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Herring EZ, Graczyk EL, Memberg WD, Adams R, Fernandez Baca-Vaca G, Hutchison BC, Krall JT, Alexander BJ, Conlan EC, Alfaro KE, Bhat P, Ketting-Olivier AB, Haddix CA, Taylor DM, Tyler DJ, Sweet JA, Kirsch RF, Ajiboye AB, Miller JP. Reconnecting the Hand and Arm to the Brain: Efficacy of Neural Interfaces for Sensorimotor Restoration After Tetraplegia. Neurosurgery 2024; 94:864-874. [PMID: 37982637 DOI: 10.1227/neu.0000000000002769] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/01/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Paralysis after spinal cord injury involves damage to pathways that connect neurons in the brain to peripheral nerves in the limbs. Re-establishing this communication using neural interfaces has the potential to bridge the gap and restore upper extremity function to people with high tetraplegia. We report a novel approach for restoring upper extremity function using selective peripheral nerve stimulation controlled by intracortical microelectrode recordings from sensorimotor networks, along with restoration of tactile sensation of the hand using intracortical microstimulation. METHODS A 27-year-old right-handed man with AIS-B (motor-complete, sensory-incomplete) C3-C4 tetraplegia was enrolled into the clinical trial. Six 64-channel intracortical microelectrode arrays were implanted into left hemisphere regions involved in upper extremity function, including primary motor and sensory cortices, inferior frontal gyrus, and anterior intraparietal area. Nine 16-channel extraneural peripheral nerve electrodes were implanted to allow targeted stimulation of right median, ulnar (2), radial, axillary, musculocutaneous, suprascapular, lateral pectoral, and long thoracic nerves, to produce selective muscle contractions on demand. Proof-of-concept studies were performed to demonstrate feasibility of using a brain-machine interface to read from and write to the brain for restoring motor and sensory functions of the participant's own arm and hand. RESULTS Multiunit neural activity that correlated with intended motor action was successfully recorded from intracortical arrays. Microstimulation of electrodes in somatosensory cortex produced repeatable sensory percepts of individual fingers for restoration of touch sensation. Selective electrical activation of peripheral nerves produced antigravity muscle contractions, resulting in functional movements that the participant was able to command under brain control to perform virtual and actual arm and hand movements. The system was well tolerated with no operative complications. CONCLUSION The combination of implanted cortical electrodes and nerve cuff electrodes has the potential to create bidirectional restoration of motor and sensory functions of the arm and hand after neurological injury.
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Affiliation(s)
- Eric Z Herring
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neurosurgery, The Neurological Institute, University Hospital Cleveland Medical Center, Cleveland , Ohio , USA
| | - Emily L Graczyk
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland , Ohio , USA
| | - William D Memberg
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland , Ohio , USA
| | - Robert Adams
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neurosurgery, The Neurological Institute, University Hospital Cleveland Medical Center, Cleveland , Ohio , USA
| | - Gaudalupe Fernandez Baca-Vaca
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neurosurgery, The Neurological Institute, University Hospital Cleveland Medical Center, Cleveland , Ohio , USA
| | - Brianna C Hutchison
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
| | - John T Krall
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
| | - Benjamin J Alexander
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
| | - Emily C Conlan
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
| | - Kenya E Alfaro
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
| | - Preethisiri Bhat
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
| | - Aaron B Ketting-Olivier
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
| | - Chase A Haddix
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neuroscience, The Cleveland Clinic, Cleveland , Ohio , USA
| | - Dawn M Taylor
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland , Ohio , USA
- Department of Neuroscience, The Cleveland Clinic, Cleveland , Ohio , USA
| | - Dustin J Tyler
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland , Ohio , USA
| | - Jennifer A Sweet
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neurosurgery, The Neurological Institute, University Hospital Cleveland Medical Center, Cleveland , Ohio , USA
| | - Robert F Kirsch
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland , Ohio , USA
| | - A Bolu Ajiboye
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland , Ohio , USA
| | - Jonathan P Miller
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neurosurgery, The Neurological Institute, University Hospital Cleveland Medical Center, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland , Ohio , USA
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Kesarwani R, Mahajan UV, Wang AS, Kilbane C, Shaikh AG, Miller JP, Sweet JA. Improved Side-Effect Stimulation Thresholds and Postoperative Transient Confusion With Asleep, Image-Guided Deep Brain Stimulation. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01042. [PMID: 38305427 DOI: 10.1227/ons.0000000000001076] [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: 07/10/2023] [Accepted: 12/01/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Asleep, image-guided deep brain stimulation (DBS) is a modern alternative to awake, microelectrode recording (MER) guidance. Studies demonstrate comparable efficacy and complications between techniques, although some report lower stimulation thresholds for side effects with image guidance. In addition, few studies directly compare the risk of postoperative transient confusion (pTC) across techniques. The purpose of this study was to compare clinical efficacy, stimulation thresholds for side effects, and rates of pTC with MER-guided DBS vs intraoperative 3D-fluoroscopy (i3D-F) guidance in Parkinson's disease and essential tremor. METHODS Consecutive patients from 2006 to 2021 were identified from the departmental database and grouped as having either MER-guided DBS or i3D-F-guided DBS insertion. Directional leads were used once commercially available. Changes in Unified Parkinson's Disease Rating Scale (UPDRS)-III scores, levodopa equivalent daily dose, Fahn-Tolosa-Marin scores, and stimulation thresholds were assessed, as were rates of complications including pTC. RESULTS MER guidance was used to implant 487 electrodes (18 globus pallidus interna, GPi; 171 subthalamic nucleus; 76 ventrointermediate thalamus, VIM) in 265 patients. i3D-F guidance was used in 167 electrodes (19 GPi; 25 subthalamic nucleus; 41 VIM) in 85 patients. There were no significant differences in Unified Parkinson's Disease Rating III Scale, levodopa equivalent daily dose, or Fahn-Tolosa-Marin between groups. Stimulation thresholds for side effects were higher with i3D-F guidance in the subthalamic nucleus (MER, 2.80 mA ± 0.98; i3D-F, 3.46 mA ± 0.92; P = .002) and VIM (MER, 2.81 mA ± 1.00; i3D-F, 3.19 mA ± 1.03; P = .0018). Less pTC with i3D-F guidance (MER, 7.5%; i3D-F, 1.2%; P = .034) was also found. CONCLUSION Although clinical efficacy between MER-guided and i3D-F-guided DBS was comparable, thresholds for stimulation side effects were higher with i3D-F guidance and the rate of pTC was lower. This suggests that image-guided DBS may affect long-term side effects and pose a decreased risk of pTC.
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Affiliation(s)
- Rohit Kesarwani
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Current Affiliation: Meritas Health Neurosurgery, North Kansas City Hospital, North Kansas City, Missouri, USA
| | - Uma V Mahajan
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Alexander S Wang
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Camilla Kilbane
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Aasef G Shaikh
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- United States Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Jonathan P Miller
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jennifer A Sweet
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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3
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Miller JP. Integrative taxonomy reveals the conspecific status of Xerotricha madritensis (Rambur, 1868) and Helicella candoni Thach, 2018 (Gastropoda, Geomitridae). ZOOLOGY 2023; 161:126128. [PMID: 37839289 DOI: 10.1016/j.zool.2023.126128] [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: 06/18/2022] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023]
Abstract
The Mediterranean region is a biodiversity hotspot. Mollusks represent the second most diverse phylum, with high species richness, endemism, and significant numbers of threatened species. The non-marine species are an especially vulnerable group. New taxa are frequently described although the descriptions often lack biological support. This is true for Helicella candoni Thach, 2018, originally described from Puerto de Santa María, Cádiz, Spain. Thatch (2018) considered H. candoni to be similar to Xerotricha madritensis (Rambur, 1868) but the comparison was made on the basis of basic conchological characters. The present study analyzed topotypes of X. madritensis and H. candoni using integrative taxonomy to evaluate the relationship of the two taxa and their status within Helicella A. Férussac, 1821 and Xerotricha Monterosato, 1892 respectively. A matrix of the mitochondrial cytochrome c oxidase subunit I (COI) yielded a total of 618 bp. Bayesian and Maximum Likelihood analyses showed that H. candoni and X. madritensis clustered closely together along with Helicella itala. Mean sequence divergence for COI between H. candoni and X. madritensis was 1.42 %. Both taxa are similar in shell shape and colour. Genitalia dimensions of H. condoni were very similar to those of X. madritensis. These data indicate that H. candoni is a junior synonym of X. madritensis. The phylogenetic analyses showed that, despite its morphological similarities, X. madritensis is a species of Helicella instead of Xerotricha.
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Affiliation(s)
- Jonathan P Miller
- Museo Nacional de Ciencias Naturales - CSIC, C/ José Gutiérrez Abascal, 2, Madrid 28006, Spain.
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4
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Pellot-Cestero JE, Herring EZ, Graczyk EL, Memberg WD, Kirsch RF, Ajiboye AB, Miller JP. Implanted Electrodes for Functional Electrical Stimulation to Restore Upper and Lower Extremity Function: History and Future Directions. Neurosurgery 2023; 93:965-970. [PMID: 37288972 DOI: 10.1227/neu.0000000000002561] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/03/2023] [Indexed: 06/09/2023] Open
Abstract
Functional electrical stimulation (FES) to activate nerves and muscles in paralyzed extremities has considerable promise to improve outcome after neurological disease or injury, especially in individuals who have upper motor nerve dysfunction due to central nervous system pathology. Because technology has improved, a wide variety of methods for providing electrical stimulation to create functional movements have been developed, including muscle stimulating electrodes, nerve stimulating electrodes, and hybrid constructs. However, in spite of decades of success in experimental settings with clear functional improvements for individuals with paralysis, the technology has not yet reached widespread clinical translation. In this review, we outline the history of FES techniques and approaches and describe future directions in evolution of the technology.
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Affiliation(s)
- Joel E Pellot-Cestero
- Department of Neurosurgery, School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neurosurgery, The Neurological Institute, University Hospital Cleveland Medical Center, Cleveland , Ohio , USA
| | - Eric Z Herring
- Department of Neurosurgery, School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neurosurgery, The Neurological Institute, University Hospital Cleveland Medical Center, Cleveland , Ohio , USA
| | - Emily L Graczyk
- Department of Neurosurgery, School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland , Ohio , USA
| | - William D Memberg
- Department of Neurosurgery, School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland , Ohio , USA
| | - Robert F Kirsch
- Department of Neurosurgery, School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland , Ohio , USA
| | - A Bolu Ajiboye
- Department of Neurosurgery, School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland , Ohio , USA
| | - Jonathan P Miller
- Department of Neurosurgery, School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neurosurgery, The Neurological Institute, University Hospital Cleveland Medical Center, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland , Ohio , USA
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5
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Aguillard DP, Albahri T, Allspach D, Anisenkov A, Badgley K, Baeßler S, Bailey I, Bailey L, Baranov VA, Barlas-Yucel E, Barrett T, Barzi E, Bedeschi F, Berz M, Bhattacharya M, Binney HP, Bloom P, Bono J, Bottalico E, Bowcock T, Braun S, Bressler M, Cantatore G, Carey RM, Casey BCK, Cauz D, Chakraborty R, Chapelain A, Chappa S, Charity S, Chen C, Cheng M, Chislett R, Chu Z, Chupp TE, Claessens C, Convery ME, Corrodi S, Cotrozzi L, Crnkovic JD, Dabagov S, Debevec PT, Di Falco S, Di Sciascio G, Drendel B, Driutti A, Duginov VN, Eads M, Edmonds A, Esquivel J, Farooq M, Fatemi R, Ferrari C, Fertl M, Fienberg AT, Fioretti A, Flay D, Foster SB, Friedsam H, Froemming NS, Gabbanini C, Gaines I, Galati MD, Ganguly S, Garcia A, George J, Gibbons LK, Gioiosa A, Giovanetti KL, Girotti P, Gohn W, Goodenough L, Gorringe T, Grange J, Grant S, Gray F, Haciomeroglu S, Halewood-Leagas T, Hampai D, Han F, Hempstead J, Hertzog DW, Hesketh G, Hess E, Hibbert A, Hodge Z, Hong KW, Hong R, Hu T, Hu Y, Iacovacci M, Incagli M, Kammel P, Kargiantoulakis M, Karuza M, Kaspar J, Kawall D, Kelton L, Keshavarzi A, Kessler DS, Khaw KS, Khechadoorian Z, Khomutov NV, Kiburg B, Kiburg M, Kim O, Kinnaird N, Kraegeloh E, Krylov VA, Kuchinskiy NA, Labe KR, LaBounty J, Lancaster M, Lee S, Li B, Li D, Li L, Logashenko I, Lorente Campos A, Lu Z, Lucà A, Lukicov G, Lusiani A, Lyon AL, MacCoy B, Madrak R, Makino K, Mastroianni S, Miller JP, Miozzi S, Mitra B, Morgan JP, Morse WM, Mott J, Nath A, Ng JK, Nguyen H, Oksuzian Y, Omarov Z, Osofsky R, Park S, Pauletta G, Piacentino GM, Pilato RN, Pitts KT, Plaster B, Počanić D, Pohlman N, Polly CC, Price J, Quinn B, Qureshi MUH, Ramachandran S, Ramberg E, Reimann R, Roberts BL, Rubin DL, Santi L, Schlesier C, Schreckenberger A, Semertzidis YK, Shemyakin D, Sorbara M, Stöckinger D, Stapleton J, Still D, Stoughton C, Stratakis D, Swanson HE, Sweetmore G, Sweigart DA, Syphers MJ, Tarazona DA, Teubner T, Tewsley-Booth AE, Tishchenko V, Tran NH, Turner W, Valetov E, Vasilkova D, Venanzoni G, Volnykh VP, Walton T, Weisskopf A, Welty-Rieger L, Winter P, Wu Y, Yu B, Yucel M, Zeng Y, Zhang C. Measurement of the Positive Muon Anomalous Magnetic Moment to 0.20 ppm. Phys Rev Lett 2023; 131:161802. [PMID: 37925710 DOI: 10.1103/physrevlett.131.161802] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/05/2023] [Indexed: 11/07/2023]
Abstract
We present a new measurement of the positive muon magnetic anomaly, a_{μ}≡(g_{μ}-2)/2, from the Fermilab Muon g-2 Experiment using data collected in 2019 and 2020. We have analyzed more than 4 times the number of positrons from muon decay than in our previous result from 2018 data. The systematic error is reduced by more than a factor of 2 due to better running conditions, a more stable beam, and improved knowledge of the magnetic field weighted by the muon distribution, ω[over ˜]_{p}^{'}, and of the anomalous precession frequency corrected for beam dynamics effects, ω_{a}. From the ratio ω_{a}/ω[over ˜]_{p}^{'}, together with precisely determined external parameters, we determine a_{μ}=116 592 057(25)×10^{-11} (0.21 ppm). Combining this result with our previous result from the 2018 data, we obtain a_{μ}(FNAL)=116 592 055(24)×10^{-11} (0.20 ppm). The new experimental world average is a_{μ}(exp)=116 592 059(22)×10^{-11} (0.19 ppm), which represents a factor of 2 improvement in precision.
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Affiliation(s)
| | - T Albahri
- University of Liverpool, Liverpool, United Kingdom
| | - D Allspach
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - A Anisenkov
- Budker Institute of Nuclear Physics, Novosibirsk, Russia
| | - K Badgley
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - S Baeßler
- University of Virginia, Charlottesville, Virginia, USA
| | - I Bailey
- Lancaster University, Lancaster, United Kingdom
| | - L Bailey
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - V A Baranov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - E Barlas-Yucel
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - T Barrett
- Cornell University, Ithaca, New York, USA
| | - E Barzi
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | | | - M Berz
- Michigan State University, East Lansing, Michigan, USA
| | - M Bhattacharya
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - H P Binney
- University of Washington, Seattle, Washington, USA
| | - P Bloom
- North Central College, Naperville, Illinois, USA
| | - J Bono
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - E Bottalico
- University of Liverpool, Liverpool, United Kingdom
| | - T Bowcock
- University of Liverpool, Liverpool, United Kingdom
| | - S Braun
- University of Washington, Seattle, Washington, USA
| | - M Bressler
- Department of Physics, University of Massachusetts, Amherst, Massachusetts, USA
| | | | - R M Carey
- Boston University, Boston, Massachusetts, USA
| | - B C K Casey
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - D Cauz
- Università di Udine, Udine, Italy
| | | | | | - S Chappa
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - S Charity
- University of Liverpool, Liverpool, United Kingdom
| | - C Chen
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
- Tsung-Dao Lee Institute, Shanghai Jiao Tong University, Shanghai, China
| | - M Cheng
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - R Chislett
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - Z Chu
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
| | - T E Chupp
- University of Michigan, Ann Arbor, Michigan, USA
| | - C Claessens
- University of Washington, Seattle, Washington, USA
| | - M E Convery
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - S Corrodi
- Argonne National Laboratory, Lemont, Illinois, USA
| | | | - J D Crnkovic
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - S Dabagov
- INFN, Laboratori Nazionali di Frascati, Frascati, Italy
| | - P T Debevec
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | | | | | - B Drendel
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | | | - V N Duginov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - M Eads
- Northern Illinois University, DeKalb, Illinois, USA
| | - A Edmonds
- Boston University, Boston, Massachusetts, USA
| | - J Esquivel
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - M Farooq
- University of Michigan, Ann Arbor, Michigan, USA
| | - R Fatemi
- University of Kentucky, Lexington, Kentucky, USA
| | | | - M Fertl
- Institute of Physics and Cluster of Excellence PRISMA+, Johannes Gutenberg University Mainz, Mainz, Germany
| | - A T Fienberg
- University of Washington, Seattle, Washington, USA
| | | | - D Flay
- Department of Physics, University of Massachusetts, Amherst, Massachusetts, USA
| | - S B Foster
- Boston University, Boston, Massachusetts, USA
| | - H Friedsam
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | | | | | - I Gaines
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | | | - S Ganguly
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - A Garcia
- University of Washington, Seattle, Washington, USA
| | - J George
- Department of Physics, University of Massachusetts, Amherst, Massachusetts, USA
| | | | - A Gioiosa
- Università del Molise, Campobasso, Italy
| | - K L Giovanetti
- Department of Physics and Astronomy, James Madison University, Harrisonburg, Virginia, USA
| | | | - W Gohn
- University of Kentucky, Lexington, Kentucky, USA
| | - L Goodenough
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - T Gorringe
- University of Kentucky, Lexington, Kentucky, USA
| | - J Grange
- University of Michigan, Ann Arbor, Michigan, USA
| | - S Grant
- Argonne National Laboratory, Lemont, Illinois, USA
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - F Gray
- Regis University, Denver, Colorado, USA
| | - S Haciomeroglu
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | | | - D Hampai
- INFN, Laboratori Nazionali di Frascati, Frascati, Italy
| | - F Han
- University of Kentucky, Lexington, Kentucky, USA
| | - J Hempstead
- University of Washington, Seattle, Washington, USA
| | - D W Hertzog
- University of Washington, Seattle, Washington, USA
| | - G Hesketh
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - E Hess
- INFN, Sezione di Pisa, Pisa, Italy
| | - A Hibbert
- University of Liverpool, Liverpool, United Kingdom
| | - Z Hodge
- University of Washington, Seattle, Washington, USA
| | - K W Hong
- University of Virginia, Charlottesville, Virginia, USA
| | - R Hong
- Argonne National Laboratory, Lemont, Illinois, USA
- University of Kentucky, Lexington, Kentucky, USA
| | - T Hu
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
- Tsung-Dao Lee Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Y Hu
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
| | | | | | - P Kammel
- University of Washington, Seattle, Washington, USA
| | | | - M Karuza
- INFN, Sezione di Trieste, Trieste, Italy
| | - J Kaspar
- University of Washington, Seattle, Washington, USA
| | - D Kawall
- Department of Physics, University of Massachusetts, Amherst, Massachusetts, USA
| | - L Kelton
- University of Kentucky, Lexington, Kentucky, USA
| | - A Keshavarzi
- Department of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - D S Kessler
- Department of Physics, University of Massachusetts, Amherst, Massachusetts, USA
| | - K S Khaw
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
- Tsung-Dao Lee Institute, Shanghai Jiao Tong University, Shanghai, China
| | | | - N V Khomutov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - B Kiburg
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - M Kiburg
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
- North Central College, Naperville, Illinois, USA
| | - O Kim
- University of Mississippi, University, Mississippi, USA
| | - N Kinnaird
- Boston University, Boston, Massachusetts, USA
| | - E Kraegeloh
- University of Michigan, Ann Arbor, Michigan, USA
| | - V A Krylov
- Joint Institute for Nuclear Research, Dubna, Russia
| | | | - K R Labe
- Cornell University, Ithaca, New York, USA
| | - J LaBounty
- University of Washington, Seattle, Washington, USA
| | - M Lancaster
- Department of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - S Lee
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | - B Li
- Argonne National Laboratory, Lemont, Illinois, USA
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
| | - D Li
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
| | - L Li
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
| | - I Logashenko
- Budker Institute of Nuclear Physics, Novosibirsk, Russia
| | | | - Z Lu
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
| | - A Lucà
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - G Lukicov
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | | | - A L Lyon
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - B MacCoy
- University of Washington, Seattle, Washington, USA
| | - R Madrak
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - K Makino
- Michigan State University, East Lansing, Michigan, USA
| | | | - J P Miller
- Boston University, Boston, Massachusetts, USA
| | - S Miozzi
- INFN, Sezione di Roma Tor Vergata, Rome, Italy
| | - B Mitra
- University of Mississippi, University, Mississippi, USA
| | - J P Morgan
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - W M Morse
- Brookhaven National Laboratory, Upton, New York, USA
| | - J Mott
- Boston University, Boston, Massachusetts, USA
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - A Nath
- INFN, Sezione di Napoli, Naples, Italy
| | - J K Ng
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
- Tsung-Dao Lee Institute, Shanghai Jiao Tong University, Shanghai, China
| | - H Nguyen
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - Y Oksuzian
- Argonne National Laboratory, Lemont, Illinois, USA
| | - Z Omarov
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
- Department of Physics, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - R Osofsky
- University of Washington, Seattle, Washington, USA
| | - S Park
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | | | | | - R N Pilato
- University of Liverpool, Liverpool, United Kingdom
| | - K T Pitts
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - B Plaster
- University of Kentucky, Lexington, Kentucky, USA
| | - D Počanić
- University of Virginia, Charlottesville, Virginia, USA
| | - N Pohlman
- Northern Illinois University, DeKalb, Illinois, USA
| | - C C Polly
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - J Price
- University of Liverpool, Liverpool, United Kingdom
| | - B Quinn
- University of Mississippi, University, Mississippi, USA
| | - M U H Qureshi
- Institute of Physics and Cluster of Excellence PRISMA+, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - E Ramberg
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - R Reimann
- Institute of Physics and Cluster of Excellence PRISMA+, Johannes Gutenberg University Mainz, Mainz, Germany
| | - B L Roberts
- Boston University, Boston, Massachusetts, USA
| | - D L Rubin
- Cornell University, Ithaca, New York, USA
| | - L Santi
- Università di Udine, Udine, Italy
| | - C Schlesier
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | | | - Y K Semertzidis
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
- Department of Physics, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - D Shemyakin
- Budker Institute of Nuclear Physics, Novosibirsk, Russia
| | - M Sorbara
- INFN, Sezione di Roma Tor Vergata, Rome, Italy
| | - D Stöckinger
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - J Stapleton
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - D Still
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - C Stoughton
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - D Stratakis
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - H E Swanson
- University of Washington, Seattle, Washington, USA
| | - G Sweetmore
- Department of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | | | - M J Syphers
- Northern Illinois University, DeKalb, Illinois, USA
| | - D A Tarazona
- Cornell University, Ithaca, New York, USA
- Michigan State University, East Lansing, Michigan, USA
- University of Liverpool, Liverpool, United Kingdom
| | - T Teubner
- University of Liverpool, Liverpool, United Kingdom
| | - A E Tewsley-Booth
- University of Kentucky, Lexington, Kentucky, USA
- University of Michigan, Ann Arbor, Michigan, USA
| | - V Tishchenko
- Brookhaven National Laboratory, Upton, New York, USA
| | - N H Tran
- Boston University, Boston, Massachusetts, USA
| | - W Turner
- University of Liverpool, Liverpool, United Kingdom
| | - E Valetov
- Michigan State University, East Lansing, Michigan, USA
| | - D Vasilkova
- Department of Physics and Astronomy, University College London, London, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - G Venanzoni
- University of Liverpool, Liverpool, United Kingdom
| | - V P Volnykh
- Joint Institute for Nuclear Research, Dubna, Russia
| | - T Walton
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - A Weisskopf
- Michigan State University, East Lansing, Michigan, USA
| | - L Welty-Rieger
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - P Winter
- Argonne National Laboratory, Lemont, Illinois, USA
| | - Y Wu
- Argonne National Laboratory, Lemont, Illinois, USA
| | - B Yu
- University of Mississippi, University, Mississippi, USA
| | - M Yucel
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - Y Zeng
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
- Tsung-Dao Lee Institute, Shanghai Jiao Tong University, Shanghai, China
| | - C Zhang
- University of Liverpool, Liverpool, United Kingdom
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6
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Greenspon CM, Shelchkova ND, Valle G, Hobbs TG, Berger-Wolf EI, Hutchison BC, Dogruoz E, Verbarschott C, Callier T, Sobinov AR, Okorokova EV, Jordan PM, Prasad D, He Q, Liu F, Kirsch RF, Miller JP, Lee RC, Satzer D, Gonzalez-Martinez J, Warnke PC, Miller LE, Boninger ML, Ajiboye AB, Graczyk EL, Downey JE, Collinger JL, Hatsopoulos NG, Gaunt RA, Bensmaia SJ. Tessellation of artificial touch via microstimulation of human somatosensory cortex. bioRxiv 2023:2023.06.23.545425. [PMID: 37425877 PMCID: PMC10327055 DOI: 10.1101/2023.06.23.545425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
When we interact with objects, we rely on signals from the hand that convey information about the object and our interaction with it. A basic feature of these interactions, the locations of contacts between the hand and object, is often only available via the sense of touch. Information about locations of contact between a brain-controlled bionic hand and an object can be signaled via intracortical microstimulation (ICMS) of somatosensory cortex (S1), which evokes touch sensations that are localized to a specific patch of skin. To provide intuitive location information, tactile sensors on the robotic hand drive ICMS through electrodes that evoke sensations at skin locations matching sensor locations. This approach requires that ICMS-evoked sensations be focal, stable, and distributed over the hand. To systematically investigate the localization of ICMS-evoked sensations, we analyzed the projected fields (PFs) of ICMS-evoked sensations - their location and spatial extent - from reports obtained over multiple years from three participants implanted with microelectrode arrays in S1. First, we found that PFs vary widely in their size across electrodes, are highly stable within electrode, are distributed over large swaths of each participant's hand, and increase in size as the amplitude or frequency of ICMS increases. Second, while PF locations match the locations of the receptive fields (RFs) of the neurons near the stimulating electrode, PFs tend to be subsumed by the corresponding RFs. Third, multi-channel stimulation gives rise to a PF that reflects the conjunction of the PFs of the component channels. By stimulating through electrodes with largely overlapping PFs, then, we can evoke a sensation that is experienced primarily at the intersection of the component PFs. To assess the functional consequence of this phenomenon, we implemented multichannel ICMS-based feedback in a bionic hand and demonstrated that the resulting sensations are more localizable than are those evoked via single-channel ICMS.
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Affiliation(s)
- Charles M Greenspon
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | | | - Giacomo Valle
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Taylor G Hobbs
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Ev I Berger-Wolf
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Brianna C Hutchison
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
| | - Efe Dogruoz
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Ceci Verbarschott
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
| | - Thierri Callier
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Anton R Sobinov
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | | | - Patrick M Jordan
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Dillan Prasad
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Qinpu He
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
| | - Fang Liu
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Robert F Kirsch
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Jonathan P Miller
- School of Medicine, Case Western Reserve University, Cleveland, OH
- The Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Ray C Lee
- Schwab Rehabilitation Hospital, Chicago, IL
| | - David Satzer
- Department of Neurological Surgery, University of Chicago, Chicago, IL
| | | | - Peter C Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, IL
| | - Lee E Miller
- Department of Neuroscience, Northwestern University, Chicago, IL
- Department of Biomedical Engineering, Northwestern University, Evanston, IL
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
- Shirley Ryan Ability Lab, Chicago, IL
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Abidemi B Ajiboye
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Emily L Graczyk
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - John E Downey
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Jennifer L Collinger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Nicholas G Hatsopoulos
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
- Neuroscience Institute, University of Chicago, Chicago, IL
| | - Robert A Gaunt
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Sliman J Bensmaia
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
- Neuroscience Institute, University of Chicago, Chicago, IL
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Fotedar N, Fernandez-BacaVaca G, Rose M, Miller JP, Lüders HO. Spectrum of motor responses elicited by electrical stimulation of primary motor cortex: A polygraphic study in patients with epilepsy. Epilepsy Behav 2023; 142:109185. [PMID: 36966591 DOI: 10.1016/j.yebeh.2023.109185] [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: 01/30/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To study the neurophysiology of motor responses elicited by electrical stimulation of the primary motor cortex. METHODS We studied motor responses in four patients undergoing invasive epilepsy monitoring and functional cortical mapping via electrical cortical stimulation using surface EMG electrodes. In addition, polygraphic analysis of intracranial EEG and EMG during bilateral tonic-clonic seizures, induced by cortical stimulation, was performed in two patients. RESULTS (a) Electrical cortical stimulation: The motor responses were classified as clonic, jittery, and tonic. The clonic responses were characterized by synchronous EMG bursts of agonist and antagonistic muscles, alternating with silent periods. At stimulation frequencies of <20 Hz, EMG bursts were of ≤50 ms duration (Type I clonic). At stimulation frequencies of 20-50 Hz, EMG bursts were of >50 ms duration and had a complex morphology (Type II clonic). Increasing the current intensity at a constant frequency converted clonic responses into jittery and tonic contractions. (b) Bilateral tonic-clonic seizures: The intracranial EEG showed continuous fast spiking activity during the tonic phase along with interference pattern on surface EMG. The clonic phase was characterized by a polyspike-and-slow wave pattern. The polyspikes were time-locked with the synchronous EMG bursts of agonists and antagonists and the slow waves were time-locked with silent periods. INTERPRETATION These results suggest that epileptic activity involving the primary motor cortex can produce a continuum of motor responses ranging from type I clonic, type II clonic, and tonic responses to bilateral tonic-clonic seizures. This continuum is related to the frequency and intensity of the epileptiform discharges with tonic seizures representing the highest end of the spectrum.
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Affiliation(s)
- Neel Fotedar
- Epilepsy Center, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA; Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
| | - Guadalupe Fernandez-BacaVaca
- Epilepsy Center, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA; Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Michael Rose
- Epilepsy Center, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Jonathan P Miller
- Epilepsy Center, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA; Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Hans O Lüders
- Epilepsy Center, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA; Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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8
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Herring EZ, Graczyk EL, Memberg WD, Adams RD, Baca-Vaca GF, Hutchison BC, Krall JT, Alexander BJ, Conlan EC, Alfaro KE, Bhat PR, Ketting-Olivier AB, Haddix CA, Taylor DM, Tyler DJ, Kirsch RF, Ajiboye AB, Miller JP. Reconnecting the Hand and Arm to the Brain: Efficacy of Neural Interfaces for Sensorimotor Restoration after Tetraplegia. medRxiv 2023:2023.04.24.23288977. [PMID: 37162904 PMCID: PMC10168522 DOI: 10.1101/2023.04.24.23288977] [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] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Paralysis after spinal cord injury involves damage to pathways that connect neurons in the brain to peripheral nerves in the limbs. Re-establishing this communication using neural interfaces has the potential to bridge the gap and restore upper extremity function to people with high tetraplegia. Objective We report a novel approach for restoring upper extremity function using selective peripheral nerve stimulation controlled by intracortical microelectrode recordings from sensorimotor networks, along with restoration of tactile sensation of the hand using intracortical microstimulation. Methods A right-handed man with motor-complete C3-C4 tetraplegia was enrolled into the clinical trial. Six 64-channel intracortical microelectrode arrays were implanted into left hemisphere regions involved in upper extremity function, including primary motor and sensory cortices, inferior frontal gyrus, and anterior intraparietal area. Nine 16-channel extraneural peripheral nerve electrodes were implanted to allow targeted stimulation of right median, ulnar (2), radial, axillary, musculocutaneous, suprascapular, lateral pectoral, and long thoracic nerves, to produce selective muscle contractions on demand. Proof-of-concept studies were performed to demonstrate feasibility of a bidirectional brain-machine interface to restore function of the participant's own arm and hand. Results Multi-unit neural activity that correlated with intended motor action was successfully recorded from intracortical arrays. Microstimulation of electrodes in somatosensory cortex produced repeatable sensory percepts of individual fingers for restoration of touch sensation. Selective electrical activation of peripheral nerves produced antigravity muscle contractions. The system was well tolerated with no operative complications. Conclusion The combination of implanted cortical electrodes and nerve cuff electrodes has the potential to allow restoration of motor and sensory functions of the arm and hand after neurological injury.
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Affiliation(s)
- Eric Z Herring
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- The Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Emily L Graczyk
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
| | - William D Memberg
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
| | - Robert D Adams
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
| | | | - Brianna C Hutchison
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - John T Krall
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Benjamin J Alexander
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Emily C Conlan
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kenya E Alfaro
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Preethi R Bhat
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Chase A Haddix
- Department of Neuroscience, Lerner Research Institute, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Dawn M Taylor
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
- Department of Neuroscience, Lerner Research Institute, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Dustin J Tyler
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Robert F Kirsch
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
| | - A Bolu Ajiboye
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
| | - Jonathan P Miller
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- The Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
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Abstract
Trigeminal neuralgia (TN) is a syndrome consisting of episodic neuropathic facial pain. Although the precise symptoms vary across individuals, TN is typically described as lancinating electrical shocks triggered by sensory stimuli (light touch, talking, eating, and brushing teeth) that improve with antiepileptic medication (especially carbamazepine), remit spontaneously for weeks to months (pain-free intervals), and do not involve any changes in baseline sensation. The etiology of TN has not been definitively established, but many cases are associated with compression of the trigeminal nerve by a blood vessel at the trigeminal root entry zone adjacent to the brainstem. Patients who do not respond to medical management and who are not candidates for microvascular decompression often benefit from focal therapeutic injury to the trigeminal nerve at some point along its course. Many lesions have been described, including peripheral neurectomies that target distal branches of the trigeminal nerve, rhizotomies of the Gasserian ganglion of the nerve within Meckel's cave, radiosurgery of the trigeminal nerve at its root entry zone, partial sensory rhizotomy at the root entry zone, tractotomy of the spinal nucleus of the trigeminal nerve, and DREZotomy of the trigeminal nucleus caudalis, Though the latter two interventions are seldom done for TN and more commonly performed for trigeminal neuropathic pain. This article reviews the relevant anatomy and lesioning procedures for the treatment of trigeminal neuralgia.
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Affiliation(s)
- Arpan R Chakraborty
- Department of Neurological Surgery, University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, HAN 5042, Cleveland, OH 44106, USA; Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - Kerrin Sunshine
- Department of Neurological Surgery, University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, HAN 5042, Cleveland, OH 44106, USA; Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - Jonathan P Miller
- Department of Neurological Surgery, University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, HAN 5042, Cleveland, OH 44106, USA; Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - Jennifer A Sweet
- Department of Neurological Surgery, University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, HAN 5042, Cleveland, OH 44106, USA; Case Western Reserve University, School of Medicine, Cleveland, OH, USA.
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10
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Rubin DB, Ajiboye AB, Barefoot L, Bowker M, Cash SS, Chen D, Donoghue JP, Eskandar EN, Friehs G, Grant C, Henderson JM, Kirsch RF, Marujo R, Masood M, Mernoff ST, Miller JP, Mukand JA, Penn RD, Shefner J, Shenoy KV, Simeral JD, Sweet JA, Walter BL, Williams ZM, Hochberg LR. Interim Safety Profile From the Feasibility Study of the BrainGate Neural Interface System. Neurology 2023; 100:e1177-e1192. [PMID: 36639237 PMCID: PMC10074470 DOI: 10.1212/wnl.0000000000201707] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 11/03/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Brain-computer interfaces (BCIs) are being developed to restore mobility, communication, and functional independence to people with paralysis. Though supported by decades of preclinical data, the safety of chronically implanted microelectrode array BCIs in humans is unknown. We report safety results from the prospective, open-label, nonrandomized BrainGate feasibility study (NCT00912041), the largest and longest-running clinical trial of an implanted BCI. METHODS Adults aged 18-75 years with quadriparesis from spinal cord injury, brainstem stroke, or motor neuron disease were enrolled through 7 clinical sites in the United States. Participants underwent surgical implantation of 1 or 2 microelectrode arrays in the motor cortex of the dominant cerebral hemisphere. The primary safety outcome was device-related serious adverse events (SAEs) requiring device explantation or resulting in death or permanently increased disability during the 1-year postimplant evaluation period. The secondary outcomes included the type and frequency of other adverse events and the feasibility of the BrainGate system for controlling a computer or other assistive technologies. RESULTS From 2004 to 2021, 14 adults enrolled in the BrainGate trial had devices surgically implanted. The average duration of device implantation was 872 days, yielding 12,203 days of safety experience. There were 68 device-related adverse events, including 6 device-related SAEs. The most common device-related adverse event was skin irritation around the percutaneous pedestal. There were no safety events that required device explantation, no unanticipated adverse device events, no intracranial infections, and no participant deaths or adverse events resulting in permanently increased disability related to the investigational device. DISCUSSION The BrainGate Neural Interface system has a safety record comparable with other chronically implanted medical devices. Given rapid recent advances in this technology and continued performance gains, these data suggest a favorable risk/benefit ratio in appropriately selected individuals to support ongoing research and development. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT00912041. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that the neurosurgically placed BrainGate Neural Interface system is associated with a low rate of SAEs defined as those requiring device explantation, resulting in death, or resulting in permanently increased disability during the 1-year postimplant period.
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Affiliation(s)
- Daniel B Rubin
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA.
| | - A Bolu Ajiboye
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Laurie Barefoot
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Marguerite Bowker
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Sydney S Cash
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - David Chen
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - John P Donoghue
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Emad N Eskandar
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Gerhard Friehs
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Carol Grant
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Jaimie M Henderson
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Robert F Kirsch
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Rose Marujo
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Maryam Masood
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Stephen T Mernoff
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Jonathan P Miller
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Jon A Mukand
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Richard D Penn
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Jeremy Shefner
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Krishna V Shenoy
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - John D Simeral
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Jennifer A Sweet
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Benjamin L Walter
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Ziv M Williams
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Leigh R Hochberg
- From the Center for Neurotechnology and Neurorecovery (CNTR) (D.B.R., L.B., S.S.C., C.G., R.M., M.M., L.R.H.), Department of Neurology, and Department of Neurosurgery (Z.M.W.), Massachusetts General Hospital, Boston; Harvard Medical School (D.B.R., S.S.C., L.R.H.), Boston, MA; Department of Biomedical Engineering (A.B.A., R.F.K.), Case Western Reserve University, Cleveland, OH; FES Center of Excellence, Rehab. R&D Service (A.B.A., R.F.K., J.P.M., J.A.S., B.L.W.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH; Center for Neurorestoration and Neurotechnology (CfNN) (M.B., J.P.D., J.D.S., L.R.H.), Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI; Legs and Walking Lab (D.C.), Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation (D.C.), Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, IL; Department of Neuroscience (J.P.D.), Robert J. and Nancy D. Carney Institute for Brain Science (J.P.D., J.D.S., L.R.H.), School of Engineering (J.P.D., J.D.S., L.R.H.), and Department of Rehabilitation Medicine (J.A.M.), Brown University, Providence, RI; Department of Neurological Surgery (E.N.E.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; European University of Cyprus (G.F.), Nicosia, Cyprus; Department of Neurosurgery (J.M.H.), Stanford University School of Medicine, CA; Wu Tsai Neurosciences Institute (J.M.H., K.V.S.), Bio-X Institute (J.M.H., K.V.S.), and Departments of Neurobiology (K.V.S.), Electrical Engineering (K.V.S.), and Bioengineering (K.V.S.), Stanford University, CA; Department of Neurological Surgery (R.F.K., J.P.M., J.A.S.), University Hospitals Case Medical Center, Cleveland, OH; Neurology Section (S.T.M.), VA Providence Health Care System, Providence, RI; Department of Neurology (S.T.M.), Alpert Medical School of Brown University, Providence, RI; Sargent Rehabilitation Center (J.A.M.), Warwick, RI; Section of Neurosurgery (R.D.P.), Department of Surgery, University of Chicago; Department of Neurosurgery (R.D.P.), Rush University Medical Center, Chicago, IL; Department of Neurology (J.S.), Barrow Neurological Institute, Phoenix, AZ; Howard Hughes Medical Institute at Stanford University (K.V.S.); Center for Neurological Restoration (B.L.W.), Cleveland Clinic, OH; and Program in Neuroscience (Z.M.W.), Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School, Boston, MA
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Mahajan UV, Labak KB, Labak CM, Herring EZ, Lineberry K, Miller JP, Smith G. Correction to: Pudendal tumor mimicking cauda equina syndrome and acute radiculopathy: case report. Spinal Cord Ser Cases 2022; 8:81. [DOI: 10.1038/s41394-022-00547-1] [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: 11/09/2022] Open
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Mahajan UV, Labak KB, Labak CM, Herring EZ, Lineberry K, Miller JP, Smith G. Pudendal tumor mimicking cauda equina syndrome and acute radiculopathy: case report. Spinal Cord Ser Cases 2022; 8:71. [PMID: 35918325 PMCID: PMC9345956 DOI: 10.1038/s41394-022-00537-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Cauda equina syndrome (CES) is most caused by lumbar disc herniation, and the associated treatment involves prompt surgical decompression. Rarer causes of CES include perineural (Tarlov) cysts. CLINICAL PRESENTATION A 62-year-old female with history of rheumatoid arthritis, hip and knee replacements, and chronic low back pain presented with worsening back pain, left leg weakness and pain for 6 weeks, and bowel/bladder incontinence with diminished sensation in the perianal region for 24 h prior to presentation. MRI demonstrated severe spinal stenosis at L4-S1, central disc herniation at L5-S1, and compression of the cauda equina, consistent with CES. A lumbar decompression was performed. Patient did well at 2-week follow up, but presented 5 weeks post-discharge with increased left leg pain/weakness and genitalia anesthesia. Imaging was unremarkable. Two months later, the patient presented with diminished sensation in the buttocks and bilateral lower extremities and bowel/bladder incontinence. Imaging demonstrated a large cystic presacral mass with involvement of the left sciatic foramen and S3 neural foramen. A team of plastic, orthopedic, and neurological surgeons performed an S3 sacral laminectomy, foraminotomy, partial sacrectomy, and S3 rhizotomy, and excision of the large left hemorrhagic pudendal mass. Final pathology demonstrated a perineural cyst with organizing hemorrhage. On follow-up, the patient's pain and weakness improved. CONCLUSION CES-like symptoms were initially attributed to a herniated disk. However, lumbar decompression did not resolve symptoms, prompting further radiographic evaluation at two separate presentations. This represents the first reported case of a pudendal tumor causing symptoms initially attributed to a herniated disc.
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Adesina A, Anthony A, Zampino A, Herring EZ, Labak CM, Lineberry K, Miller JP, Preston DC. Infiltrative Arteriovenous Malformation of the Sciatic Nerve: Imaging and Management. Muscle Nerve 2022; 66:E11-E13. [PMID: 35751299 DOI: 10.1002/mus.27666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Adeleso Adesina
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Austin Anthony
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Anthony Zampino
- Case Western Reserve University School of Medicine, Cleveland, OH.,Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Eric Z Herring
- Case Western Reserve University School of Medicine, Cleveland, OH.,Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Collin M Labak
- Case Western Reserve University School of Medicine, Cleveland, OH.,Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Kyle Lineberry
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Jonathan P Miller
- Case Western Reserve University School of Medicine, Cleveland, OH.,Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - David C Preston
- Case Western Reserve University School of Medicine, Cleveland, OH.,Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH
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Miller JP, Delicado D, García-Guerrero F, Ramos MA. Recurrent founder-event speciation across the Mediterranean likely shaped the species diversity and geographic distribution of the freshwater snail genus Mercuria Boeters, 1971 (Caenogastropoda: Hydrobiidae). Mol Phylogenet Evol 2022; 173:107524. [DOI: 10.1016/j.ympev.2022.107524] [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] [Received: 12/16/2021] [Revised: 03/31/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
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Pérez JM, Pacheco MC, Miller JP. First record of a rare sinistral specimen of Pyramidula jaenensis (Clessin, 1882) (Gastropoda: Pyramidulidae) in Spain. Folia Malacol 2022. [DOI: 10.12657/folmal.030.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Enantiomorphism in gastropods is related to the shell shape: high-spired snails present a higher proportion of enantiomorphs, in the low-spired snails it is less frequent. This could be a consequence of the way the snails mate; shell mounting mating occurs in the high-spired species and is independent of the chirality while the low-spired snails mate face-to-face which implies a certain degree of genitalia adjustment for successful copulation. Cases of sinistral Pyramidula have been reported in Eurasia, however, it is the first time it has been observed in P. jaenensis and Spain.
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Sweet JA, Gao K, Chen Z, Tatsuoka C, Calabrese JR, Sajatovic M, Miller JP, McIntyre CC. Cingulum bundle connectivity in treatment-refractory compared to treatment-responsive patients with bipolar disorder and healthy controls: a tractography and surgical targeting analysis. J Neurosurg 2022; 137:1-13. [PMID: 35061996 PMCID: PMC10193487 DOI: 10.3171/2021.11.jns211833] [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: 07/27/2021] [Accepted: 11/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The clinical response of patients with bipolar disorder to medical treatment is variable. A better understanding of the underlying neural circuitry involved in bipolar treatment responsivity subtypes may provide insight into treatment resistance and aid in identifying an effective surgical target for deep brain stimulation (DBS) specific to the disorder. Despite considerable imaging research related to the disease, a paucity of comparative imaging analyses of treatment responsiveness exists. There are also no DBS targets designed expressly for patients with bipolar disorder. Therefore, the authors analyzed cingulum bundle axonal connectivity in relation to cortico-striatal-thalamo-cortical (CSTC) loops implicated in bipolar disorder across subjects who are responsive to treatment (RSP) and those who are refractory to therapy (REF), compared to healthy controls (HCs). METHODS Twenty-five subjects with bipolar disorder (13 RSP and 12 REF), diagnosed using the Mini International Neuropsychiatric Interview and classified with standardized rating scales, and 14 HCs underwent MRI with diffusion sequences for probabilistic diffusion-weighted tractography analysis. Image processing and tractography were performed using MRTrix. Region of interest (ROI) masks were created manually for 10 anterior cingulum bundle subregions, including surgical targets previously evaluated for the treatment of bipolar disorder (cingulotomy and subgenual cingulate DBS targets). Cortical and subcortical ROIs of brain areas thought to be associated with bipolar disorder and described in animal tract-tracing models were created via FreeSurfer. The number of axonal projections from the cingulum bundle subregion ROIs to cortical/subcortical ROIs for each group was compared. RESULTS Significant differences were found across groups involving cingulum bundle and CSTC loops. Subjects in the RSP group had increased connections from rostral cingulum bundle to medial orbitofrontal cortex, which is part of the limbic CSTC loop, whereas subjects in the REF group had increased connectivity from rostral cingulum bundle to thalamus. Additionally, compared to HCs, both RSP and REF subjects had decreased cingulum bundle dorsal connectivity (dorsal anterior/posterior cingulate, dorsomedial/lateral frontal cortex) and increased cingulum bundle ventral connectivity (subgenual cingulate, frontal pole, lateral orbitofrontal cortex) involving limbic and associative CSTC loops. CONCLUSIONS Findings demonstrate that bipolar treatment responsivity may be associated with significant differences in cingulum bundle connectivity in relation to CSTC loops, which may help identify a surgical target for bipolar disorder treatment via DBS in the future.
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Affiliation(s)
- Jennifer A. Sweet
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine
| | - Keming Gao
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine
| | - Zhengyi Chen
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine; and
| | - Curtis Tatsuoka
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine; and
| | - Joseph R. Calabrese
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine
| | - Martha Sajatovic
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine
| | - Jonathan P. Miller
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine
| | - Cameron C. McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
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Miller JP. On the validity of the name Pseudamnicola subproductus (Paladilhe, 1869) (Caenogastropoda, Hydrobiidae). Folia Malacol 2021. [DOI: 10.12657/folmal.029.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The validity of the name Amnicola subproducta Paladilhe has been controversial since the time of its publication. Several authors debated about whether to use this name instead of the original Amnicola spirata Paladilhe. Since the recent resumption of the debate seems poorly justified, literature research was done in order to clarify the validity of these names. An etymological analysis of the word Pseudamnicola is presented in order to ascertain the correct grammatical gender of the name.
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Staudt MD, Pouratian N, Miller JP, Hamani C, Raviv N, McKhann GM, Gonzalez-Martinez JA, Pilitsis JG. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Deep Brain Stimulations for Obsessive-Compulsive Disorder: Update of the 2014 Guidelines. Neurosurgery 2021; 88:710-712. [PMID: 33559678 DOI: 10.1093/neuros/nyaa596] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND In 2020, the Guidelines Task Force conducted another systematic review of the relevant literature on deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) to update the original 2014 guidelines to ensure timeliness and accuracy for clinical practice. OBJECTIVE To conduct a systematic review of the literature and update the evidence-based guidelines on DBS for OCD. METHODS The Guidelines Task Force conducted another systematic review of the relevant literature, using the same search terms and strategies as used to search PubMed and Embase for relevant literature. The updated search included studies published between 1966 and December 2019. The same inclusion/exclusion criteria as the original guideline were also applied. Abstracts were reviewed and relevant full-text articles were retrieved and graded. Of 864 articles, 10 were retrieved for full-text review and analysis. Recommendations were updated according to new evidence yielded by this update. RESULTS Seven studies were included in the original guideline, reporting the use of bilateral DBS as more effective in improving OCD symptoms than sham treatment. An additional 10 studies were included in this update: 1 class II and 9 class III. CONCLUSION Based on the data published in the literature, the following recommendations can be made: (1) It is recommended that clinicians utilize bilateral subthalamic nucleus DBS over best medical management for the treatment of patients with medically refractory OCD (level I). (2) Clinicians may use bilateral nucleus accumbens or bed nucleus of stria terminalis DBS for the treatment of patients with medically refractory OCD (level II). There is insufficient evidence to make a recommendation for the identification of the most effective target.The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/deep-brain-stimulation-obsessive-compulsive-disord.
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Affiliation(s)
- Michael D Staudt
- Department of Neurosurgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.,Michigan Head and Spine Institute, Southfield, Michigan, USA
| | - Nader Pouratian
- Department of Neurosurgery, University of California, Los Angeles, California, USA
| | - Jonathan P Miller
- Department of Neurosurgery, Case Western Reserve University, Cleveland, Ohio, USA
| | - Clement Hamani
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Nataly Raviv
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA.,Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
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Abi B, Albahri T, Al-Kilani S, Allspach D, Alonzi LP, Anastasi A, Anisenkov A, Azfar F, Badgley K, Baeßler S, Bailey I, Baranov VA, Barlas-Yucel E, Barrett T, Barzi E, Basti A, Bedeschi F, Behnke A, Berz M, Bhattacharya M, Binney HP, Bjorkquist R, Bloom P, Bono J, Bottalico E, Bowcock T, Boyden D, Cantatore G, Carey RM, Carroll J, Casey BCK, Cauz D, Ceravolo S, Chakraborty R, Chang SP, Chapelain A, Chappa S, Charity S, Chislett R, Choi J, Chu Z, Chupp TE, Convery ME, Conway A, Corradi G, Corrodi S, Cotrozzi L, Crnkovic JD, Dabagov S, De Lurgio PM, Debevec PT, Di Falco S, Di Meo P, Di Sciascio G, Di Stefano R, Drendel B, Driutti A, Duginov VN, Eads M, Eggert N, Epps A, Esquivel J, Farooq M, Fatemi R, Ferrari C, Fertl M, Fiedler A, Fienberg AT, Fioretti A, Flay D, Foster SB, Friedsam H, Frlež E, Froemming NS, Fry J, Fu C, Gabbanini C, Galati MD, Ganguly S, Garcia A, Gastler DE, George J, Gibbons LK, Gioiosa A, Giovanetti KL, Girotti P, Gohn W, Gorringe T, Grange J, Grant S, Gray F, Haciomeroglu S, Hahn D, Halewood-Leagas T, Hampai D, Han F, Hazen E, Hempstead J, Henry S, Herrod AT, Hertzog DW, Hesketh G, Hibbert A, Hodge Z, Holzbauer JL, Hong KW, Hong R, Iacovacci M, Incagli M, Johnstone C, Johnstone JA, Kammel P, Kargiantoulakis M, Karuza M, Kaspar J, Kawall D, Kelton L, Keshavarzi A, Kessler D, Khaw KS, Khechadoorian Z, Khomutov NV, Kiburg B, Kiburg M, Kim O, Kim SC, Kim YI, King B, Kinnaird N, Korostelev M, Kourbanis I, Kraegeloh E, Krylov VA, Kuchibhotla A, Kuchinskiy NA, Labe KR, LaBounty J, Lancaster M, Lee MJ, Lee S, Leo S, Li B, Li D, Li L, Logashenko I, Lorente Campos A, Lucà A, Lukicov G, Luo G, Lusiani A, Lyon AL, MacCoy B, Madrak R, Makino K, Marignetti F, Mastroianni S, Maxfield S, McEvoy M, Merritt W, Mikhailichenko AA, Miller JP, Miozzi S, Morgan JP, Morse WM, Mott J, Motuk E, Nath A, Newton D, Nguyen H, Oberling M, Osofsky R, Ostiguy JF, Park S, Pauletta G, Piacentino GM, Pilato RN, Pitts KT, Plaster B, Počanić D, Pohlman N, Polly CC, Popovic M, Price J, Quinn B, Raha N, Ramachandran S, Ramberg E, Rider NT, Ritchie JL, Roberts BL, Rubin DL, Santi L, Sathyan D, Schellman H, Schlesier C, Schreckenberger A, Semertzidis YK, Shatunov YM, Shemyakin D, Shenk M, Sim D, Smith MW, Smith A, Soha AK, Sorbara M, Stöckinger D, Stapleton J, Still D, Stoughton C, Stratakis D, Strohman C, Stuttard T, Swanson HE, Sweetmore G, Sweigart DA, Syphers MJ, Tarazona DA, Teubner T, Tewsley-Booth AE, Thomson K, Tishchenko V, Tran NH, Turner W, Valetov E, Vasilkova D, Venanzoni G, Volnykh VP, Walton T, Warren M, Weisskopf A, Welty-Rieger L, Whitley M, Winter P, Wolski A, Wormald M, Wu W, Yoshikawa C. Measurement of the Positive Muon Anomalous Magnetic Moment to 0.46 ppm. Phys Rev Lett 2021; 126:141801. [PMID: 33891447 DOI: 10.1103/physrevlett.126.141801] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
We present the first results of the Fermilab National Accelerator Laboratory (FNAL) Muon g-2 Experiment for the positive muon magnetic anomaly a_{μ}≡(g_{μ}-2)/2. The anomaly is determined from the precision measurements of two angular frequencies. Intensity variation of high-energy positrons from muon decays directly encodes the difference frequency ω_{a} between the spin-precession and cyclotron frequencies for polarized muons in a magnetic storage ring. The storage ring magnetic field is measured using nuclear magnetic resonance probes calibrated in terms of the equivalent proton spin precession frequency ω[over ˜]_{p}^{'} in a spherical water sample at 34.7 °C. The ratio ω_{a}/ω[over ˜]_{p}^{'}, together with known fundamental constants, determines a_{μ}(FNAL)=116 592 040(54)×10^{-11} (0.46 ppm). The result is 3.3 standard deviations greater than the standard model prediction and is in excellent agreement with the previous Brookhaven National Laboratory (BNL) E821 measurement. After combination with previous measurements of both μ^{+} and μ^{-}, the new experimental average of a_{μ}(Exp)=116 592 061(41)×10^{-11} (0.35 ppm) increases the tension between experiment and theory to 4.2 standard deviations.
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Affiliation(s)
- B Abi
- University of Oxford, Oxford, United Kingdom
| | - T Albahri
- University of Liverpool, Liverpool, United Kingdom
| | - S Al-Kilani
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - D Allspach
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - L P Alonzi
- University of Washington, Seattle, Washington, USA
| | | | - A Anisenkov
- Budker Institute of Nuclear Physics, Novosibirsk, Russia
| | - F Azfar
- University of Oxford, Oxford, United Kingdom
| | - K Badgley
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - S Baeßler
- University of Virginia, Charlottesville, Virginia, USA
| | - I Bailey
- Lancaster University, Lancaster, United Kingdom
| | - V A Baranov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - E Barlas-Yucel
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - T Barrett
- Cornell University, Ithaca, New York, USA
| | - E Barzi
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - A Basti
- INFN, Sezione di Pisa, Pisa, Italy
- Università di Pisa, Pisa, Italy
| | | | - A Behnke
- Northern Illinois University, DeKalb, Illinois, USA
| | - M Berz
- Michigan State University, East Lansing, Michigan, USA
| | | | - H P Binney
- University of Washington, Seattle, Washington, USA
| | | | - P Bloom
- North Central College, Naperville, Illinois, USA
| | - J Bono
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - E Bottalico
- INFN, Sezione di Pisa, Pisa, Italy
- Università di Pisa, Pisa, Italy
| | - T Bowcock
- University of Liverpool, Liverpool, United Kingdom
| | - D Boyden
- Northern Illinois University, DeKalb, Illinois, USA
| | - G Cantatore
- INFN, Sezione di Trieste, Trieste, Italy
- Università di Trieste, Trieste, Italy
| | - R M Carey
- Boston University, Boston, Massachusetts, USA
| | - J Carroll
- University of Liverpool, Liverpool, United Kingdom
| | - B C K Casey
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - D Cauz
- INFN Gruppo Collegato di Udine, Sezione di Trieste, Udine, Italy
- Università di Udine, Udine, Italy
| | - S Ceravolo
- INFN, Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - S P Chang
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
- Department of Physics, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | | | - S Chappa
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - S Charity
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - R Chislett
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - J Choi
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | - Z Chu
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
| | - T E Chupp
- University of Michigan, Ann Arbor, Michigan, USA
| | - M E Convery
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - A Conway
- Department of Physics, University of Massachusetts, Amherst, Massachusetts, USA
| | - G Corradi
- INFN, Laboratori Nazionali di Frascati, Frascati, Italy
| | - S Corrodi
- Argonne National Laboratory, Lemont, Illinois, USA
| | - L Cotrozzi
- INFN, Sezione di Pisa, Pisa, Italy
- Università di Pisa, Pisa, Italy
| | - J D Crnkovic
- Brookhaven National Laboratory, Upton, New York, USA
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- University of Mississippi, University, Mississippi, USA
| | - S Dabagov
- INFN, Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - P T Debevec
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | | | - P Di Meo
- INFN, Sezione di Napoli, Napoli, Italy
| | | | - R Di Stefano
- INFN, Sezione di Napoli, Napoli, Italy
- Università di Cassino e del Lazio Meridionale, Cassino, Italy
| | - B Drendel
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - A Driutti
- INFN, Sezione di Trieste, Trieste, Italy
- Università di Udine, Udine, Italy
- University of Kentucky, Lexington, Kentucky, USA
| | - V N Duginov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - M Eads
- Northern Illinois University, DeKalb, Illinois, USA
| | - N Eggert
- Cornell University, Ithaca, New York, USA
| | - A Epps
- Northern Illinois University, DeKalb, Illinois, USA
| | - J Esquivel
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - M Farooq
- University of Michigan, Ann Arbor, Michigan, USA
| | - R Fatemi
- University of Kentucky, Lexington, Kentucky, USA
| | - C Ferrari
- INFN, Sezione di Pisa, Pisa, Italy
- Istituto Nazionale di Ottica-Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - M Fertl
- Institute of Physics and Cluster of Excellence PRISMA+, Johannes Gutenberg University Mainz, Mainz, Germany
- University of Washington, Seattle, Washington, USA
| | - A Fiedler
- Northern Illinois University, DeKalb, Illinois, USA
| | - A T Fienberg
- University of Washington, Seattle, Washington, USA
| | - A Fioretti
- INFN, Sezione di Pisa, Pisa, Italy
- Istituto Nazionale di Ottica-Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - D Flay
- Department of Physics, University of Massachusetts, Amherst, Massachusetts, USA
| | - S B Foster
- Boston University, Boston, Massachusetts, USA
| | - H Friedsam
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - E Frlež
- University of Virginia, Charlottesville, Virginia, USA
| | - N S Froemming
- Northern Illinois University, DeKalb, Illinois, USA
- University of Washington, Seattle, Washington, USA
| | - J Fry
- University of Virginia, Charlottesville, Virginia, USA
| | - C Fu
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
| | - C Gabbanini
- INFN, Sezione di Pisa, Pisa, Italy
- Istituto Nazionale di Ottica-Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - M D Galati
- INFN, Sezione di Pisa, Pisa, Italy
- Università di Pisa, Pisa, Italy
| | - S Ganguly
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - A Garcia
- University of Washington, Seattle, Washington, USA
| | - D E Gastler
- Boston University, Boston, Massachusetts, USA
| | - J George
- Department of Physics, University of Massachusetts, Amherst, Massachusetts, USA
| | | | - A Gioiosa
- INFN, Sezione di Pisa, Pisa, Italy
- Università del Molise, Campobasso, Italy
| | - K L Giovanetti
- Department of Physics and Astronomy, James Madison University, Harrisonburg, Virginia, USA
| | - P Girotti
- INFN, Sezione di Pisa, Pisa, Italy
- Università di Pisa, Pisa, Italy
| | - W Gohn
- University of Kentucky, Lexington, Kentucky, USA
| | - T Gorringe
- University of Kentucky, Lexington, Kentucky, USA
| | - J Grange
- Argonne National Laboratory, Lemont, Illinois, USA
- University of Michigan, Ann Arbor, Michigan, USA
| | - S Grant
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - F Gray
- Regis University, Denver, Colorado, USA
| | - S Haciomeroglu
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | - D Hahn
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | | | - D Hampai
- INFN, Laboratori Nazionali di Frascati, Frascati, Italy
| | - F Han
- University of Kentucky, Lexington, Kentucky, USA
| | - E Hazen
- Boston University, Boston, Massachusetts, USA
| | - J Hempstead
- University of Washington, Seattle, Washington, USA
| | - S Henry
- University of Oxford, Oxford, United Kingdom
| | - A T Herrod
- University of Liverpool, Liverpool, United Kingdom
| | - D W Hertzog
- University of Washington, Seattle, Washington, USA
| | - G Hesketh
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - A Hibbert
- University of Liverpool, Liverpool, United Kingdom
| | - Z Hodge
- University of Washington, Seattle, Washington, USA
| | - J L Holzbauer
- University of Mississippi, University, Mississippi, USA
| | - K W Hong
- University of Virginia, Charlottesville, Virginia, USA
| | - R Hong
- Argonne National Laboratory, Lemont, Illinois, USA
- University of Kentucky, Lexington, Kentucky, USA
| | - M Iacovacci
- INFN, Sezione di Napoli, Napoli, Italy
- Università di Napoli, Napoli, Italy
| | | | - C Johnstone
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - J A Johnstone
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - P Kammel
- University of Washington, Seattle, Washington, USA
| | | | - M Karuza
- INFN, Sezione di Trieste, Trieste, Italy
- University of Rijeka, Rijeka, Croatia
| | - J Kaspar
- University of Washington, Seattle, Washington, USA
| | - D Kawall
- Department of Physics, University of Massachusetts, Amherst, Massachusetts, USA
| | - L Kelton
- University of Kentucky, Lexington, Kentucky, USA
| | - A Keshavarzi
- Department of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - D Kessler
- Department of Physics, University of Massachusetts, Amherst, Massachusetts, USA
| | - K S Khaw
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
- Tsung-Dao Lee Institute, Shanghai Jiao Tong University, Shanghai, China
- University of Washington, Seattle, Washington, USA
| | | | - N V Khomutov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - B Kiburg
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - M Kiburg
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
- North Central College, Naperville, Illinois, USA
| | - O Kim
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
- Department of Physics, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - S C Kim
- Cornell University, Ithaca, New York, USA
| | - Y I Kim
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | - B King
- University of Liverpool, Liverpool, United Kingdom
| | - N Kinnaird
- Boston University, Boston, Massachusetts, USA
| | | | - I Kourbanis
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - E Kraegeloh
- University of Michigan, Ann Arbor, Michigan, USA
| | - V A Krylov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - A Kuchibhotla
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | | | - K R Labe
- Cornell University, Ithaca, New York, USA
| | - J LaBounty
- University of Washington, Seattle, Washington, USA
| | - M Lancaster
- Department of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - M J Lee
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | - S Lee
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | - S Leo
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - B Li
- Argonne National Laboratory, Lemont, Illinois, USA
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
| | - D Li
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
| | - L Li
- School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai, China
| | - I Logashenko
- Budker Institute of Nuclear Physics, Novosibirsk, Russia
| | | | - A Lucà
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - G Lukicov
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - G Luo
- Northern Illinois University, DeKalb, Illinois, USA
| | - A Lusiani
- INFN, Sezione di Pisa, Pisa, Italy
- Scuola Normale Superiore, Pisa, Italy
| | - A L Lyon
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - B MacCoy
- University of Washington, Seattle, Washington, USA
| | - R Madrak
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - K Makino
- Michigan State University, East Lansing, Michigan, USA
| | - F Marignetti
- INFN, Sezione di Napoli, Napoli, Italy
- Università di Cassino e del Lazio Meridionale, Cassino, Italy
| | | | - S Maxfield
- University of Liverpool, Liverpool, United Kingdom
| | - M McEvoy
- Northern Illinois University, DeKalb, Illinois, USA
| | - W Merritt
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | | | - J P Miller
- Boston University, Boston, Massachusetts, USA
| | - S Miozzi
- INFN, Sezione di Roma Tor Vergata, Roma, Italy
| | - J P Morgan
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - W M Morse
- Brookhaven National Laboratory, Upton, New York, USA
| | - J Mott
- Boston University, Boston, Massachusetts, USA
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - E Motuk
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - A Nath
- INFN, Sezione di Napoli, Napoli, Italy
- Università di Napoli, Napoli, Italy
| | - D Newton
- University of Liverpool, Liverpool, United Kingdom
| | - H Nguyen
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - M Oberling
- Argonne National Laboratory, Lemont, Illinois, USA
| | - R Osofsky
- University of Washington, Seattle, Washington, USA
| | - J-F Ostiguy
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - S Park
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | - G Pauletta
- INFN Gruppo Collegato di Udine, Sezione di Trieste, Udine, Italy
- Università di Udine, Udine, Italy
| | - G M Piacentino
- INFN, Sezione di Roma Tor Vergata, Roma, Italy
- Università del Molise, Campobasso, Italy
| | - R N Pilato
- INFN, Sezione di Pisa, Pisa, Italy
- Università di Pisa, Pisa, Italy
| | - K T Pitts
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - B Plaster
- University of Kentucky, Lexington, Kentucky, USA
| | - D Počanić
- University of Virginia, Charlottesville, Virginia, USA
| | - N Pohlman
- Northern Illinois University, DeKalb, Illinois, USA
| | - C C Polly
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - M Popovic
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - J Price
- University of Liverpool, Liverpool, United Kingdom
| | - B Quinn
- University of Mississippi, University, Mississippi, USA
| | - N Raha
- INFN, Sezione di Pisa, Pisa, Italy
| | | | - E Ramberg
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - N T Rider
- Cornell University, Ithaca, New York, USA
| | - J L Ritchie
- Department of Physics, University of Texas at Austin, Austin, Texas, USA
| | - B L Roberts
- Boston University, Boston, Massachusetts, USA
| | - D L Rubin
- Cornell University, Ithaca, New York, USA
| | - L Santi
- INFN Gruppo Collegato di Udine, Sezione di Trieste, Udine, Italy
- Università di Udine, Udine, Italy
| | - D Sathyan
- Boston University, Boston, Massachusetts, USA
| | - H Schellman
- Northwestern University, Evanston, Illinois, USA
| | - C Schlesier
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - A Schreckenberger
- Boston University, Boston, Massachusetts, USA
- University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Physics, University of Texas at Austin, Austin, Texas, USA
| | - Y K Semertzidis
- Center for Axion and Precision Physics (CAPP)/Institute for Basic Science (IBS), Daejeon, Republic of Korea
- Department of Physics, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Y M Shatunov
- Budker Institute of Nuclear Physics, Novosibirsk, Russia
| | - D Shemyakin
- Budker Institute of Nuclear Physics, Novosibirsk, Russia
| | - M Shenk
- Northern Illinois University, DeKalb, Illinois, USA
| | - D Sim
- University of Liverpool, Liverpool, United Kingdom
| | - M W Smith
- INFN, Sezione di Pisa, Pisa, Italy
- University of Washington, Seattle, Washington, USA
| | - A Smith
- University of Liverpool, Liverpool, United Kingdom
| | - A K Soha
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - M Sorbara
- INFN, Sezione di Roma Tor Vergata, Roma, Italy
- Università di Roma Tor Vergata, Rome, Italy
| | - D Stöckinger
- Institut für Kern-und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - J Stapleton
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - D Still
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - C Stoughton
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - D Stratakis
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - C Strohman
- Cornell University, Ithaca, New York, USA
| | - T Stuttard
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - H E Swanson
- University of Washington, Seattle, Washington, USA
| | - G Sweetmore
- Department of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | | | - M J Syphers
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
- Northern Illinois University, DeKalb, Illinois, USA
| | - D A Tarazona
- Michigan State University, East Lansing, Michigan, USA
| | - T Teubner
- University of Liverpool, Liverpool, United Kingdom
| | | | - K Thomson
- University of Liverpool, Liverpool, United Kingdom
| | - V Tishchenko
- Brookhaven National Laboratory, Upton, New York, USA
| | - N H Tran
- Boston University, Boston, Massachusetts, USA
| | - W Turner
- University of Liverpool, Liverpool, United Kingdom
| | - E Valetov
- Lancaster University, Lancaster, United Kingdom
- Michigan State University, East Lansing, Michigan, USA
- Tsung-Dao Lee Institute, Shanghai Jiao Tong University, Shanghai, China
| | - D Vasilkova
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | | | - V P Volnykh
- Joint Institute for Nuclear Research, Dubna, Russia
| | - T Walton
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - M Warren
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - A Weisskopf
- Michigan State University, East Lansing, Michigan, USA
| | - L Welty-Rieger
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
| | - M Whitley
- University of Liverpool, Liverpool, United Kingdom
| | - P Winter
- Argonne National Laboratory, Lemont, Illinois, USA
| | - A Wolski
- University of Liverpool, Liverpool, United Kingdom
| | - M Wormald
- University of Liverpool, Liverpool, United Kingdom
| | - W Wu
- University of Mississippi, University, Mississippi, USA
| | - C Yoshikawa
- Fermi National Accelerator Laboratory, Batavia, Illinois, USA
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Sweet JA, Beylergil SB, Thyagaraj S, Herring EZ, Drapekin JE, Gao K, Calabrese JR, Miller JP, McIntyre CC. Clinical Evaluation of Cingulum Bundle Connectivity for Neurosurgical Hypothesis Development. Neurosurgery 2020; 86:724-735. [PMID: 31264700 DOI: 10.1093/neuros/nyz225] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/18/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The cingulum bundle (CB) has long been a target for psychiatric neurosurgical procedures, but with limited understanding of the brain networks being impacted. Recent advances in human tractography could provide a foundation to better understand the effects of neurosurgical interventions on the CB; however, the reliability of tractography remains in question. OBJECTIVE To evaluate the ability of different tractography techniques, derived from typical, human diffusion-weighted imaging (DWI) data, to characterize CB connectivity described in animal models. This will help validate the clinical applicability of tractography, and generate insight on current and future neurosurgical targets for psychiatric disorders. METHODS Connectivity of the CB in 15 healthy human subjects was evaluated using DWI-based tractography, and compared to tract-tracing findings from nonhuman primates. Brain regions of interest were defined to coincide with the animal model. Tractography was performed using 3 techniques (FSL probabilistic, Camino probabilistic, and Camino deterministic). Differences in connectivity were assessed, and the CB segment with the greatest connectivity was determined. RESULTS Each tractography technique successfully reproduced the animal tracing model with a mean accuracy of 72% (68-75%, P < .05). Additionally, one region of the CB, the rostral dorsal segment, had significantly greater connectivity to associated brain structures than all other CB segments (P < .05). CONCLUSION Noninvasive, in vivo human analysis of the CB, using clinically available DWI for tractography, consistently reproduced the results of an animal tract-tracing model. This suggests that tractography of the CB can be used for clinical applications, which may aid in neurosurgical targeting for psychiatric disorders.
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Affiliation(s)
- Jennifer A Sweet
- University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | - Keming Gao
- University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Case Western Reserve University, Cleveland, Ohio
| | - Joseph R Calabrese
- University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Case Western Reserve University, Cleveland, Ohio
| | - Jonathan P Miller
- University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Case Western Reserve University, Cleveland, Ohio
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Angelopoulos V, Tsai E, Bingley L, Shaffer C, Turner DL, Runov A, Li W, Liu J, Artemyev AV, Zhang XJ, Strangeway RJ, Wirz RE, Shprits YY, Sergeev VA, Caron RP, Chung M, Cruce P, Greer W, Grimes E, Hector K, Lawson MJ, Leneman D, Masongsong EV, Russell CL, Wilkins C, Hinkley D, Blake JB, Adair N, Allen M, Anderson M, Arreola-Zamora M, Artinger J, Asher J, Branchevsky D, Capitelli MR, Castro R, Chao G, Chung N, Cliffe M, Colton K, Costello C, Depe D, Domae BW, Eldin S, Fitzgibbon L, Flemming A, Fox I, Frederick DM, Gilbert A, Gildemeister A, Gonzalez A, Hesford B, Jha S, Kang N, King J, Krieger R, Lian K, Mao J, McKinney E, Miller JP, Norris A, Nuesca M, Palla A, Park ESY, Pedersen CE, Qu Z, Rozario R, Rye E, Seaton R, Subramanian A, Sundin SR, Tan A, Turner W, Villegas AJ, Wasden M, Wing G, Wong C, Xie E, Yamamoto S, Yap R, Zarifian A, Zhang GY. The ELFIN Mission. Space Sci Rev 2020; 216:103. [PMID: 32831412 PMCID: PMC7413588 DOI: 10.1007/s11214-020-00721-7] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
The Electron Loss and Fields Investigation with a Spatio-Temporal Ambiguity-Resolving option (ELFIN-STAR, or heretoforth simply: ELFIN) mission comprises two identical 3-Unit (3U) CubeSats on a polar (∼93∘ inclination), nearly circular, low-Earth (∼450 km altitude) orbit. Launched on September 15, 2018, ELFIN is expected to have a >2.5 year lifetime. Its primary science objective is to resolve the mechanism of storm-time relativistic electron precipitation, for which electromagnetic ion cyclotron (EMIC) waves are a prime candidate. From its ionospheric vantage point, ELFIN uses its unique pitch-angle-resolving capability to determine whether measured relativistic electron pitch-angle and energy spectra within the loss cone bear the characteristic signatures of scattering by EMIC waves or whether such scattering may be due to other processes. Pairing identical ELFIN satellites with slowly-variable along-track separation allows disambiguation of spatial and temporal evolution of the precipitation over minutes-to-tens-of-minutes timescales, faster than the orbit period of a single low-altitude satellite (Torbit ∼ 90 min). Each satellite carries an energetic particle detector for electrons (EPDE) that measures 50 keV to 5 MeV electrons with Δ E/E < 40% and a fluxgate magnetometer (FGM) on a ∼72 cm boom that measures magnetic field waves (e.g., EMIC waves) in the range from DC to 5 Hz Nyquist (nominally) with <0.3 nT/sqrt(Hz) noise at 1 Hz. The spinning satellites (Tspin ∼ 3 s) are equipped with magnetorquers (air coils) that permit spin-up or -down and reorientation maneuvers. Using those, the spin axis is placed normal to the orbit plane (nominally), allowing full pitch-angle resolution twice per spin. An energetic particle detector for ions (EPDI) measures 250 keV - 5 MeV ions, addressing secondary science. Funded initially by CalSpace and the University Nanosat Program, ELFIN was selected for flight with joint support from NSF and NASA between 2014 and 2018 and launched by the ELaNa XVIII program on a Delta II rocket (with IceSatII as the primary). Mission operations are currently funded by NASA. Working under experienced UCLA mentors, with advice from The Aerospace Corporation and NASA personnel, more than 250 undergraduates have matured the ELFIN implementation strategy; developed the instruments, satellite, and ground systems and operate the two satellites. ELFIN's already high potential for cutting-edge science return is compounded by concurrent equatorial Heliophysics missions (THEMIS, Arase, Van Allen Probes, MMS) and ground stations. ELFIN's integrated data analysis approach, rapid dissemination strategies via the SPace Environment Data Analysis System (SPEDAS), and data coordination with the Heliophysics/Geospace System Observatory (H/GSO) optimize science yield, enabling the widest community benefits. Several storm-time events have already been captured and are presented herein to demonstrate ELFIN's data analysis methods and potential. These form the basis of on-going studies to resolve the primary mission science objective. Broad energy precipitation events, precipitation bands, and microbursts, clearly seen both at dawn and dusk, extend from tens of keV to >1 MeV. This broad energy range of precipitation indicates that multiple waves are providing scattering concurrently. Many observed events show significant backscattered fluxes, which in the past were hard to resolve by equatorial spacecraft or non-pitch-angle-resolving ionospheric missions. These observations suggest that the ionosphere plays a significant role in modifying magnetospheric electron fluxes and wave-particle interactions. Routine data captures starting in February 2020 and lasting for at least another year, approximately the remainder of the mission lifetime, are expected to provide a very rich dataset to address questions even beyond the primary mission science objective.
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Affiliation(s)
- V Angelopoulos
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - E Tsai
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - L Bingley
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - C Shaffer
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Tyvak Nano-Satellite Systems, Inc., Irvine, CA 92618 USA
| | - D L Turner
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723 USA
| | - A Runov
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - W Li
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Department of Astronomy and Center for Space Physics, Boston University, Boston, MA 02215 USA
| | - J Liu
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - A V Artemyev
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - X-J Zhang
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - R J Strangeway
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - R E Wirz
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - Y Y Shprits
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- GFZ German Research Centre for Geosciences, Potsdam, 14473 Germany
| | - V A Sergeev
- Saint Petersburg State University, St. Petersburg, 199034 Russia
| | - R P Caron
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - M Chung
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723 USA
| | - P Cruce
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Northrop Grumman Aerospace Systems, Redondo Beach, CA 90278 USA
| | - W Greer
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - E Grimes
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - K Hector
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Raytheon Space and Airborne Systems, El Segundo, CA 90245 USA
| | - M J Lawson
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - D Leneman
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - E V Masongsong
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - C L Russell
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - C Wilkins
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - D Hinkley
- The Aerospace Corporation, El Segundo, CA 90245 USA
| | - J B Blake
- The Aerospace Corporation, El Segundo, CA 90245 USA
| | - N Adair
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Millenium Space Systems, El Segundo, CA 90245 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - M Allen
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Northrop Grumman Aerospace Systems, Redondo Beach, CA 90278 USA
| | - M Anderson
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Aptiv, Agoura Hills, CA 91301 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - M Arreola-Zamora
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - J Artinger
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Physics and Astronomy Department, University of California, Los Angeles, CA 90095 USA
| | - J Asher
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723 USA
| | - D Branchevsky
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- The Aerospace Corporation, El Segundo, CA 90245 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - M R Capitelli
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Millenium Space Systems, El Segundo, CA 90245 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - R Castro
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Raytheon Space and Airborne Systems, El Segundo, CA 90245 USA
| | - G Chao
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: The Boeing Company, Long Beach, CA 90808 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - N Chung
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: SF Motors, Santa Clara, CA 95054 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - M Cliffe
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: SpaceX, Hawthorne, CA 90250 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - K Colton
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Planet Labs, Inc., San Francisco, CA 94107 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - C Costello
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - D Depe
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - B W Domae
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - S Eldin
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - L Fitzgibbon
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Tyvak Nano-Satellite Systems, Inc., Irvine, CA 92618 USA
| | - A Flemming
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Northrop Grumman Aerospace Systems, Redondo Beach, CA 90278 USA
| | - I Fox
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - D M Frederick
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Millenium Space Systems, El Segundo, CA 90245 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - A Gilbert
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - A Gildemeister
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Northrop Grumman Aerospace Systems, Redondo Beach, CA 90278 USA
| | - A Gonzalez
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: SpaceX, Hawthorne, CA 90250 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - B Hesford
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Jet Propulsion Laboratory, Pasadena, CA 91109 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - S Jha
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - N Kang
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Millenium Space Systems, El Segundo, CA 90245 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - J King
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - R Krieger
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Mercedes-Benz Research and Development North America, Long Beach, CA 90810 USA
| | - K Lian
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Northrop Grumman Aerospace Systems, Redondo Beach, CA 90278 USA
| | - J Mao
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Verona, WI 53593 USA
| | - E McKinney
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: California State Polytechnic University, Pomona, CA 91768 USA
| | - J P Miller
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - A Norris
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
| | - M Nuesca
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - A Palla
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - E S Y Park
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Economics Department, University of California, Los Angeles, CA 90095 USA
| | - C E Pedersen
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - Z Qu
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - R Rozario
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: SpaceX, Hawthorne, CA 90250 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - E Rye
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - R Seaton
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - A Subramanian
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Northrop Grumman Aerospace Systems, Redondo Beach, CA 90278 USA
| | - S R Sundin
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Tyvak Nano-Satellite Systems, Inc., Irvine, CA 92618 USA
| | - A Tan
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Experior Laboratories, Oxnard, CA 93033 USA
| | - W Turner
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Physics and Astronomy Department, University of California, Los Angeles, CA 90095 USA
| | - A J Villegas
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Physics and Astronomy Department, University of California, Los Angeles, CA 90095 USA
| | - M Wasden
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - G Wing
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - C Wong
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Physics and Astronomy Department, University of California, Los Angeles, CA 90095 USA
| | - E Xie
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - S Yamamoto
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - R Yap
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Mathematics Department, University of California, Los Angeles, CA 90095 USA
| | - A Zarifian
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Jet Propulsion Laboratory, Pasadena, CA 91109 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - G Y Zhang
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Qualcomm, San Diego, CA 92121 USA
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23
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Krucoff MO, Miller JP, Saxena T, Bellamkonda R, Rahimpour S, Harward SC, Lad SP, Turner DA. Toward Functional Restoration of the Central Nervous System: A Review of Translational Neuroscience Principles. Neurosurgery 2020; 84:30-40. [PMID: 29800461 DOI: 10.1093/neuros/nyy128] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/15/2018] [Indexed: 01/09/2023] Open
Abstract
Injury to the central nervous system (CNS) can leave patients with devastating neurological deficits that may permanently impair independence and diminish quality of life. Recent insights into how the CNS responds to injury and reacts to critically timed interventions are being translated into clinical applications that have the capacity to drastically improve outcomes for patients suffering from permanent neurological deficits due to spinal cord injury, stroke, or other CNS disorders. The translation of such knowledge into practical and impactful treatments involves the strategic collaboration between neurosurgeons, clinicians, therapists, scientists, and industry. Therefore, a common understanding of key neuroscientific principles is crucial. Conceptually, current approaches to CNS revitalization can be divided by scale into macroscopic (systems-circuitry) and microscopic (cellular-molecular). Here we review both emerging and well-established tenets that are being utilized to enhance CNS recovery on both levels, and we explore the role of neurosurgeons in developing therapies moving forward. Key principles include plasticity-driven functional recovery, cellular signaling mechanisms in axonal sprouting, critical timing for recovery after injury, and mechanisms of action underlying cellular replacement strategies. We then discuss integrative approaches aimed at synergizing interventions across scales, and we make recommendations for the basis of future clinical trial design. Ultimately, we argue that strategic modulation of microscopic cellular behavior within a macroscopic framework of functional circuitry re-establishment should provide the foundation for most neural restoration strategies, and the early involvement of neurosurgeons in the process will be crucial to successful clinical translation.
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Affiliation(s)
- Max O Krucoff
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Jonathan P Miller
- Department of Neurosurgery, Case Western Reserve University, Cleve-land, Ohio
| | - Tarun Saxena
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Ravi Bellamkonda
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Shervin Rahimpour
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Stephen C Harward
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.,Department of Mechan-ical Engineering and Material Sciences, Pratt School of Engineering, Duke Uni-versity, Durham, North Carolina.,Duke Institute for Brain Sciences, Duke Univer-sity, Durham, North Carolina.,Research and Surgery Services, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Dennis A Turner
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.,Department of Biomedical Engineering, Duke University, Durham, North Carolina.,Depart-ment of Neurobiology, Duke University, Durham, North Carolina.,Research and Surgery Services, Durham Veterans Affairs Medical Center, Durham, North Carolina
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24
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Stavisky SD, Willett FR, Wilson GH, Murphy BA, Rezaii P, Avansino DT, Memberg WD, Miller JP, Kirsch RF, Hochberg LR, Ajiboye AB, Druckmann S, Shenoy KV, Henderson JM. Neural ensemble dynamics in dorsal motor cortex during speech in people with paralysis. eLife 2019; 8:e46015. [PMID: 31820736 PMCID: PMC6954053 DOI: 10.7554/elife.46015] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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: 02/14/2019] [Accepted: 11/14/2019] [Indexed: 01/20/2023] Open
Abstract
Speaking is a sensorimotor behavior whose neural basis is difficult to study with single neuron resolution due to the scarcity of human intracortical measurements. We used electrode arrays to record from the motor cortex 'hand knob' in two people with tetraplegia, an area not previously implicated in speech. Neurons modulated during speaking and during non-speaking movements of the tongue, lips, and jaw. This challenges whether the conventional model of a 'motor homunculus' division by major body regions extends to the single-neuron scale. Spoken words and syllables could be decoded from single trials, demonstrating the potential of intracortical recordings for brain-computer interfaces to restore speech. Two neural population dynamics features previously reported for arm movements were also present during speaking: a component that was mostly invariant across initiating different words, followed by rotatory dynamics during speaking. This suggests that common neural dynamical motifs may underlie movement of arm and speech articulators.
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Affiliation(s)
- Sergey D Stavisky
- Department of NeurosurgeryStanford UniversityStanfordUnited States
- Department of Electrical EngineeringStanford UniversityStanfordUnited States
| | - Francis R Willett
- Department of NeurosurgeryStanford UniversityStanfordUnited States
- Department of Electrical EngineeringStanford UniversityStanfordUnited States
| | - Guy H Wilson
- Neurosciences ProgramStanford UniversityStanfordUnited States
| | - Brian A Murphy
- Department of Biomedical EngineeringCase Western Reserve UniversityClevelandUnited States
- FES Center, Rehab R&D ServiceLouis Stokes Cleveland Department of Veterans Affairs Medical CenterClevelandUnited States
| | - Paymon Rezaii
- Department of NeurosurgeryStanford UniversityStanfordUnited States
| | | | - William D Memberg
- Department of Biomedical EngineeringCase Western Reserve UniversityClevelandUnited States
- FES Center, Rehab R&D ServiceLouis Stokes Cleveland Department of Veterans Affairs Medical CenterClevelandUnited States
| | - Jonathan P Miller
- FES Center, Rehab R&D ServiceLouis Stokes Cleveland Department of Veterans Affairs Medical CenterClevelandUnited States
- Department of NeurosurgeryUniversity Hospitals Cleveland Medical CenterClevelandUnited States
| | - Robert F Kirsch
- Department of Biomedical EngineeringCase Western Reserve UniversityClevelandUnited States
- FES Center, Rehab R&D ServiceLouis Stokes Cleveland Department of Veterans Affairs Medical CenterClevelandUnited States
| | - Leigh R Hochberg
- VA RR&D Center for Neurorestoration and Neurotechnology, Rehabilitation R&D ServiceProvidence VA Medical CenterProvidenceUnited States
- Center for Neurotechnology and Neurorecovery, Department of NeurologyMassachusetts General Hospital, Harvard Medical SchoolBostonUnited States
- School of Engineering and Robert J. & Nandy D. Carney Institute for Brain ScienceBrown UniversityProvidenceUnited States
| | - A Bolu Ajiboye
- Department of Biomedical EngineeringCase Western Reserve UniversityClevelandUnited States
- FES Center, Rehab R&D ServiceLouis Stokes Cleveland Department of Veterans Affairs Medical CenterClevelandUnited States
| | - Shaul Druckmann
- Department of NeurobiologyStanford UniversityStanfordUnited States
| | - Krishna V Shenoy
- Department of Electrical EngineeringStanford UniversityStanfordUnited States
- Department of NeurobiologyStanford UniversityStanfordUnited States
- Department of BioengineeringStanford UniversityStanfordUnited States
- Howard Hughes Medical Institute, Stanford UniversityStanfordUnited States
- Wu Tsai Neurosciences InstituteStanford UniversityStanfordUnited States
- Bio-X ProgramStanford UniversityStanfordUnited States
| | - Jaimie M Henderson
- Department of NeurosurgeryStanford UniversityStanfordUnited States
- Wu Tsai Neurosciences InstituteStanford UniversityStanfordUnited States
- Bio-X ProgramStanford UniversityStanfordUnited States
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25
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Yang LY, Greig NH, Tweedie D, Jung YJ, Chiang YH, Hoffer BJ, Miller JP, Chang KH, Wang JY. The p53 inactivators pifithrin-μ and pifithrin-α mitigate TBI-induced neuronal damage through regulation of oxidative stress, neuroinflammation, autophagy and mitophagy. Exp Neurol 2019; 324:113135. [PMID: 31778663 DOI: 10.1016/j.expneurol.2019.113135] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 06/30/2019] [Revised: 10/20/2019] [Accepted: 11/24/2019] [Indexed: 01/06/2023]
Abstract
Traumatic brain injury (TBI) is one of the most common causes of death and disability worldwide. We investigated whether inhibition of p53 using pifithrin (PFT)-α or PFT-μ provides neuroprotective effects via p53 transcriptional dependent or -independent mechanisms, respectively. Sprague Dawley rats were subjected to controlled cortical impact TBI followed by the administration of PFTα or PFT-μ (2 mg/kg, i.v.) at 5 h after TBI. Brain contusion volume, as well as sensory and motor functions were evaluated at 24 h after TBI. TBI-induced impairments were mitigated by both PFT-α and PFT-μ. Fluoro-Jade C staining was used to label degenerating neurons within the TBI-induced cortical contusion region that, together with Annexin V positive neurons, were reduced by PFT-μ. Double immunofluorescence staining similarly demonstrated that PFT-μ significantly increased HO-1 positive neurons and mRNA expression in the cortical contusion region as well as decreased numbers of 4-hydroxynonenal (4HNE)-positive cells. Levels of mRNA encoding for p53, autophagy, mitophagy, anti-oxidant, anti-inflammatory related genes and proteins were measured by RT-qPCR and immunohistochemical staining, respectively. PFT-α, but not PFT-μ, significantly lowered p53 mRNA expression. Both PFT-α and PFT-μ lowered TBI-induced pro-inflammatory cytokines (IL-1β and IL-6) mRNA levels as well as TBI-induced autophagic marker localization (LC3 and p62). Finally, treatment with PFT-μ mitigated TBI-induced declines in mRNA levels of PINK-1 and SOD2. Our data suggest that both PFT-μ and PFT-α provide neuroprotective actions through regulation of oxidative stress, neuroinflammation, autophagy, and mitophagy mechanisms, and that PFT-μ, in particular, holds promise as a TBI treatment strategy.
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Affiliation(s)
- Ling-Yu Yang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Nigel H Greig
- Drug Design & Development Section, Translational Gerontology Branch, Intramural Research Program National Institute on Aging, NIH, Baltimore, MD 21224, USA
| | - David Tweedie
- Drug Design & Development Section, Translational Gerontology Branch, Intramural Research Program National Institute on Aging, NIH, Baltimore, MD 21224, USA
| | - Yoo Jin Jung
- Drug Design & Development Section, Translational Gerontology Branch, Intramural Research Program National Institute on Aging, NIH, Baltimore, MD 21224, USA
| | - Yung-Hsiao Chiang
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei 110, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei 110, Taiwan
| | - Barry J Hoffer
- Department of Neurological Surgery, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Jonathan P Miller
- Department of Neurological Surgery, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Ke-Hui Chang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Jia-Yi Wang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110, Taiwan; Department of Neurosurgery, Taipei Medical University Hospital, Taipei 110, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei 110, Taiwan.
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26
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Kirsch RF, Ajiboye AB, Miller JP. The Reconnecting the Hand and Arm with Brain (ReHAB) Commentary on "An Integrated Brain-Machine Interface Platform With Thousands of Channels". J Med Internet Res 2019; 21:e16339. [PMID: 31674921 PMCID: PMC6914246 DOI: 10.2196/16339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/19/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 11/13/2022] Open
Abstract
Intracortical brain-machine interfaces are a promising technology for allowing people with chronic and severe neurological disorders that resulted in loss of function to potentially regain those functions through neuroprosthetic devices. The penetrating microelectrode arrays used in almost all previous studies of intracortical brain-machine interfaces in people had a limited recording life (potentially due to issues with long-term biocompatibility), as well as a limited number of recording electrodes with limited distribution in the brain. Significant advances are required in this array interface to deal with the issues of long-term biocompatibility and lack of distributed recordings. The Musk and Neuralink manuscript proposes a novel and potentially disruptive approach to advancing the brain-electrode interface technology, with the potential of addressing many of these hurdles. Our commentary addresses the potential advantages of the proposed approach, as well as the remaining challenges to be addressed.
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Affiliation(s)
- Robert F Kirsch
- VA Rehabilitation Research and Development Service, Center for Functional Electrical Stimulation, Case Western Reserve University, Cleveland, OH, United States
| | - A Bolu Ajiboye
- Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Jonathan P Miller
- Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
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27
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Staudt MD, Maturu S, Miller JP. Radiofrequency Energy and Electrode Proximity Influences Stereoelectroencephalography-Guided Radiofrequency Thermocoagulation Lesion Size: An In Vitro Study with Clinical Correlation. Oper Neurosurg (Hagerstown) 2019; 15:461-469. [PMID: 29462411 DOI: 10.1093/ons/opx291] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/21/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Radiofrequency thermocoagulation of epileptogenic foci via stereoelectroencephalography (SEEG) electrodes has been suggested as a treatment for medically intractable epilepsy, but reported outcomes have been suboptimal, possibly because lesions generated using conventional high-energy radiofrequency parameters are relatively small. OBJECTIVE To describe a technique of delivering low energy across separate SEEG electrodes in order to create large confluent radiofrequency lesions. METHODS The size and configuration of radiofrequency lesions using different radiofrequency intensity and interelectrode distance was assessed in egg whites. Magnetic resonance images (MRI) from 3 patients who had undergone radiofrequency lesion creation were evaluated to determine the contribution of lesion intensity and electrode separation on lesion size. Electroencephalography, MRI, and clinical data were assessed before and after lesion creation. RESULTS Both in Vitro and in Vivo analysis revealed that less energy paradoxically produced larger lesions, with the largest possible lesions produced when radiofrequency power was applied for long duration at less than 3 W. Linear separation of electrodes also contributed to lesion size, with largest lesions produced when electrodes were separated by a linear distance of between 5 and 12 mm. Clinical lesions produced using these parameters were large and resulted in improvement in interictal and ictal activity. CONCLUSION Radiofrequency lesions produced using low-energy delivery between SEEG electrodes in close proximity can produce a large lesion. These findings might have advantages for treatment of focal epilepsy.
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Affiliation(s)
- Michael D Staudt
- Department of Neurosurgery, University Hospital Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sarita Maturu
- Department of Neurosurgery, University Hospital Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jonathan P Miller
- Department of Neurosurgery, University Hospital Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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28
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Brandman DM, Hosman T, Saab J, Burkhart MC, Shanahan BE, Ciancibello JG, Sarma AA, Milstein DJ, Vargas-Irwin CE, Franco B, Kelemen J, Blabe C, Murphy BA, Young DR, Willett FR, Pandarinath C, Stavisky SD, Kirsch RF, Walter BL, Bolu Ajiboye A, Cash SS, Eskandar EN, Miller JP, Sweet JA, Shenoy KV, Henderson JM, Jarosiewicz B, Harrison MT, Simeral JD, Hochberg LR. Rapid calibration of an intracortical brain-computer interface for people with tetraplegia. J Neural Eng 2019; 15:026007. [PMID: 29363625 DOI: 10.1088/1741-2552/aa9ee7] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Brain-computer interfaces (BCIs) can enable individuals with tetraplegia to communicate and control external devices. Though much progress has been made in improving the speed and robustness of neural control provided by intracortical BCIs, little research has been devoted to minimizing the amount of time spent on decoder calibration. APPROACH We investigated the amount of time users needed to calibrate decoders and achieve performance saturation using two markedly different decoding algorithms: the steady-state Kalman filter, and a novel technique using Gaussian process regression (GP-DKF). MAIN RESULTS Three people with tetraplegia gained rapid closed-loop neural cursor control and peak, plateaued decoder performance within 3 min of initializing calibration. We also show that a BCI-naïve user (T5) was able to rapidly attain closed-loop neural cursor control with the GP-DKF using self-selected movement imagery on his first-ever day of closed-loop BCI use, acquiring a target 37 s after initiating calibration. SIGNIFICANCE These results demonstrate the potential for an intracortical BCI to be used immediately after deployment by people with paralysis, without the need for user learning or extensive system calibration.
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Affiliation(s)
- David M Brandman
- Neuroscience Graduate Program, Brown University, Providence, RI, United States of America. Department of Neuroscience, Brown University, Providence, RI, United States of America. Brown Institute for Brain Science, Brown University, Providence, RI, United States of America. Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada
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29
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Lacuey N, Hampson JP, Theeranaew W, Zonjy B, Vithala A, Hupp NJ, Loparo KA, Miller JP, Lhatoo SD. Cortical Structures Associated With Human Blood Pressure Control. JAMA Neurol 2019; 75:194-202. [PMID: 29181526 DOI: 10.1001/jamaneurol.2017.3344] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance A better understanding of the role of cortical structures in blood pressure control may help us understand cardiovascular collapse that may lead to sudden unexpected death in epilepsy (SUDEP). Objective To identify cortical control sites for human blood pressure regulation. Design, Setting, and Participants Patients with intractable epilepsy undergoing intracranial electrode implantation as a prelude to epilepsy surgery in the Epilepsy Monitoring Unit at University Hospitals Cleveland Medical Center were potential candidates for this study. Inclusion criteria were patients 18 years or older who had electrodes implanted in one or more of the regions of interest and in whom deep brain electrical stimulation was indicated for mapping of ictal onset or eloquent cortex as a part of the presurgical evaluation. Twelve consecutive patients were included in this prospective case series from June 1, 2015, to February 28, 2017. Main Outcomes and Measures Changes in continuous, noninvasive, beat-by-beat blood pressure parameter responses from amygdala, hippocampal, insular, orbitofrontal, temporal, cingulate, and subcallosal stimulation. Electrocardiogram, arterial oxygen saturation, end-tidal carbon dioxide, nasal airflow, and abdominal and thoracic plethysmography were monitored. Results Among 12 patients (7 female; mean [SD] age, 44.25 [12.55] years), 9 electrodes (7 left and 2 right) all in Brodmann area 25 (subcallosal neocortex) in 4 patients produced striking systolic hypotensive changes. Well-maintained diastolic arterial blood pressure and narrowed pulse pressure indicated stimulation-induced reduction in sympathetic drive and consequent probable reduction in cardiac output rather than bradycardia or peripheral vasodilation-induced hypotension. Frequency-domain analysis of heart rate and blood pressure variability showed a mixed picture. No other stimulated structure produced significant blood pressure changes. Conclusions and Relevance These findings suggest that Brodmann area 25 has a role in lowering systolic blood pressure in humans. It is a potential symptomatogenic zone for peri-ictal hypotension in patients with epilepsy.
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Affiliation(s)
- Nuria Lacuey
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Johnson P Hampson
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Wanchat Theeranaew
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Cleveland, Ohio.,Department of Electrical Engineering and Computer Sciences, Case School of Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Bilal Zonjy
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Cleveland, Ohio
| | - Ajay Vithala
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Norma J Hupp
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Kenneth A Loparo
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Cleveland, Ohio.,Department of Electrical Engineering and Computer Sciences, Case School of Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Jonathan P Miller
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Samden D Lhatoo
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Cleveland, Ohio
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30
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Zhou X, Miller JP. Commentary: The Emerging Role of Biomarkers in Adaptive Modulation of Clinical Brain Stimulation. Neurosurgery 2019; 85:E440-E441. [PMID: 31329949 DOI: 10.1093/neuros/nyz097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/28/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Xiaofei Zhou
- Case Western Reserve, University School of Medicine, Cleveland, Ohio
| | - Jonathan P Miller
- Case Western Reserve, University School of Medicine, Cleveland, Ohio
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31
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Freeman L, Wu OC, Sweet J, Cohen M, Smith GA, Miller JP. Facial Sensory Restoration After Trigeminal Sensory Rhizotomy by Collateral Sprouting From the Occipital Nerves. Neurosurgery 2019; 86:E436-E441. [DOI: 10.1093/neuros/nyz306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/18/2019] [Indexed: 01/14/2023] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE
Lesioning procedures are effective for trigeminal neuralgia (TN), but late pain recurrence associated with sensory recovery is common. We report a case of recurrence of type 1A TN and recovery of facial sensory function after trigeminal rhizotomy associated with collateral sprouting from upper cervical spinal nerves.
CLINICAL PRESENTATION
A 41-yr-old woman presented 2 yr after open left trigeminal sensory rhizotomy for TN with pain-free anesthesia in the entire left trigeminal nerve distribution. Over 18 mo, she developed gradual recovery of facial sensation migrating anteromedially from the occipital region, eventually extending to the midpupillary line across the distribution of all trigeminal nerve branches. She reported recurrence of her triggered lancinating TN pain isolated to the area of recovered sensation with no pain in anesthetic areas. Nerve ultrasound demonstrated enlargement of ipsilateral greater and lesser occipital nerves, and occipital nerve block restored facial anesthesia and resolved her pain, indicating that recovered facial sensation was provided exclusively by the upper cervical spinal nerves. She underwent C2/C3 ganglionectomy, and ganglia were observed to be hypertrophic. Postoperatively, trigeminal anesthesia was restored with complete resolution of pain that persisted at 12-mo follow-up.
CONCLUSION
This is the first documented case of a spinal nerve innervating a cranial dermatome by collateral sprouting after cranial nerve injury. The fact that typical TN pain can occur even when sensation is mediated by spinal nerves suggests that the disorder can be centrally mediated and late failure after lesioning procedures may result from maladaptive reinnervation.
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Affiliation(s)
- Lindsey Freeman
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Osmond C Wu
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Jennifer Sweet
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Mark Cohen
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Gabriel A Smith
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Jonathan P Miller
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
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32
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Smith GA, Pace J, Strohl M, Kaul A, Hayek S, Miller JP. Rare Neurosurgical Complications of Epidural Injections: An 8-Yr Single-Institution Experience. Oper Neurosurg (Hagerstown) 2019; 13:271-279. [PMID: 28927205 DOI: 10.1093/ons/opw014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/07/2015] [Accepted: 10/22/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Neurosurgical complications from epidural injections have rarely been reported. OBJECTIVE To define the spectrum of complications from these procedures in order to identify risk factors and strategies for prevention. METHODS A prospectively maintained database of 14 247 neurosurgical admissions over 8 yr was screened to identify patients who had suffered procedural complications associated with 1182 cervical and 4617 lumbar interlaminar epidural injection procedures performed at a single institution. Patients who developed new neurological symptoms or deficits were included. A retrospective analysis of demographic and procedural features was performed. RESULTS Thirteen patients experienced complications requiring neurosurgical treatment, accounting for an overall procedural complication rate of 0.22% (0.51% and 0.15% for cervical and lumbar injections, respectively), and representing 0.09% of all neurosurgical admissions over 8 yr. There were 3 categories: hemorrhage (n = 7), infection (n = 3), and inadvertent dural penetration (n = 3). There was significant association with anticoagulation use among patients with hemorrhagic vs nonhemorrhagic complications ( P < .01, Fisher's exact test). Six patients who developed epidural hematoma had been managed in accordance with current guidelines, either after prolonged cessation of anticoagulation (n = 3) or taking only aspirin (n = 3); all were decompressed promptly with good long-term outcome. All infections were associated with lumbar injection. Dural penetration resulted in diffuse pneumocephalus (n = 1), intramedullary air at the site of injection (n = 1), and acutely symptomatic colloid cyst (n = 1). CONCLUSION A majority of neurosurgical complications from epidural injections are hemorrhagic and associated with anticoagulation, although infection and inadvertent dural penetration also occur. Prompt treatment of compressive lesions is associated with good outcome.
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Affiliation(s)
- Gabriel A Smith
- Department of Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Jonathan Pace
- Department of Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Madeleine Strohl
- Department of Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Anand Kaul
- Department of Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Salim Hayek
- Division of Pain Medicine, Depart-ment of Anesthesiology, University Hospi-tals Case Medical Center, Cleveland, Ohio
| | - Jonathan P Miller
- Department of Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio
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33
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Willett FR, Young DR, Murphy BA, Memberg WD, Blabe CH, Pandarinath C, Stavisky SD, Rezaii P, Saab J, Walter BL, Sweet JA, Miller JP, Henderson JM, Shenoy KV, Simeral JD, Jarosiewicz B, Hochberg LR, Kirsch RF, Bolu Ajiboye A. Principled BCI Decoder Design and Parameter Selection Using a Feedback Control Model. Sci Rep 2019; 9:8881. [PMID: 31222030 PMCID: PMC6586941 DOI: 10.1038/s41598-019-44166-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 09/19/2018] [Accepted: 03/04/2019] [Indexed: 02/01/2023] Open
Abstract
Decoders optimized offline to reconstruct intended movements from neural recordings sometimes fail to achieve optimal performance online when they are used in closed-loop as part of an intracortical brain-computer interface (iBCI). This is because typical decoder calibration routines do not model the emergent interactions between the decoder, the user, and the task parameters (e.g. target size). Here, we investigated the feasibility of simulating online performance to better guide decoder parameter selection and design. Three participants in the BrainGate2 pilot clinical trial controlled a computer cursor using a linear velocity decoder under different gain (speed scaling) and temporal smoothing parameters and acquired targets with different radii and distances. We show that a user-specific iBCI feedback control model can predict how performance changes under these different decoder and task parameters in held-out data. We also used the model to optimize a nonlinear speed scaling function for the decoder. When used online with two participants, it increased the dynamic range of decoded speeds and decreased the time taken to acquire targets (compared to an optimized standard decoder). These results suggest that it is feasible to simulate iBCI performance accurately enough to be useful for quantitative decoder optimization and design.
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Affiliation(s)
- Francis R Willett
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA. .,Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland, Ohio, USA. .,Department of Neurosurgery, Stanford University, Stanford, California, USA. .,Department of Electrical Engineering, Stanford University, Stanford, California, USA.
| | - Daniel R Young
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA.,Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland, Ohio, USA
| | - Brian A Murphy
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA.,Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland, Ohio, USA
| | - William D Memberg
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA.,Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland, Ohio, USA
| | - Christine H Blabe
- Department of Neurosurgery, Stanford University, Stanford, California, USA
| | - Chethan Pandarinath
- Department of Neurosurgery, Stanford University, Stanford, California, USA.,Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Sergey D Stavisky
- Department of Neurosurgery, Stanford University, Stanford, California, USA.,Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Paymon Rezaii
- Department of Neurosurgery, Stanford University, Stanford, California, USA
| | - Jad Saab
- School of Engineering, Brown University, Providence, RI, USA.,Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI, USA
| | - Benjamin L Walter
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland, Ohio, USA.,Department of Neurology, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Jennifer A Sweet
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland, Ohio, USA.,Department of Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Jonathan P Miller
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland, Ohio, USA.,Department of Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Jaimie M Henderson
- Department of Neurosurgery, Stanford University, Stanford, California, USA.,Stanford Neurosciences Institute, Stanford University, Stanford, 94305, California, USA
| | - Krishna V Shenoy
- Department of Electrical Engineering, Stanford University, Stanford, California, USA.,Stanford Neurosciences Institute, Stanford University, Stanford, 94305, California, USA.,Department of Bioengineering, Stanford University, Stanford, California, 94305, USA.,Department of Neurobiology, Stanford University, Stanford, California, 94305, USA.,Howard Hughes Medical Institute, Stanford University, Stanford, California, 94305, USA.,Neurosciences Program, Stanford University, Stanford, California, 94305, USA.,Bio-X Program, Stanford University, Stanford, California, 94305, USA
| | - John D Simeral
- School of Engineering, Brown University, Providence, RI, USA.,Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI, USA.,Carney Institute for Brain Science, Brown University, Providence, Rhode Island, USA.,Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Beata Jarosiewicz
- Department of Neurosurgery, Stanford University, Stanford, California, USA
| | - Leigh R Hochberg
- School of Engineering, Brown University, Providence, RI, USA.,Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI, USA.,Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert F Kirsch
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA.,Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland, Ohio, USA
| | - A Bolu Ajiboye
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA.,Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland, Ohio, USA
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Hsueh SC, Lecca D, Greig NH, Wang JY, Selman W, Hoffer BJ, Miller JP, Chiang YH. (-)-Phenserine Ameliorates Contusion Volume, Neuroinflammation, and Behavioral Impairments Induced by Traumatic Brain Injury in Mice. Cell Transplant 2019; 28:1183-1196. [PMID: 31177840 PMCID: PMC6767878 DOI: 10.1177/0963689719854693] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Indexed: 01/05/2023] Open
Abstract
Traumatic brain injury (TBI), a major cause of mortality and morbidity, affects 10 million people worldwide, with limited treatment options. We have previously shown that (-)-phenserine (Phen), an acetylcholinesterase inhibitor originally designed and tested in clinical phase III trials for Alzheimer's disease, can reduce neurodegeneration after TBI and reduce cognitive impairments induced by mild TBI. In this study, we used a mouse model of moderate to severe TBI by controlled cortical impact to assess the effects of Phen on post-trauma histochemical and behavioral changes. Animals were treated with Phen (2.5 mg/kg, IP, BID) for 5 days started on the day of injury and the effects were evaluated by behavioral and histological examinations at 1 and 2 weeks after injury. Phen significantly attenuated TBI-induced contusion volume, enlargement of the lateral ventricle, and behavioral impairments in motor asymmetry, sensorimotor functions, motor coordination, and balance functions. The morphology of microglia was shifted to an active from a resting form after TBI, and Phen dramatically reduced the ratio of activated to resting microglia, suggesting that Phen also mitigates neuroinflammation after TBI. While Phen has potent anti-acetylcholinesterase activity, its (+) isomer Posiphen shares many neuroprotective properties but is almost completely devoid of anti-acetylcholinesterase activity. We evaluated Posiphen at a similar dose to Phen and found similar mitigation in lateral ventricular size increase, motor asymmetry, motor coordination, and balance function, suggesting the improvement of these histological and behavioral tests by Phen treatment occur via pathways other than anti-acetylcholinesterase inhibition. However, the reduction of lesion size and improvement of sensorimotor function by Posiphen were much smaller than with equivalent doses of Phen. Taken together, these results show that post-injury treatment with Phen over 5 days significantly ameliorates severity of TBI. These data suggest a potential development of this compound for clinical use in TBI therapy.
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Affiliation(s)
- Shih-Chang Hsueh
- The Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei.,Center for Neurotrauma and Neuroregeneration, Taipei Medical University, Taipei.,Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Daniela Lecca
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Nigel H Greig
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Jia-Yi Wang
- The Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei.,Center for Neurotrauma and Neuroregeneration, Taipei Medical University, Taipei.,Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei
| | - Warren Selman
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Barry J Hoffer
- The Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei.,Center for Neurotrauma and Neuroregeneration, Taipei Medical University, Taipei.,Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jonathan P Miller
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Yung-Hsiao Chiang
- The Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei.,Center for Neurotrauma and Neuroregeneration, Taipei Medical University, Taipei.,Department of Neurosurgery, Taipei Medical University Hospital, Taipei.,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei
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Ems R, Garg A, Ostergard TA, Miller JP. Potential Deep Brain Stimulation Targets for the Management of Refractory Hypertension. Front Neurosci 2019; 13:93. [PMID: 30858796 PMCID: PMC6397890 DOI: 10.3389/fnins.2019.00093] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/25/2019] [Indexed: 11/13/2022] Open
Abstract
Hypertension is the single greatest contributor to human disease and mortality affecting over 75 million people in the United States alone. Hypertension is defined according to the American College of Cardiology as systolic blood pressure (SBP) greater than 120 mm Hg and diastolic blood pressure (DBP) above 80 mm Hg measured on two separate occasions. While there are multiple medication classes available for blood pressure control, fewer than 50% of hypertensive patients maintain appropriate control. In fact, 0.5% of patients are refractory to medical treatment which is defined as uncontrolled blood pressure despite treatment with five classes of antihypertensive agents. With new guidelines to define hypertension that will increase the incidence of hypertension world-wide, the prevalence of refractory hypertension is expected to increase. Thus, investigation into alternative methods of blood pressure control will be crucial to reduce comorbidities such as higher risk of myocardial infarction, cardiovascular accident, aneurysm formation, heart failure, coronary artery disease, end stage renal disease, arrhythmia, left ventricular hypertrophy, intracerebral hemorrhage, hypertensive enchaphelopathy, hypertensive retinopathy, glomerulosclerosis, limb loss due to arterial occlusion, and sudden death. Recently, studies demonstrated efficacious treatment of neurological diseases with deep brain stimulation (DBS) for Tourette's, depression, intermittent explosive disorder, epilepsy, chronic pain, and headache as these diseases have defined neurophysiology with anatomical targets. Currently, clinical applications of DBS is limited to neurological conditions as such conditions have well-defined neurophysiology and anatomy. However, rapidly expanding knowledge about neuroanatomical controls of systemic conditions such as hypertension are expanding the possibilities for DBS neuromodulation. Within the central autonomic network (CAN), multiple regions play a role in homeostasis and blood pressure control that could be DBS targets. While the best defined autonomic target is the ventrolateral periaqueductal gray matter, other targets including the subcallosal neocortex, subthalamic nucleus (STN), posterior hypothalamus, rostrocaudal cingulate gyrus, orbitofrontal gyrus, and insular cortex are being further characterized as potential targets. This review aims to summarize the current knowledge regarding neurologic contribution to the pathophysiology of hypertension, delineate the complex interactions between neuroanatomic structures involved in blood pressure homeostasis, and then discuss the potential for using DBS as a treatment for refractory hypertension.
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Affiliation(s)
- Raleigh Ems
- Department of Neurological Surgery, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Anisha Garg
- Department of Neurological Surgery, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Thomas A Ostergard
- Department of Neurological Surgery, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Jonathan P Miller
- Department of Neurological Surgery, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
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Staudt MD, Herring EZ, Gao K, Miller JP, Sweet JA. Evolution in the Treatment of Psychiatric Disorders: From Psychosurgery to Psychopharmacology to Neuromodulation. Front Neurosci 2019; 13:108. [PMID: 30828289 PMCID: PMC6384258 DOI: 10.3389/fnins.2019.00108] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 01/29/2019] [Indexed: 12/22/2022] Open
Abstract
The treatment of psychiatric patients presents significant challenges to the clinical community, and a multidisciplinary approach to diagnosis and management is essential to facilitate optimal care. In particular, the neurosurgical treatment of psychiatric disorders, or “psychosurgery,” has held fascination throughout human history as a potential method of influencing behavior and consciousness. Early evidence of such procedures can be traced to prehistory, and interest flourished in the nineteenth and early twentieth century with greater insight into cerebral functional and anatomic localization. However, any discussion of psychosurgery invariably invokes controversy, as the widespread and indiscriminate use of the transorbital lobotomy in the mid-twentieth century resulted in profound ethical ramifications that persist to this day. The concurrent development of effective psychopharmacological treatments virtually eliminated the need and desire for psychosurgical procedures, and accordingly the research and practice of psychosurgery was dormant, but not forgotten. There has been a recent resurgence of interest for non-ablative therapies, due in part to modern advances in functional and structural neuroimaging and neuromodulation technology. In particular, deep brain stimulation is a promising treatment paradigm with the potential to modulate abnormal pathways and networks implicated in psychiatric disease states. Although there is enthusiasm regarding these recent advancements, it is important to reflect on the scientific, social, and ethical considerations of this controversial field.
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Affiliation(s)
- Michael D Staudt
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States.,Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
| | - Eric Z Herring
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Keming Gao
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Jonathan P Miller
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Jennifer A Sweet
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
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Abstract
Surgical resection of the epileptogenic zone within the frontal lobe can be a very effective treatment for medically refractory epilepsy originating from this area. While much of the frontal lobe consists of highly eloquent tissue, surgery is not necessarily contraindicated as long as the epileptogenic zone is well-localized and the tissue resected is limited. Resection of the primary motor cortex was described by Victor Horsley in the 19th century and was used frequently in the early 20th century for a variety of neurological disorders including epilepsy; improvements in surgical techniques and mapping has led to a resurgence of its use in the past few decades. Although many surgeons are hesitant to resect tissue adjacent to the primary hand area based on fears of new motor deficits, there is extensive evidence that focal resections are well-tolerated over the long-term with residual weakness that is fairly mild: some patients experience postoperative weakness, including hemiparesis, but a stereotypical recovery of strength from proximal to distal muscles occurs over months, and only one quarter will have a permanent neurologic deficit, usually consisting of difficulty with fine motor movements. The main alternative to surgical resection is subpial transection, characterized by a small decrease in postoperative deficits and significantly worse seizure outcomes. The treatment of patients with seizures originating from this region requires a solid understanding of the structural and functional anatomy of the frontal lobe.
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Affiliation(s)
- Thomas A Ostergard
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jonathan P Miller
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
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Batsaikhan B, Wang JY, Scerba MT, Tweedie D, Greig NH, Miller JP, Hoffer BJ, Lin CT, Wang JY. Post-Injury Neuroprotective Effects of the Thalidomide Analog 3,6'-Dithiothalidomide on Traumatic Brain Injury. Int J Mol Sci 2019; 20:ijms20030502. [PMID: 30682785 PMCID: PMC6387371 DOI: 10.3390/ijms20030502] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 12/28/2018] [Revised: 01/18/2019] [Accepted: 01/21/2019] [Indexed: 01/09/2023] Open
Abstract
Traumatic brain injury (TBI) is a major cause of mortality and disability worldwide. Long-term deficits after TBI arise not only from the direct effects of the injury but also from ongoing processes such as neuronal excitotoxicity, inflammation, oxidative stress and apoptosis. Tumor necrosis factor-α (TNF-α) is known to contribute to these processes. We have previously shown that 3,6′-dithiothalidomide (3,6′-DT), a thalidomide analog that is more potent than thalidomide with similar brain penetration, selectively inhibits the synthesis of TNF-α in cultured cells and reverses behavioral impairments induced by mild TBI in mice. In the present study, we further explored the therapeutic potential of 3,6′-DT in an animal model of moderate TBI using Sprague-Dawley rats subjected to controlled cortical impact. A single dose of 3,6′-DT (28 mg/kg, i.p.) at 5 h after TBI significantly reduced contusion volume, neuronal degeneration, neuronal apoptosis and neurological deficits at 24 h post-injury. Expression of pro-inflammatory cytokines in the contusion regions were also suppressed at the transcription and translation level by 3,6′-DT. Notably, neuronal oxidative stress was also suppressed by 3,6′-DT. We conclude that 3,6′-DT may represent a potential therapy to ameliorate TBI-induced functional deficits.
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Affiliation(s)
- Buyandelger Batsaikhan
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, 250 Wu-Xing Street, Taipei 11031, Taiwan.
| | - Jing-Ya Wang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, 250 Wu-Xing Street, Taipei 11031, Taiwan.
| | - Michael T Scerba
- Drug Design & Development Section, Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, NIH, Baltimore, MD 21224, USA.
| | - David Tweedie
- Drug Design & Development Section, Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, NIH, Baltimore, MD 21224, USA.
| | - Nigel H Greig
- Drug Design & Development Section, Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, NIH, Baltimore, MD 21224, USA.
| | - Jonathan P Miller
- Department of Neurological Surgery, Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Barry J Hoffer
- Department of Neurological Surgery, Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Chih-Tung Lin
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, 250 Wu-Xing Street, Taipei 11031, Taiwan.
| | - Jia-Yi Wang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, 250 Wu-Xing Street, Taipei 11031, Taiwan.
- Department of Physiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
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Lacuey N, Hampson JP, Harper RM, Miller JP, Lhatoo S. Limbic and paralimbic structures driving ictal central apnea. Neurology 2019; 92:e655-e669. [PMID: 30635481 DOI: 10.1212/wnl.0000000000006920] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/14/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To precisely identify cortical regions that modulate breathing, and delineate a network of cortical structures that underpin ictal central apnea (ICA) during epileptic seizures. METHODS We electrically stimulated multiple cortical structures in patients undergoing stereotactic EEG (SEEG) evaluation before epilepsy surgery. Structures investigated were orbitofrontal cortex, anterior and posterior cingulate and subcallosal gyri, insula, hippocampus, parahippocampal gyrus, amygdala, temporo-polar cortex, antero-mesial fusiform gyrus, and lateral and basal temporal cortices. Chest/abdominal excursions using thoracic/abdominal belts, peripheral capillary oxygen saturation, end tidal and transcutaneous carbon dioxide, and airflow were continuously monitored. RESULTS Nineteen consecutive adult patients (10 female) aged 18-69 years were investigated. Transient central apnea was elicited in 13/19 patients with amygdala, hippocampus head and body, anterior parahippocampal gyrus, and antero-mesial fusiform gyrus. Insula, cingulate, subcallosal, orbitofrontal, lateral, and basal temporal cortices stimulation did not induce apnea. Apnea duration was associated with stimulus duration (p < 0.001) and current intensity (p = 0.004). CONCLUSIONS These findings suggest a limbic/paralimbic mesial temporal breathing modulation network that includes amygdala, hippocampus, anterior parahippocampal, and antero-mesial fusiform gyri. These structures likely represent anatomical and functional substrates for ICA, a putative sudden unexpected death in epilepsy (SUDEP) breathing biomarker. Damage to such areas is known to occur in high SUDEP risk patients and SUDEP victims, and may underpin the prolonged ICA that is thought to be particularly dangerous. Furthermore, inclusive targeting of apnea-producing structures in SEEG implantations, peri-ictal breathing signal recordings, and stringent analysis of apneic sequences in seizure semiology may enhance accurate identification of symptomatogenic and seizure onset zones for epilepsy surgery.
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Affiliation(s)
- Nuria Lacuey
- From the Epilepsy Center (N.L., J.P.H., J.P.M., S.L.), University Hospitals Cleveland Medical Center, OH; Department of Neurobiology and the Brain Research Institute (R.M.H.), University of California, Los Angeles; and NINDS Center for SUDEP Research (R.M.H., S.L.), Case Western Reserve University, Cleveland, OH.
| | - Johnson P Hampson
- From the Epilepsy Center (N.L., J.P.H., J.P.M., S.L.), University Hospitals Cleveland Medical Center, OH; Department of Neurobiology and the Brain Research Institute (R.M.H.), University of California, Los Angeles; and NINDS Center for SUDEP Research (R.M.H., S.L.), Case Western Reserve University, Cleveland, OH
| | - Ronald M Harper
- From the Epilepsy Center (N.L., J.P.H., J.P.M., S.L.), University Hospitals Cleveland Medical Center, OH; Department of Neurobiology and the Brain Research Institute (R.M.H.), University of California, Los Angeles; and NINDS Center for SUDEP Research (R.M.H., S.L.), Case Western Reserve University, Cleveland, OH
| | - Jonathan P Miller
- From the Epilepsy Center (N.L., J.P.H., J.P.M., S.L.), University Hospitals Cleveland Medical Center, OH; Department of Neurobiology and the Brain Research Institute (R.M.H.), University of California, Los Angeles; and NINDS Center for SUDEP Research (R.M.H., S.L.), Case Western Reserve University, Cleveland, OH
| | - Samden Lhatoo
- From the Epilepsy Center (N.L., J.P.H., J.P.M., S.L.), University Hospitals Cleveland Medical Center, OH; Department of Neurobiology and the Brain Research Institute (R.M.H.), University of California, Los Angeles; and NINDS Center for SUDEP Research (R.M.H., S.L.), Case Western Reserve University, Cleveland, OH
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Willett FR, Murphy BA, Young DR, Memberg WD, Blabe CH, Pandarinath C, Franco B, Saab J, Walter BL, Sweet JA, Miller JP, Henderson JM, Shenoy KV, Simeral JD, Jarosiewicz B, Hochberg LR, Kirsch RF, Ajiboye AB. A Comparison of Intention Estimation Methods for Decoder Calibration in Intracortical Brain-Computer Interfaces. IEEE Trans Biomed Eng 2018; 65:2066-2078. [PMID: 29989927 PMCID: PMC6043406 DOI: 10.1109/tbme.2017.2783358] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Recent reports indicate that making better assumptions about the user's intended movement can improve the accuracy of decoder calibration for intracortical brain-computer interfaces. Several methods now exist for estimating user intent, including an optimal feedback control model, a piecewise-linear feedback control model, ReFIT, and other heuristics. Which of these methods yields the best decoding performance? METHODS Using data from the BrainGate2 pilot clinical trial, we measured how a steady-state velocity Kalman filter decoder was affected by the choice of intention estimation method. We examined three separate components of the Kalman filter: dimensionality reduction, temporal smoothing, and output gain (speed scaling). RESULTS The decoder's dimensionality reduction properties were largely unaffected by the intention estimation method. Decoded velocity vectors differed by <5% in terms of angular error and speed vs. target distance curves across methods. In contrast, the smoothing and gain properties of the decoder were greatly affected (> 50% difference in average values). Since the optimal gain and smoothing properties are task-specific (e.g. lower gains are better for smaller targets but worse for larger targets), no one method was better for all tasks. CONCLUSION Our results show that, when gain and smoothing differences are accounted for, current intention estimation methods yield nearly equivalent decoders and that simple models of user intent, such as a position error vector (target position minus cursor position), perform comparably to more elaborate models. Our results also highlight that simple differences in gain and smoothing properties have a large effect on online performance and can confound decoder comparisons.
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Bari AA, Mikell CB, Abosch A, Ben-Haim S, Buchanan RJ, Burton AW, Carcieri S, Cosgrove GR, D'Haese PF, Daskalakis ZJ, Eskandar EN, Gerrard JL, Goodman WK, Greenberg BD, Gross RE, Hamani C, Kiss ZHT, Konrad P, Kopell BH, Krinke L, Langevin JP, Lozano AM, Malone D, Mayberg HS, Miller JP, Patil PG, Peichel D, Petersen EA, Rezai AR, Richardson RM, Riva-Posse P, Sankar T, Schwalb JM, Simpson HB, Slavin K, Stypulkowski PH, Tosteson T, Warnke P, Willie JT, Zaghloul KA, Neimat JS, Pouratian N, Sheth SA. Charting the road forward in psychiatric neurosurgery: proceedings of the 2016 American Society for Stereotactic and Functional Neurosurgery workshop on neuromodulation for psychiatric disorders. J Neurol Neurosurg Psychiatry 2018; 89:886-896. [PMID: 29371415 PMCID: PMC7340367 DOI: 10.1136/jnnp-2017-317082] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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: 08/15/2017] [Revised: 11/28/2017] [Accepted: 12/19/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Refractory psychiatric disease is a major cause of morbidity and mortality worldwide, and there is a great need for new treatments. In the last decade, investigators piloted novel deep brain stimulation (DBS)-based therapies for depression and obsessive-compulsive disorder (OCD). Results from recent pivotal trials of these therapies, however, did not demonstrate the degree of efficacy expected from previous smaller trials. To discuss next steps, neurosurgeons, neurologists, psychiatrists and representatives from industry convened a workshop sponsored by the American Society for Stereotactic and Functional Neurosurgery in Chicago, Illinois, in June of 2016. DESIGN Here we summarise the proceedings of the workshop. Participants discussed a number of issues of importance to the community. First, we discussed how to interpret results from the recent pivotal trials of DBS for OCD and depression. We then reviewed what can be learnt from lesions and closed-loop neurostimulation. Subsequently, representatives from the National Institutes of Health, the Food and Drug Administration and industry discussed their views on neuromodulation for psychiatric disorders. In particular, these third parties discussed their criteria for moving forward with new trials. Finally, we discussed the best way of confirming safety and efficacy of these therapies, including registries and clinical trial design. We close by discussing next steps in the journey to new neuromodulatory therapies for these devastating illnesses. CONCLUSION Interest and motivation remain strong for deep brain stimulation for psychiatric disease. Progress will require coordinated efforts by all stakeholders.
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Affiliation(s)
- Ausaf A Bari
- Department of Neurosurgery, University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Charles B Mikell
- Department of Neurosurgery, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Aviva Abosch
- Department of Neurosurgery, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Sharona Ben-Haim
- Department of Neurosurgery, University of California San Diego Health, La Jolla, California, USA
| | - Robert J Buchanan
- Department of Neurosurgery, Seton Brain and Spine Institute, Austin, Texas, USA
| | - Allen W Burton
- Neuromodulation, Movement Disorders, and Pain, St. Jude-Abbott, Plano, Texas, USA
| | - Stephen Carcieri
- Neuromodulation, Boston Scientific Corp, Marlborough, Massachusetts, USA
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Emad N Eskandar
- Department of Neurosurgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jason L Gerrard
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Wayne K Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | | | - Robert E Gross
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Clement Hamani
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Zelma H T Kiss
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Peter Konrad
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian H Kopell
- Department of Neurosurgery, The Mount Sinai Hospital, New York City, New York, USA
| | - Lothar Krinke
- Medtronic Neuromodulation, Minneapolis, Minnesota, USA
| | - Jean-Philippe Langevin
- Department of Neurosurgery, University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Andres M Lozano
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Donald Malone
- Department of Psychiatry and Psychology, Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Helen S Mayberg
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan P Miller
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Parag G Patil
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - DeLea Peichel
- Neuromodulation, Movement Disorders, and Pain, St. Jude-Abbott, Plano, Texas, USA
| | - Erika A Petersen
- Department of Neurosurgery, University of Arkansas for Medical Science, Little Rock, Arkansas, USA
| | - Ali R Rezai
- Neurological Institute, Ohio State University, Columbus, Ohio, USA
| | - R Mark Richardson
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tejas Sankar
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Helen Blair Simpson
- Department of Psychiatry, Columbia University, NY State Psychiatric Institute, New York, NY
| | - Konstantin Slavin
- Department of Neurosurgery, University of Illinois College of Medicine, Chicago, Illinois, USA
| | | | - Tor Tosteson
- Departmentof Biomedical Data Science, Geisel School of Medicine, Dartmouth University, Hanover, New Hampshire, USA
| | - Peter Warnke
- Section of Neurosurgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Jon T Willie
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Kareem A Zaghloul
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Joseph S Neimat
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Nader Pouratian
- Department of Neurosurgery, University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
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Park JT, Fernandez-Baca Vaca G, Tangen RB, Cohen ML, Miller JP. Noninvasive Presurgical Data for One-Stage Leucotomy in Catastrophic Epilepsy. World Neurosurg 2018; 116:268-273. [PMID: 29864567 DOI: 10.1016/j.wneu.2018.05.182] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Catastrophic epilepsy results in severe neurodevelopmental delay in infants because of frequent and/or long seizures. Therefore, consideration of early epilepsy surgery is essential for neurodevelopmental outcome. Once an infant with catastrophic seizures is identified as a surgical candidate, it is important that the surgical plan be carefully defined based on detailed presurgical evidence to minimize surgical complications in this age group. CASE DESCRIPTION We present 2 infants with catastrophic epilepsy, epileptic spasms, and bihemispheric electroencephalographic abnormalities who underwent one-stage disconnection surgery based on a sound hypothesis of the epileptogenic zone. Each patient underwent an extensive noninvasive presurgical investigation followed by stereotactic disconnection leucotomy in a single stage. After the 2 children were followed for 24-36 months. A seizure reduction by at least 90% (Engel class I) was achieved in both cases with subsequent improvement in neurodevelopmental progress. There were no perioperative complications. Both patients had widespread cortical dysplasia on pathologic evaluation. CONCLUSIONS Careful consideration of the noninvasive presurgical workup can identify focal onset even in the presence of catastrophic epilepsy with widespread bilateral abnormalities. Single-stage lobar leucotomy for disconnection of the epileptogenic zone can lead to excellent outcome in these patients.
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Affiliation(s)
- Jun T Park
- Section of Pediatric Epilepsy, Department of Pediatrics, Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA; Epilepsy Center, Neurological Institute, Department of Neurology, University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
| | - Guadalupe Fernandez-Baca Vaca
- Epilepsy Center, Neurological Institute, Department of Neurology, University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Rachel B Tangen
- Division of Developmental and Behavioral Pediatrics and Psychology, Department of Pediatrics, Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mark L Cohen
- Department of Pathology, University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jonathan P Miller
- Department of Neurosurgery, Neurological Institute, University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Wright JM, Staudt MD, Alonso A, Miller JP, Sloan AE. A novel use of the NeuroBlate SideFire probe for minimally invasive disconnection of a hypothalamic hamartoma in a child with gelastic seizures. J Neurosurg Pediatr 2018; 21:302-307. [PMID: 29328005 DOI: 10.3171/2017.9.peds1747] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Indexed: 11/06/2022]
Abstract
The authors describe the case of a 22-month-old boy who presented with gelastic seizures and developmental delay. Magnetic resonance imaging and video-electroencephalography monitoring revealed a primarily intraventricular hypothalamic hamartoma and gelastic seizures occurring 20-30 times daily. The patient was treated with various regimens of antiepileptic medications for 16 months, but the seizures remained medically intractable. At 3 years of age, he underwent stereotactic laser ablation with an aim of disconnection of the lesion. The procedure was performed with the NeuroBlate SideFire probe. To the authors' knowledge, this is the first reported use of this technology for this procedure and serves as proof of concept. There were no perioperative complications, and 2 years postprocedure, the patient remains seizure free with marked behavioral and cognitive improvements.
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Affiliation(s)
- James M Wright
- 1Department of Neurological Surgery, University Hospitals, Case Western Reserve University.,3Case Western Reserve University School of Medicine, Cleveland, Ohio; and
| | - Michael D Staudt
- 1Department of Neurological Surgery, University Hospitals, Case Western Reserve University.,4Department of Clinical Neurological Sciences, London Health Science Centre, Western University, London, Ontario, Canada
| | - Andrea Alonso
- 3Case Western Reserve University School of Medicine, Cleveland, Ohio; and
| | - Jonathan P Miller
- 1Department of Neurological Surgery, University Hospitals, Case Western Reserve University.,3Case Western Reserve University School of Medicine, Cleveland, Ohio; and
| | - Andrew E Sloan
- 1Department of Neurological Surgery, University Hospitals, Case Western Reserve University.,3Case Western Reserve University School of Medicine, Cleveland, Ohio; and
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Staudt MD, Pourtaheri N, Lakin GE, Soltanian HT, Miller JP. Surgical Management of Deep Brain Stimulator Scalp Erosion without Hardware Removal. Stereotact Funct Neurosurg 2017; 95:385-391. [PMID: 29232685 DOI: 10.1159/000484323] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 04/11/2017] [Accepted: 10/16/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Scalp erosion in patients with deep brain stimulation (DBS) hardware is an uncommon complication that lacks a clearly defined management strategy. Previous studies have described various therapies including conservative treatment with antibiotics and surgical debridement with or without hardware removal. OBJECTIVES The aim of this study was to review the efficacy of a hardware-sparing management strategy for the treatment of scalp erosion. METHODS Five patients with previous DBS implantation presented with scalp erosion and visible hardware exposure at the calvarial burr hole site, and underwent tension-free, vascularized, rotational scalp flap, with preservation of the leads under the pericranium. Two of the procedures were performed after an unsuccessful attempt at primary closure and 3 as a primary procedure. Each patient was followed clinically for at least 14 months postoperatively to evaluate for wound-healing and adverse effects. RESULTS The median duration from initial DBS hardware implantation to erosion and revision surgery was 12 months (range 1.5-62 months). Three patients were documented to have positive intraoperative cultures in spite of the absence of purulence. At the last follow-up, all patients were noted to have complete wound-healing and no evidence of infection or erosion. CONCLUSIONS DBS scalp erosion can be managed by rotational scalp flap without hardware removal, even in cases where infection is identified.
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Affiliation(s)
- Michael D Staudt
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Krom AJ, Cohen Y, Ezri T, Halpern SH, Miller JP, Ginosar Y. Category-1 caesarean section, airways and Julius Caesar. A reply. Anaesthesia 2017; 72:1154-1155. [PMID: 28804890 DOI: 10.1111/anae.13955] [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: 11/30/2022]
Affiliation(s)
- A J Krom
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Y Cohen
- Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - T Ezri
- Wolfson Medical Center, Holon, Israel
| | | | - J P Miller
- Washington University School of Medicine, St Louis, MO, USA
| | - Y Ginosar
- Washington University School of Medicine, St Louis, MO, USA
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Staudt MD, Ray A, Hdeib A, Miller JP. Atypical anatomy associated with a lumbar far lateral disc herniation. Interdisciplinary Neurosurgery 2017. [DOI: 10.1016/j.inat.2017.01.007] [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: 10/20/2022] Open
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Ajiboye AB, Willett FR, Young DR, Memberg WD, Murphy BA, Miller JP, Walter BL, Sweet JA, Hoyen HA, Keith MW, Peckham PH, Simeral JD, Donoghue JP, Hochberg LR, Kirsch RF. Restoration of reaching and grasping movements through brain-controlled muscle stimulation in a person with tetraplegia: a proof-of-concept demonstration. Lancet 2017; 389:1821-1830. [PMID: 28363483 PMCID: PMC5516547 DOI: 10.1016/s0140-6736(17)30601-3] [Citation(s) in RCA: 419] [Impact Index Per Article: 59.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 01/02/2017] [Accepted: 01/06/2017] [Indexed: 11/01/2022]
Abstract
BACKGROUND People with chronic tetraplegia, due to high-cervical spinal cord injury, can regain limb movements through coordinated electrical stimulation of peripheral muscles and nerves, known as functional electrical stimulation (FES). Users typically command FES systems through other preserved, but unrelated and limited in number, volitional movements (eg, facial muscle activity, head movements, shoulder shrugs). We report the findings of an individual with traumatic high-cervical spinal cord injury who coordinated reaching and grasping movements using his own paralysed arm and hand, reanimated through implanted FES, and commanded using his own cortical signals through an intracortical brain-computer interface (iBCI). METHODS We recruited a participant into the BrainGate2 clinical trial, an ongoing study that obtains safety information regarding an intracortical neural interface device, and investigates the feasibility of people with tetraplegia controlling assistive devices using their cortical signals. Surgical procedures were performed at University Hospitals Cleveland Medical Center (Cleveland, OH, USA). Study procedures and data analyses were performed at Case Western Reserve University (Cleveland, OH, USA) and the US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center (Cleveland, OH, USA). The study participant was a 53-year-old man with a spinal cord injury (cervical level 4, American Spinal Injury Association Impairment Scale category A). He received two intracortical microelectrode arrays in the hand area of his motor cortex, and 4 months and 9 months later received a total of 36 implanted percutaneous electrodes in his right upper and lower arm to electrically stimulate his hand, elbow, and shoulder muscles. The participant used a motorised mobile arm support for gravitational assistance and to provide humeral abduction and adduction under cortical control. We assessed the participant's ability to cortically command his paralysed arm to perform simple single-joint arm and hand movements and functionally meaningful multi-joint movements. We compared iBCI control of his paralysed arm with that of a virtual three-dimensional arm. This study is registered with ClinicalTrials.gov, number NCT00912041. FINDINGS The intracortical implant occurred on Dec 1, 2014, and we are continuing to study the participant. The last session included in this report was Nov 7, 2016. The point-to-point target acquisition sessions began on Oct 8, 2015 (311 days after implant). The participant successfully cortically commanded single-joint and coordinated multi-joint arm movements for point-to-point target acquisitions (80-100% accuracy), using first a virtual arm and second his own arm animated by FES. Using his paralysed arm, the participant volitionally performed self-paced reaches to drink a mug of coffee (successfully completing 11 of 12 attempts within a single session 463 days after implant) and feed himself (717 days after implant). INTERPRETATION To our knowledge, this is the first report of a combined implanted FES+iBCI neuroprosthesis for restoring both reaching and grasping movements to people with chronic tetraplegia due to spinal cord injury, and represents a major advance, with a clear translational path, for clinically viable neuroprostheses for restoration of reaching and grasping after paralysis. FUNDING National Institutes of Health, Department of Veterans Affairs.
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Affiliation(s)
- A Bolu Ajiboye
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA.
| | - Francis R Willett
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA
| | - Daniel R Young
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA
| | - William D Memberg
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA
| | - Brian A Murphy
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA
| | - Jonathan P Miller
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Benjamin L Walter
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA; Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jennifer A Sweet
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Harry A Hoyen
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Department of Orthopaedics, MetroHealth Medical Center, Cleveland, OH, USA
| | - Michael W Keith
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Department of Orthopaedics, MetroHealth Medical Center, Cleveland, OH, USA
| | - P Hunter Peckham
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA
| | - John D Simeral
- School of Engineering, Brown University, Providence, RI, USA; Brown Institute for Brain Science, Brown University, Providence, RI, USA; Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - John P Donoghue
- Brown Institute for Brain Science, Brown University, Providence, RI, USA; Department of Neuroscience, Brown University, Providence, RI, USA; Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI, USA; Wyss Center for Bio and Neuroengineering, Geneva, Switzerland
| | - Leigh R Hochberg
- School of Engineering, Brown University, Providence, RI, USA; Brown Institute for Brain Science, Brown University, Providence, RI, USA; Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Robert F Kirsch
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Girgis F, Greil ME, Fastenau PS, Sweet J, Lüders H, Miller JP. Resection of Temporal Neocortex During Multiple Hippocampal Transections for Mesial Temporal Lobe Epilepsy Does not Affect Seizure or Memory Outcome. Oper Neurosurg (Hagerstown) 2017; 13:711-717. [DOI: 10.1093/ons/opx031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 01/31/2017] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Multiple hippocampal transection (MHT) is a surgical treatment for mesial temporal lobe epilepsy associated with improved postoperative neuropsychological outcomes compared with lobectomy.
OBJECTIVE
To determine whether resection of the amygdala and anterior temporal neocortex during MHT affects postoperative seizure/memory outcome.
METHODS
Seventeen patients with normal magnetic resonance imaging and stereo-electroencephalogram-proven drug-resistant dominant mesial temporal lobe epilepsy were treated with MHT. Nine patients underwent MHT alone (MHT–) and 8 patients underwent MHT plus removal of the amygdala and anterior 4.5 cm of temporal neocortex lateral to the fusiform gyrus (MHT+). Verbal and visual-spatial memory were assessed in all patients preoperatively and in 14 patients postoperatively using the Wechsler Memory Scale. Postoperative seizure control was assessed at 12 months for all patients.
RESULTS
Overall, 11 of 17 patients (64.7%) were Engel class 1 at 1 year (6/9 MHT–, 5/8 MHT+, P = .38), and 10 of 14 patients (71.4%) had no significant postoperative decline in either verbal or visual memory (6/8 MHT–, 4/6 MHT+, P = .42). Verbal memory declined in 2 of 8 MHT– and 1 of 6 MHT+ patients, and visual memory declined in 1 of 8 MHT– and 2 of 6 MHT+ patients. Two patients had improved visual memory postoperatively, both in the MHT+ group.
CONCLUSION
MHT on the dominant side is associated with high rates of seizure freedom and favorable memory preservation outcomes regardless of the extent of neocortical resection. Preservation of the temporal neocortex and amygdala during MHT does not appear to decrease the risk of postoperative memory decline, nor does it alter seizure outcome.
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Affiliation(s)
- Fady Girgis
- Department of Neurosurgery, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Madeline E Greil
- Department of Neurosurgery, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Philip S Fastenau
- Department of Neurology, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jennifer Sweet
- Department of Neurosurgery, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Hans Lüders
- Department of Neurology, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jonathan P Miller
- Department of Neurosurgery, University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Willett FR, Murphy BA, Memberg WD, Blabe CH, Pandarinath C, Walter BL, Sweet JA, Miller JP, Henderson JM, Shenoy KV, Hochberg LR, Kirsch RF, Ajiboye AB. Signal-independent noise in intracortical brain-computer interfaces causes movement time properties inconsistent with Fitts' law. J Neural Eng 2017; 14:026010. [PMID: 28177925 DOI: 10.1088/1741-2552/aa5990] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Do movements made with an intracortical BCI (iBCI) have the same movement time properties as able-bodied movements? Able-bodied movement times typically obey Fitts' law: [Formula: see text] (where MT is movement time, D is target distance, R is target radius, and [Formula: see text] are parameters). Fitts' law expresses two properties of natural movement that would be ideal for iBCIs to restore: (1) that movement times are insensitive to the absolute scale of the task (since movement time depends only on the ratio [Formula: see text]) and (2) that movements have a large dynamic range of accuracy (since movement time is logarithmically proportional to [Formula: see text]). APPROACH Two participants in the BrainGate2 pilot clinical trial made cortically controlled cursor movements with a linear velocity decoder and acquired targets by dwelling on them. We investigated whether the movement times were well described by Fitts' law. MAIN RESULTS We found that movement times were better described by the equation [Formula: see text], which captures how movement time increases sharply as the target radius becomes smaller, independently of distance. In contrast to able-bodied movements, the iBCI movements we studied had a low dynamic range of accuracy (absence of logarithmic proportionality) and were sensitive to the absolute scale of the task (small targets had long movement times regardless of the [Formula: see text] ratio). We argue that this relationship emerges due to noise in the decoder output whose magnitude is largely independent of the user's motor command (signal-independent noise). Signal-independent noise creates a baseline level of variability that cannot be decreased by trying to move slowly or hold still, making targets below a certain size very hard to acquire with a standard decoder. SIGNIFICANCE The results give new insight into how iBCI movements currently differ from able-bodied movements and suggest that restoring a Fitts' law-like relationship to iBCI movements may require non-linear decoding strategies.
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Affiliation(s)
- Francis R Willett
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America. Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland, OH, United States of America
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Park JT, Baca Vaca GF, Avery J, Miller JP. Utility of Stereoelectroencephalography in Children with Dysembryoplastic Neuroepithelial Tumor and Cortical Malformation. Neurodiagn J 2017; 57:191-210. [PMID: 28898173 DOI: 10.1080/21646821.2017.1326270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 06/07/2023]
Abstract
BACKGROUND Uncontrolled seizures in children can contribute to irreversible cognitive impairment and developmental delay, in addition to placing them at risk for sudden unexplained death in epileptic patients (SUDEP). Since its introduction at Saint Ann Hospital in Paris in the 1960s, stereoelectroencephalography (SEEG) is increasingly being utilized at epilepsy centers in the United States as an invasive tool to help localize the seizure focus in drug-resistant focal epilepsy. INDICATIONS Children with symptomatic epilepsy, commonly due to cortical dysplasia and dysembryoplastic neuroepithelial tumor (DNET), may benefit from SEEG investigation. The arrangement of SEEG electrodes is individually tailored based on the suspected location of the epileptogenic zone (EZ). The implanted depth electrodes are used to electrically stimulate the corresponding cortices to obtain information about the topography of eloquent cortex and EZ. Morbidity: Surgical morbidity in these children undergoing SEEG investigation is low, but not negligible. The number of electrodes directly correlates with the risk of intraoperative complication. Thus a risk and benefit analysis needs to be carefully considered for each patient. Neurodiagnostic technology: Both during and after the SEEG electrode implantation, the intraoperative monitoring and EEG technologists play a vital role in the successful monitoring of the patient. CONCLUSION SEEG is an important tool in the process of epilepsy surgery in children with symptomatic epilepsy, commonly due to cortical dysplasia and DNET.
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Affiliation(s)
- Jun T Park
- a Epilepsy Center , Cleveland University Hospitals , Cleveland , Ohio
- b Case Western Reserve University School of Medicine , Cleveland , Ohio
| | - Guadalupe Fernandez Baca Vaca
- a Epilepsy Center , Cleveland University Hospitals , Cleveland , Ohio
- b Case Western Reserve University School of Medicine , Cleveland , Ohio
| | - Jennifer Avery
- a Epilepsy Center , Cleveland University Hospitals , Cleveland , Ohio
| | - Jonathan P Miller
- a Epilepsy Center , Cleveland University Hospitals , Cleveland , Ohio
- b Case Western Reserve University School of Medicine , Cleveland , Ohio
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