0.0001) and continued to postoperative day 14 (shGCH1 vs. control: 11.4 ± 1.1 vs. 2.05 ± 0.60, p < 0.001 and shGCH1 vs. sham: 11.4 ± 1.1 vs. 1.43 ± 0.54, p < 0.001). Immunohistochemical staining of the spinal cord dorsal horn showed deactivation of microglia in the shGCH1 group without any change of delayed pattern of astrocyte activation as in STT model. CONCLUSIONS Neuropathic pain after spinal cord injury can be modulated bilaterally by deactivating microglial activation after a unilateral injection of rAAV-shGCH1 into the dorsal horn of a STT lesion spinal cord pain model. This new attempt would be another therapeutic approach for NP after SCI, which once happens; there is no clear curative options still now.
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Affiliation(s)
- Hyun Ho Jung
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 PLUS Project for Medical Science and Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chin Su Koh
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Minkyung Park
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 PLUS Project for Medical Science and Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyun Kim
- Department of Microbiology, University of Ulsan College of Medicine, Seoul, Korea.,Bio-Medical Institute of Technology, University of Ulsan College of Medicine, Seoul, Korea
| | - Ha-Na Woo
- Bio-Medical Institute of Technology, University of Ulsan College of Medicine, Seoul, Korea.,Department of Biochemistry & Molecular Biology, University of Ulsan College of Medicine, Seoul, Korea
| | - Heuiran Lee
- Bio-Medical Institute of Technology, University of Ulsan College of Medicine, Seoul, Korea.,Department of Microbiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 PLUS Project for Medical Science and Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Park SH, Baik K, Jeon S, Chang WS, Ye BS, Chang JW. Extensive frontal focused ultrasound mediated blood-brain barrier opening for the treatment of Alzheimer's disease: a proof-of-concept study. Transl Neurodegener 2021; 10:44. [PMID: 34740367 PMCID: PMC8570037 DOI: 10.1186/s40035-021-00269-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/19/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Focused ultrasound (FUS)-mediated blood-brain barrier (BBB) opening has shown efficacy in removal of amyloid plaque and improvement of cognitive functions in preclinical studies, but this is rarely reported in clinical studies. This study was conducted to evaluate the safety, feasibility and potential benefits of repeated extensive BBB opening. METHODS In this open-label, prospective study, six patients with Alzheimer's disease (AD) were enrolled at Severance Hospital in Korea between August 2020 and September 2020. Five of them completed the study. FUS-mediated BBB opening, targeting the bilateral frontal lobe regions over 20 cm3, was performed twice at three-month intervals. Magnetic resonance imaging, 18F-Florbetaben (FBB) positron emission tomography, Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI) and comprehensive neuropsychological tests were performed before and after the procedures. RESULTS FUS targeted a mean volume of 21.1 ± 2.7 cm3 and BBB opening was confirmed at 95.7% ± 9.4% of the targeted volume. The frontal-to-other cortical region FBB standardized uptake value ratio at 3 months after the procedure showed a slight decrease, which was statistically significant, compared to the pre-procedure value (- 1.6%, 0.986 vs1.002, P = 0.043). The CGA-NPI score at 2 weeks after the second procedure significantly decreased compared to baseline (2.2 ± 3.0 vs 8.6 ± 6.0, P = 0.042), but recovered after 3 months (5.2 ± 5.8 vs 8.6 ± 6.0, P = 0.89). No adverse effects were observed. CONCLUSIONS The repeated and extensive BBB opening in the frontal lobe is safe and feasible for patients with AD. In addition, the BBB opening is potentially beneficial for amyloid removal in AD patients.
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Affiliation(s)
- So Hee Park
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seun Jeon
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Won Seok Chang
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
| | - Jin Woo Chang
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
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Cho K, Chang WS, Kim HD, Chang JW, Kim SH, Lee JS, Kang HC. Robot-Assisted Stereoelectroencephalography for Pediatric Epilepsy Surgery: The First Case in Korea. Ann Child Neurol 2021. [DOI: 10.26815/acn.2021.00430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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34
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Jung IH, Chang KW, Park SH, Moon JH, Kim EH, Jung HH, Kang SG, Chang JH, Chang JW, Chang WS. Stereotactic biopsy for adult brainstem lesions: A surgical approach and its diagnostic value according to the 2016 World Health Organization Classification. Cancer Med 2021; 10:7514-7524. [PMID: 34510820 PMCID: PMC8559459 DOI: 10.1002/cam4.4272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/17/2021] [Accepted: 09/01/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The brainstem has the critical role of regulating cardiac and respiratory function and it also provides motor and sensory function to the face via the cranial nerves. Despite the observation of a brainstem lesion in a radiological examination, it is difficult to obtain tissues for a pathological diagnosis because of the location and small volume of the brainstem. Thus, we aimed to share our 6-year experience with stereotactic biopsies from brainstem lesions and confirm the value and safety of stereotactic biopsy on this highly eloquent area in this study. METHODS We retrospectively reviewed the medical records of 42 adult patients who underwent stereotactic biopsy on brainstem lesions from 2015 to 2020. The radiological findings, surgical records, pathological diagnosis, and postoperative complications of all patients were analyzed. RESULTS Histopathological diagnoses were made in 40 (95.2%) patients. Astrocytic tumors were diagnosed in 29 (69.0%) patients, diffuse large B cell lymphoma in 5 (11.9%) patients, demyelinating disease in 4 (9.5%) patients, germinoma in 1 (2.4%) patient, and radiation necrosis in 1 (2.4%) patient. In the 40 patients with successful stereotactic biopsy, 10 (25.0%) patients had inconsistent preoperative radiological diagnosis and postoperative pathological diagnosis. In addition, there was a difference between the treatments prescribed by the radiological and pathological diagnoses in 8 out of 10 patients whose diagnoses changed after biopsy. There was no operative mortality among the 42 patients. CONCLUSIONS A pathological diagnosis can be made safely and efficiently in brainstem lesions using stereotactic biopsy. This pathological diagnosis will enable patients to receive appropriate treatment.
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Affiliation(s)
- In-Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Won Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Hee Park
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju Hyung Moon
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eui Hyun Kim
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok-Gu Kang
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Koh CS, Park HY, Shin J, Kong C, Park M, Seo IS, Koo B, Jung HH, Chang JW, Shin HC. A novel rat robot controlled by electrical stimulation of the nigrostriatal pathway. Neurosurg Focus 2021; 49:E11. [PMID: 32610286 DOI: 10.3171/2020.4.focus20150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Artificial manipulation of animal movement could offer interesting advantages and potential applications using the animal's inherited superior sensation and mobility. Although several behavior control models have been introduced, they generally epitomize virtual reward-based training models. In this model, rats are trained multiple times so they can recall the relationship between cues and rewards. It is well known that activation of one side of the nigrostriatal pathway (NSP) in the rat induces immediate turning toward the contralateral side. However, this NSP stimulation-induced directional movement has not been used for the purpose of animal-robot navigation. In this study, the authors aimed to electrically stimulate the NSP of conscious rats to build a command-prompt rat robot. METHODS Repetitive NSP stimulation at 1-second intervals was applied via implanted electrodes to induce immediate contraversive turning movements in 7 rats in open field tests in the absence of any sensory cues or rewards. The rats were manipulated to navigate from the start arm to a target zone in either the left or right arm of a T-maze. A leftward trial was followed by a rightward trial, and each rat completed a total of 10 trials. In the control group, 7 rats were tested in the same way without NSP stimulation. The time taken to navigate the maze was compared between experimental and control groups. RESULTS All rats in the experimental group successfully reached the target area for all 70 trials in a short period of time with a short interstimulus interval (< 0.7 seconds), but only 41% of rats in the control group reached the target area and required a longer period of time to do so. The experimental group made correct directional turning movements at the intersection zone of the T-maze, taking significantly less time than the control group. No significant difference in navigation duration for the forward movements on the start and goal arms was observed between the two groups. However, the experimental group showed quick and accurate movement at the intersection zone, which made the difference in the success rate and elapsed time of tasks. CONCLUSIONS The results of this study clearly indicate that a rat-robot model based on NSP stimulation can be a practical alternative to previously reported models controlled by virtual sensory cues and rewards.
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Affiliation(s)
- Chin Su Koh
- 1Department of Neurosurgery, Yonsei University College of Medicine, Seoul
| | - Hae-Yong Park
- 2Department of Physiology, College of Medicine, Hallym University, Chuncheon
| | - Jaewoo Shin
- 1Department of Neurosurgery, Yonsei University College of Medicine, Seoul
| | - Chanho Kong
- 1Department of Neurosurgery, Yonsei University College of Medicine, Seoul
| | - Minkyung Park
- 1Department of Neurosurgery, Yonsei University College of Medicine, Seoul.,4Brain Korea 21 PLUS Project for Medical Science and Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - In-Seok Seo
- 2Department of Physiology, College of Medicine, Hallym University, Chuncheon
| | - Bonkon Koo
- 3School of Interdisciplinary Bioscience and Bioengineering, POSTECH, Pohang; and
| | - Hyun Ho Jung
- 1Department of Neurosurgery, Yonsei University College of Medicine, Seoul
| | - Jin Woo Chang
- 1Department of Neurosurgery, Yonsei University College of Medicine, Seoul.,4Brain Korea 21 PLUS Project for Medical Science and Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung-Cheul Shin
- 2Department of Physiology, College of Medicine, Hallym University, Chuncheon
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Germann J, Elias GJB, Neudorfer C, Boutet A, Chow CT, Wong EHY, Parmar R, Gouveia FV, Loh A, Giacobbe P, Kim SJ, Jung HH, Bhat V, Kucharczyk W, Chang JW, Lozano AM. Potential optimization of focused ultrasound capsulotomy for obsessive compulsive disorder. Brain 2021; 144:3529-3540. [PMID: 34145884 DOI: 10.1093/brain/awab232] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/19/2021] [Accepted: 05/21/2021] [Indexed: 11/13/2022] Open
Abstract
Obsessive-compulsive disorder is a debilitating and often refractory psychiatric disorder. Magnetic resonance-guided focused ultrasound is a novel, minimally invasive neuromodulatory technique that has shown promise in treating this condition. We investigated the relationship between lesion location and long-term outcome in obsessive-compulsive disorder patients treated with focused ultrasound to discern the optimal lesion location and elucidate the efficacious network underlying symptom alleviation. Postoperative images of eleven patients who underwent focused ultrasound capsulotomy were used to correlate lesion characteristics with symptom improvement at one year follow-up. Normative resting-state functional MRI and normative diffusion MRI-based tractography analyses were used to determine the networks associated with successful lesions. Obsessive-compulsive disorder patients treated with inferior thalamic peduncle deep brain stimulation (n = 5) and lesions from the literature implicated in obsessive-compulsive disorder (n = 18) were used for external validation. Successful long-term relief of obsessive-compulsive disorder was associated with lesions that included a specific area in the dorsal anterior limb of the internal capsule. Normative resting-state functional MRI analysis showed that lesion engagement of areas 24 and 46 was significantly associated with clinical outcomes (R = 0.79, p = 0.004). The key role of areas 24 and 46 was confirmed by (1) normative diffusion MRI-based tractography analysis showing that streamlines associated with better outcome projected to these areas, (2) association of these areas with inferior thalamic peduncle deep brain stimulation patients' outcome (R = 0.83, p = 0.003); (3) the connectedness of these areas to obsessive-compulsive disorder-causing lesions, as identified using literature-based lesion network mapping. These results provide considerations for target improvement, outlining the specific area of the internal capsule critical for successful magnetic resonance-guided focused ultrasound outcome and demonstrating that discrete frontal areas are involved in symptom relief. This could help refine focused ultrasound treatment for obsessive-compulsive disorder and provide a network-based rationale for potential alternative targets.
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Affiliation(s)
- Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Clemens Neudorfer
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Clement T Chow
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Emily H Y Wong
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Roohie Parmar
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Flavia Venetucci Gouveia
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Peter Giacobbe
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Se Joo Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Venkat Bhat
- Centre for Mental Health and Krembil Research Centre, University Health Network, Toronto, Canada
| | - Walter Kucharczyk
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
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Kim MJ, Chang KW, Park SH, Chang WS, Jung HH, Chang JW. Stimulation-Induced Side Effects of Deep Brain Stimulation in the Ventralis Intermedius and Posterior Subthalamic Area for Essential Tremor. Front Neurol 2021; 12:678592. [PMID: 34177784 PMCID: PMC8220085 DOI: 10.3389/fneur.2021.678592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation (DBS) targeting the ventralis intermedius (VIM) nucleus of the thalamus and the posterior subthalamic area (PSA) has been shown to be an effective treatment for essential tremor (ET). The aim of this study was to compare the stimulation-induced side effects of DBS targeting the VIM and PSA using a single electrode. Patients with medication-refractory ET who underwent DBS electrode implantation between July 2011 and October 2020 using a surgical technique that simultaneously targets the VIM and PSA with a single electrode were enrolled in this study. A total of 93 patients with ET who had 115 implanted DBS electrodes (71 unilateral and 22 bilateral) were enrolled. The Clinical Rating Scale for Tremor (CRST) subscores improved from 20.0 preoperatively to 4.3 (78.5% reduction) at 6 months, 6.3 (68.5% reduction) at 1 year, and 6.5 (67.5% reduction) at 2 years postoperation. The best clinical effect was achieved in the PSA at significantly lower stimulation amplitudes. Gait disturbance and clumsiness in the leg was found in 13 patients (14.0%) upon stimulation of the PSA and in significantly few patients upon stimulation of the VIM (p = 0.0002). Fourteen patients (15.1%) experienced dysarthria when the VIM was stimulated; this number was significantly more than that with PSA stimulation (p = 0.0233). Transient paresthesia occurred in 13 patients (14.0%) after PSA stimulation and in six patients (6.5%) after VIM stimulation. Gait disturbance and dysarthria were significantly more prevalent in patients undergoing bilateral DBS than in those undergoing unilateral DBS (p = 0.00112 and p = 0.0011, respectively). Paresthesia resolved either after reducing the amplitude or switching to bipolar stimulation. However, to control gait disturbance and dysarthria, some loss of optimal tremor control was necessary at that particular electrode contact. In the present study, the most common stimulation-induced side effect associated with VIM DBS was dysarthria, while that associated with PSA DBS was gait disturbance. Significantly, more side effects were associated with bilateral DBS than with unilateral DBS. Therefore, changing active DBS contacts to simultaneous targeting of the VIM and PSA may be especially helpful for ameliorating stimulation-induced side effects.
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Affiliation(s)
- Myung Ji Kim
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Ansan Hospital, Ansan-si, South Korea
| | - Kyung Won Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - So Hee Park
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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Kim MJ, Park SH, Chang KW, Kim Y, Gao J, Kovalevsky M, Rachmilevitch I, Zadicario E, Chang WS, Jung HH, Chang JW. Technical and operative factors affecting magnetic resonance imaging-guided focused ultrasound thalamotomy for essential tremor: experience from 250 treatments. J Neurosurg 2021:1-9. [PMID: 34020416 DOI: 10.3171/2020.11.jns202580] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Magnetic resonance imaging-guided focused ultrasound (MRgFUS) provides real-time monitoring of patients to assess tremor control and document any adverse effects. MRgFUS of the ventral intermediate nucleus (VIM) of the thalamus has become an effective treatment option for medically intractable essential tremor (ET). The aim of this study was to analyze the correlations of clinical and technical parameters with 12-month outcomes after unilateral MRgFUS thalamotomy for ET to help guide future clinical treatments. METHODS From October 2013 to January 2019, data on unilateral MRgFUS thalamotomy from the original pivotal study and continued-access studies from three different geographic regions were collected. Authors of the present study retrospectively reviewed those data and evaluated the efficacy of the procedure on the basis of improvement in the Clinical Rating Scale for Tremor (CRST) subscore at 1 year posttreatment. Safety was based on the rates of moderate and severe thalamotomy-related adverse events. Treatment outcomes in relation to various patient- and sonication-related parameters were analyzed in a large cohort of patients with ET. RESULTS In total, 250 patients were included in the present analysis. Improvement was sustained throughout the 12-month follow-up period, and 184 (73.6%) of 250 patients had minimal or no disability due to tremor (CRST subscore < 10) at the 12-month follow-up. Younger age and higher focal temperature (Tmax) correlated with tremor improvement in the multivariate analysis (OR 0.948, p = 0.013; OR 1.188, p = 0.025; respectively). However, no single statistically significant factor correlated with Tmax in the multivariate analysis. The cutoff value of Tmax in predicting a CRST subscore < 10 was 55.8°C. Skull density ratio (SDR) was positively correlated with heating efficiency (β = 0.005, p < 0.001), but no significant relationship with tremor improvement was observed. In the low-temperature group, 1-3 repetitions to the right target with 52°C ≤ Tmax ≤ 54°C was sufficient to generate sustained tremor suppression within the investigated follow-up period. The high-temperature group had a higher rate of balance disturbances than the low-temperature group (p = 0.04). CONCLUSIONS The authors analyzed the data of 250 patients with the aim of improving practices for patient screening and determining treatment endpoints. These results may improve the safety, efficacy, and efficiency of MRgFUS thalamotomy for ET.
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Affiliation(s)
- Myung Ji Kim
- 1Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; and
| | - So Hee Park
- 1Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; and
| | - Kyung Won Chang
- 1Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; and
| | - Yuhee Kim
- 2InSightec Ltd., Tirat Carmel, Israel
| | - Jing Gao
- 2InSightec Ltd., Tirat Carmel, Israel
| | | | | | | | - Won Seok Chang
- 1Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; and
| | - Hyun Ho Jung
- 1Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; and
| | - Jin Woo Chang
- 1Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; and
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Tsai KWK, Chen JC, Lai HC, Chang WC, Taira T, Chang JW, Wei CY. The Distribution of Skull Score and Skull Density Ratio in Tremor Patients for MR-Guided Focused Ultrasound Thalamotomy. Front Neurosci 2021; 15:612940. [PMID: 34079434 PMCID: PMC8165389 DOI: 10.3389/fnins.2021.612940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 04/08/2021] [Indexed: 12/20/2022] Open
Abstract
Objective Magnetic resonance-guided focused ultrasound (MRgFUS) is a minimum-invasive surgical approach to non-incisionally cause the thermos-coagulation inside the human brain. The skull score (SS) has already been approved as one of the most dominant factors related to a successful MRgFUS treatment. In this study, we first reveal the SS distribution of the tremor patients, and correlate the SS with the image feature from customized skull density ratio (cSDR). This correlation might give a direction to future clinical studies for improving the SS. Methods Two hundred and forty-six patients received a computed tomography (CT) scan of the brain, and a bone-enhanced filter was applied and reconstructed to a high spatial resolution CT images. The SS of all patients would be estimated by the MRgFUS system after importing the reconstructed CT images into the MRgFUS system. The histogram and the cumulative distribution of the SS from all the patients were calculated to show the percentage of the patients whose SS lower than 0.3 and 0.4. The same CT images of all patients were utilized to calculated the cSDR by first segmented the trabecular bone and the cortical bone from the CT images and divided the average trabecular bone intensity (aTBI) by the average cortical bone intensity (aCBI). The Pearson’s correlations between the SS and the cSDR, aTBI, and the aCBI were calculated, respectively. Results There were 19.19 and 50% of the patient who had the SS lower than the empirical threshold 0.3 and 0.4, respectively. The Pearson’s correlation between the SS and the cSDR, aCBI, and the aTBI were R = 0.8145, 0.5723, and 0.8842. Conclusion Half of the patients were eligible for the MRgFUS thalamotomy based on the SS, and nearly 20% of patients were empirically difficult to achieve a therapeutic temperature during MRgFUS. The SS and our cSDR are highly correlated, and the SS had a higher correlation with aTBI than with aCBI. This is the first report to explicitly reveal the SS population and indicate a potential way to increase the chance to achieve a therapeutic temperature for those who originally have low SS.
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Affiliation(s)
- Kevin Wen-Kai Tsai
- MR-guided Focused Ultrasound Center, Chang Bing Show Chwan Memorial Hospital, Changhua City, Taiwan
| | - Jui-Cheng Chen
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung City, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung City, Taiwan.,Department of Neurology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Hui-Chin Lai
- MR-guided Focused Ultrasound Center, Chang Bing Show Chwan Memorial Hospital, Changhua City, Taiwan
| | - Wei-Chieh Chang
- MR-guided Focused Ultrasound Center, Chang Bing Show Chwan Memorial Hospital, Changhua City, Taiwan.,Department of Neurosurgery, Chang Bing Show Chwan Memorial Hospital, Changhua City, Taiwan
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Cheng-Yu Wei
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan.,Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua City, Taiwan
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Chang KW, Rachmilevitch I, Chang WS, Jung HH, Zadicario E, Prus O, Chang JW. Safety and Efficacy of Magnetic Resonance-Guided Focused Ultrasound Surgery With Autofocusing Echo Imaging. Front Neurosci 2021; 14:592763. [PMID: 33510610 PMCID: PMC7835836 DOI: 10.3389/fnins.2020.592763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/30/2020] [Indexed: 02/01/2023] Open
Abstract
Objective Magnetic resonance-guided focused ultrasound surgery (MRgFUS) lesioning is a new treatment for brain disorders. However, the skull is a major barrier of ultrasound sonication in MRgFUS because it has an irregular surface and varies its size and shape among individuals. We recently developed the concept of skull density ratio (SDR) to select candidates for MRgFUS from among patients with essential tremor (ET). However, SDR is not the only factor contributing to successful MRgFUS lesioning treatment-refining the target through exact measurement of the ultrasonic echo in the transducer also improves treatment efficacy. In the present study, we carried out MRgFUS lesioning using an autofocusing echo imaging technique. We aimed to evaluate the safety and efficacy of this new approach, especially in patients with low SDR in whom previous focusing methods have failed. Methods From December 2019 to March 2020, we recruited 10 patients with ET or Parkinson's disease (PD) who had a low SDR. Two patients dropped out of the trial due to the screening failure of other medical diseases. In total, eight patients were included: six with ET who underwent MRgFUS thalamotomy and two with PD who underwent MRgFUS pallidotomy. The autofocusing echo imaging technique was used in all cases. Results The mean SDR of the patients with ET was 0.34 (range: 0.29-0.39), while that of the patients with PD was 0.41 (range: 0.38-0.44). The mean skull volume of patients with ET was 280.57 cm3 (range: 227-319 cm3), while that of the patients with PD was 287.13 cm3 (range: 271-303 cm3). During MRgFUS, a mean of 15 sonications were performed, among which a mean of 5.63 used the autofocusing technique. The mean maximal temperature (Tmax) achieved was 55.88°C (range: 52-59°C), while the mean energy delivered was 34.75 kJ (range: 20-42 kJ) among all patients. No serious adverse events occurred during or after treatment. Tmax or sonication factors (skull volume, SDR, sonication number, autofocusing score, similarity score, energy range, and power) were not correlated with autofocusing technique (p > 0.05, autofocusing score showed a p-value of 0.071). Conclusion Using autofocusing echo imaging lesioning, a safe and efficient MRgFUS treatment, is available even for patients with a low SDR. Therefore, the indications for MRgFUS lesioning could be expanded to include patients with ET who have an SDR < 0.4 and those with PD who have an SDR < 0.45. Clinical Trial Registration clinicaltrials.gov, identifier: NCT03935581.
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Affiliation(s)
- Kyung Won Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | | | | | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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41
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Chang KW, Jung HH, Chang JW. Magnetic Resonance-Guided Focused Ultrasound Surgery for Obsessive-Compulsive Disorders: Potential for use as a Novel Ablative Surgical Technique. Front Psychiatry 2021; 12:640832. [PMID: 33889100 PMCID: PMC8057302 DOI: 10.3389/fpsyt.2021.640832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/11/2021] [Indexed: 12/24/2022] Open
Abstract
Surgical treatment for psychiatric disorders, such as obsessive-compulsive disorder (OCD) and depression, using ablative techniques, such as cingulotomy and capsulotomy, have historically been controversial for a number of scientific, social, and ethical reasons. Recently, with the elucidation of anatomical and neurochemical substrates of brain function in healthy controls and patients with such disorders using various functional neuroimaging techniques, these criticisms are becoming less valid. Furthermore, by using new techniques, such as deep brain stimulation (DBS), and identifying more precise targets, beneficial effects and the lack of serious complications have been demonstrated in patients with psychiatric disorders. However, DBS also has many disadvantages. Currently, magnetic resonance-guided focused ultrasound surgery (MRgFUS) is used as a minimal-invasive surgical method for generating precisely placed focal thermal lesions in the brain. Here, we review surgical techniques and their potential complications, along with anterior limb of the internal capsule (ALIC) capsulotomy by radiofrequency lesioning and gamma knife radiosurgery, for the treatment of OCD and depression. We also discuss the limitations and technical issues related to ALIC capsulotomy with MRgFUS for medically refractory OCD and depression. Through this review we hope MRgFUS could be considered as a new treatment choice for refractory OCD.
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Affiliation(s)
- Kyung Won Chang
- Department of Neurosurgery & Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Ho Jung
- Department of Neurosurgery & Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Woo Chang
- Department of Neurosurgery & Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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Krauss JK, Lipsman N, Aziz T, Boutet A, Brown P, Chang JW, Davidson B, Grill WM, Hariz MI, Horn A, Schulder M, Mammis A, Tass PA, Volkmann J, Lozano AM. Technology of deep brain stimulation: current status and future directions. Nat Rev Neurol 2020; 17:75-87. [PMID: 33244188 DOI: 10.1038/s41582-020-00426-z] [Citation(s) in RCA: 246] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 01/20/2023]
Abstract
Deep brain stimulation (DBS) is a neurosurgical procedure that allows targeted circuit-based neuromodulation. DBS is a standard of care in Parkinson disease, essential tremor and dystonia, and is also under active investigation for other conditions linked to pathological circuitry, including major depressive disorder and Alzheimer disease. Modern DBS systems, borrowed from the cardiac field, consist of an intracranial electrode, an extension wire and a pulse generator, and have evolved slowly over the past two decades. Advances in engineering and imaging along with an improved understanding of brain disorders are poised to reshape how DBS is viewed and delivered to patients. Breakthroughs in electrode and battery designs, stimulation paradigms, closed-loop and on-demand stimulation, and sensing technologies are expected to enhance the efficacy and tolerability of DBS. In this Review, we provide a comprehensive overview of the technical development of DBS, from its origins to its future. Understanding the evolution of DBS technology helps put the currently available systems in perspective and allows us to predict the next major technological advances and hurdles in the field.
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Affiliation(s)
- Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Nir Lipsman
- Department of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tipu Aziz
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alexandre Boutet
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Benjamin Davidson
- Department of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Marwan I Hariz
- Department of Clinical Neuroscience, University of Umea, Umea, Sweden
| | - Andreas Horn
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité Medicine University of Berlin, Berlin, Germany
| | - Michael Schulder
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Antonios Mammis
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Peter A Tass
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Jens Volkmann
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany.,Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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Chang JG, Jung HH, Kim SJ, Chang WS, Jung NY, Kim CH, Chang JW. Bilateral thermal capsulotomy with magnetic resonance-guided focused ultrasound for patients with treatment-resistant depression: A proof-of-concept study. Bipolar Disord 2020; 22:771-774. [PMID: 32580242 DOI: 10.1111/bdi.12964] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 03/21/2020] [Accepted: 06/11/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jhin-Goo Chang
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea.,Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Se Joo Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Na Young Jung
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Korea
| | - Chan-Hyung Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Park SH, Kim MJ, Jung HH, Chang WS, Choi HS, Rachmilevitch I, Zadicario E, Chang JW. One-Year Outcome of Multiple Blood-Brain Barrier Disruptions With Temozolomide for the Treatment of Glioblastoma. Front Oncol 2020; 10:1663. [PMID: 33014832 PMCID: PMC7511634 DOI: 10.3389/fonc.2020.01663] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: To overcome the blood-brain barrier (BBB) which interferes with the effect of chemotherapeutic agents, we performed multiple disruptions of BBB (BBBD) with magnetic resonance-guided focused ultrasound on patients with glioblastoma (GBM) during standard adjuvant temozolomide (TMZ) chemotherapy [clinical trial registration no.NCT03712293 (clinicaltrials.gov)]. We report a 1-year follow-up result of BBBD with TMZ for GBM. Methods: From September 2018 to January 2019, six patients were enrolled (four men and two women, median age: 53 years, range: 50-67 years). Of the six patients, five underwent a total of six cycles of BBBD during standard TMZ adjuvant therapy. One patient underwent three cycles of BBBD but continued with TMZ chemotherapy. The 1-year follow-up results of these six patients were reviewed. Results: The mean follow-up duration was 15.17 ± 1.72 months. Two patients showed a recurrence of tumor at 11 and 16 months, respectively. One underwent surgery, and the other patient was restarted with TMZ chemotherapy due to the tumor location with a highly possibility of surgical complications. The survival rate up to 1 year was 100%, and the other four patients are on observation without recurrence. None of the six patients had immediate or delayed BBBD-related complications. Conclusion: Multiple BBBDs can be regarded as a safe procedure without long-term complications, and it seems to have some survival benefits. However, since TMZ partially crosses the BBB, a further extended study with large numbers would be needed to evaluate the benefits of BBBD resulting in an increase of TMZ concentration. This study opened a new therapeutic strategy for GBM by combining BBBD with a larger molecular agent.
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Affiliation(s)
- So Hee Park
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Myung Ji Kim
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Seok Choi
- Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
| | | | | | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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Abstract
Background An accurate and precise surgical procedure is crucial for patient safety and treatment efficacy of deep brain stimulation (DBS). Objectives To investigate the characteristics of intracranial lead bending phenomenon after DBS, and to suggest the methods to avoid bending-related complications. Methods A retrospective review of brain computed tomography scans after DBS was performed. Using 3-dimensional reconstruction, the maximal distance between the planned trajectory and actual lead location was measured. When the distance exceeded the lead body diameter, the lead was considered bent. The distance between the bending point and planned trajectory, and the relative direction between the bending point and lead securing site were analyzed. Changes over time in the range of lead bending and depth were analyzed when possible. Results A total of 190 implanted leads in 102 patients were analyzed; 104 leads (54.7%) were bent. The average deviation of bent leads was 2.3 mm (range, 1.3–7.1 mm). Thirty-five (18.4%) and seven leads (3.7%) had deviations exceeding twice and three times the lead body diameter, respectively. Angles between the deviation point and securing site at the skull ranged from 135–180° in 83 leads (53.2%), 45–135° in 58 (37.2%), and 0–45° in 15 (9.6%). Among 17 leads that were initially bent, 16 had less deviation compared to baseline. The lead depth increased in 35 (92.1%) of 38 leads by 1.2 mm (range, 0.1–4.7 mm). Conclusion The extent of lead bending should be considered during the planning and procedural phases of intracranial lead implantation for DBS.
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Affiliation(s)
- Minsoo Kim
- Department of Neurosurgery, Samsung Medical Center, Seoul, Korea
- Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Korea
| | - Na Young Jung
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Affiliation(s)
- Kai J Miller
- 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Nader Pouratian
- 2Department of Neurosurgery, University of California, Los Angeles, California; and
| | - Jin Woo Chang
- 3Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kendall H Lee
- 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
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Park SH, Chang JW. Gamma Knife Radiosurgery on the Trigeminal Root Entry Zone for Idiopathic Trigeminal Neuralgia: Results and a Review of the Literature. Yonsei Med J 2020; 61:111-119. [PMID: 31997619 PMCID: PMC6992458 DOI: 10.3349/ymj.2020.61.2.111] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/24/2019] [Accepted: 12/30/2019] [Indexed: 01/03/2023] Open
Abstract
Trigeminal neuralgia (TN) is a chronic disorder of the trigeminal nerve characterized by repeated electrical shock-like sensations on one side of the face. It can cause severe pain in the face and disrupt or impair quality of life in patients. Options for the management of TN consist of pharmacological and surgical treatments, including Gamma Knife radiosurgery (GKRS). GKRS has been used for TN for a long time because of its low rate of complications and high success rate. Moreover, GKRS can be of use for drug-resistant TN patients who are poor surgical candidates due to medical comorbidities, patients of older age, or patients who refuse invasive therapy. We reviewed the rationale, effects, safety, and current treatment policies of GKRS for TN in view of our institution's results and a review of the literature to date.
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Affiliation(s)
- So Hee Park
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
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Lee J, Chang WS, Shin J, Seo Y, Kong C, Song BW, Na YC, Kim BS, Chang JW. Non-invasively enhanced intracranial transplantation of mesenchymal stem cells using focused ultrasound mediated by overexpression of cell-adhesion molecules. Stem Cell Res 2020; 43:101726. [PMID: 32028085 DOI: 10.1016/j.scr.2020.101726] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 01/16/2020] [Accepted: 01/29/2020] [Indexed: 12/11/2022] Open
Abstract
Although there have been reports of promising results regarding the transplantation of mesenchymal stem cells (MSCs) for neurodegenerative diseases through the use of neuronal differentiation or control of the microenvironment, traditional surgical transplantation methods like parenchymal or intravenous injection have limitations such as secondary injuries in the brain, infection, and low survival rate of stem cells in the target site. Focused ultrasound (FUS) treatment is an emerging modality for the treatment of brain diseases, including neurodegenerative disorders. The various biological effects of FUS treatment have been investigated; therefore, the goal is now to improve the delivery efficiency and function of MSCs by capitalizing on the advantages of FUS. In this study, we demonstrated that FUS increases MSC transplantation into brain tissue by >2-fold, and that this finding might be related to the activation of intercellular adhesion molecule-1 in endothelial and subendothelial cells and vascular adhesion molecule-1 in endothelial cells.
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Affiliation(s)
- Jihyeon Lee
- Brain Korea 21 PLUS Project for Medical Science & Brain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
| | - Jaewoo Shin
- Brain Korea 21 PLUS Project for Medical Science & Brain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Younghee Seo
- Brain Korea 21 PLUS Project for Medical Science & Brain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Chanho Kong
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Byeong-Wook Song
- Biomedical Research Institute, International St. Mary's Hospital, Incheon Metropolitan City 22711, Republic of Korea; Department of Medical Science, Catholic Kwandong University College of Medicine, Gangneung 25601, Republic of Korea
| | - Young Cheol Na
- Department of Neurosurgery, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon Metropolitan City 22711, Republic of Korea
| | - Bong Soo Kim
- Biomedical Research Institute, International St. Mary's Hospital, Incheon Metropolitan City 22711, Republic of Korea; Department of Medical Science, Catholic Kwandong University College of Medicine, Gangneung 25601, Republic of Korea
| | - Jin Woo Chang
- Brain Korea 21 PLUS Project for Medical Science & Brain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
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49
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Park SH, Kim MJ, Jung HH, Chang WS, Choi HS, Rachmilevitch I, Zadicario E, Chang JW. Safety and feasibility of multiple blood-brain barrier disruptions for the treatment of glioblastoma in patients undergoing standard adjuvant chemotherapy. J Neurosurg 2020:1-9. [PMID: 31899873 DOI: 10.3171/2019.10.jns192206] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/14/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Glioblastoma (GBM) remains fatal due to the blood-brain barrier (BBB), which interferes with the delivery of chemotherapeutic agents. The purpose of this study was to evaluate the safety and feasibility of repeated disruption of the BBB (BBBD) with MR-guided focused ultrasound (MRgFUS) in patients with GBM during standard adjuvant temozolomide (TMZ) chemotherapy. METHODS This study was a prospective, single-center, single-arm study. BBBD with MRgFUS was performed adjacent to the tumor resection margin on the 1st or 2nd day of the adjuvant TMZ chemotherapy at the same targets for 6 cycles. T2*-weighted/gradient echo (GRE) MRI was performed immediately after every sonication trial, and comprehensive MRI was performed at the completion of all sonication sessions. Radiological, laboratory, and clinical evaluations were performed 2 days before each planned BBBD. RESULTS From September 2018, 6 patients underwent 145 BBBD trials at various locations in the brain. The authors observed gadolinium-enhancing spots at the site of BBBD on T1-weighted MRI in 131 trials (90.3%) and 93 trials (64.1%) showed similar spots on T2*-weighted/GRE MRI. When the 2 sequences were combined, BBBD was observed in 134 targets (92.4%). The spots disappeared on follow-up MRI. There were no imaging changes related to BBBD and no clinical adverse effects during the 6 cycles. CONCLUSIONS This study is the first in which repetitive MRgFUS was performed at the same targets with a standard chemotherapy protocol for malignant brain tumor. BBBD with MRgFUS was performed accurately, repeatedly, and safely. Although a longer follow-up period is needed, this study allows for the possibility of other therapeutic agents that previously could not be used due to the BBB.Clinical trial registration no.: NCT03712293 (clinicaltrials.gov).
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Affiliation(s)
- So Hee Park
- 1Brain Research Institute, Department of Neurosurgery and
| | - Myung Ji Kim
- 1Brain Research Institute, Department of Neurosurgery and
| | - Hyun Ho Jung
- 1Brain Research Institute, Department of Neurosurgery and
| | - Won Seok Chang
- 1Brain Research Institute, Department of Neurosurgery and
| | - Hyun Seok Choi
- 2Department of Radiology, Yonsei University College of Medicine, Seoul, Korea; and
| | | | | | - Jin Woo Chang
- 1Brain Research Institute, Department of Neurosurgery and
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Park S, Kim WJ, Lee SK, Chang JW. Central Nervous System Infection-Related Isolated Hippocampal Atrophy as Another Subtype of Medial Temporal Lobe Epilepsy with Hippocampal Atrophy: A Comparison to Conventional Medial Temporal Lobe Epilepsy with Hippocampal Atrophy. J Clin Neurol 2020; 16:688-695. [PMID: 33029977 PMCID: PMC7541999 DOI: 10.3988/jcn.2020.16.4.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Soochul Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Won-Joo Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Koo Lee
- Department of Neuro-Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
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