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Wessel MJ, Draaisma LR, Durand-Ruel M, Maceira-Elvira P, Moyne M, Turlan JL, Mühl A, Chauvigné L, Koch PJ, Morishita T, Guggisberg AG, Hummel FC. Multi-focal Stimulation of the Cortico-cerebellar Loop During the Acquisition of a Novel Hand Motor Skill in Chronic Stroke Survivors. Cerebellum 2024; 23:341-354. [PMID: 36802021 PMCID: PMC10951005 DOI: 10.1007/s12311-023-01526-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/21/2023]
Abstract
Impairment of hand motor function is a frequent consequence after a stroke and strongly determines the ability to regain a self-determined life. An influential research strategy for improving motor deficits is the combined application of behavioral training and non-invasive brain stimulation of the motor cortex (M1). However, a convincing clinical translation of the present stimulation strategies has not been achieved yet. One alternative and innovative approach is to target the functionally relevant brain network-based architecture, e.g., the dynamic interactions within the cortico-cerebellar system during learning. Here, we tested a sequential multifocal stimulation strategy targeting the cortico-cerebellar loop. Anodal transcranial direct current stimulation (tDCS) was applied simultaneously to a hand-based motor training in N = 11 chronic stroke survivors during four training sessions on two consecutive days. The tested conditions were: sequential multifocal (M1-cerebellum (CB)-M1-CB) vs. monofocal control stimulation (M1-sham-M1-sham). Additionally, skill retention was assessed 1 and 10 days after the training phase. Paired-pulse transcranial magnetic stimulation data were recorded to characterize stimulation response determining features. The application of CB-tDCS boosted motor behavior in the early training phase in comparison to the control condition. No faciliatory effects on the late training phase or skill retention were detected. Stimulation response variability was related to the magnitude of baseline motor ability and short intracortical inhibition (SICI). The present findings suggest a learning phase-specific role of the cerebellar cortex during the acquisition of a motor skill in stroke and that personalized stimulation strategies encompassing several nodes of the underlying brain network should be considered.
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Affiliation(s)
- M J Wessel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - L R Draaisma
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
| | - M Durand-Ruel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
| | - P Maceira-Elvira
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
| | - M Moyne
- Department of Clinical Neurosciences, Geneva University Hospital (HUG), Geneva, Switzerland
| | - J-L Turlan
- Clinique Romande de Réadaptation (CRR Suva), Sion, Switzerland
| | - A Mühl
- Clinique Romande de Réadaptation (CRR Suva), Sion, Switzerland
| | - L Chauvigné
- Department of Clinical Neurosciences, Geneva University Hospital (HUG), Geneva, Switzerland
| | - P J Koch
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
| | - T Morishita
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
| | - A G Guggisberg
- Department of Clinical Neurosciences, Geneva University Hospital (HUG), Geneva, Switzerland
- Universitäre Neurorehabilitation, Universitätsklinik für Neurologie, Inselspital, University Hospital of Berne, Berne, Switzerland
| | - F C Hummel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland.
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland.
- Department of Clinical Neurosciences, Geneva University Hospital (HUG), Geneva, Switzerland.
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Permana GI, Morishita T, Tanaka H, Matsushita R, Kobayashi H, Abe H. Asymptomatic cable twisting in a patient with impending Twiddler syndrome detected during deep brain stimulation surgery for Parkinson's disease: A case report. Surg Neurol Int 2024; 15:86. [PMID: 38628532 PMCID: PMC11021058 DOI: 10.25259/sni_844_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/20/2024] [Indexed: 04/19/2024] Open
Abstract
Background Deep brain stimulation (DBS) has consistently demonstrated high efficacy and safety in patients with Parkinson's disease. Twiddler's syndrome is a rare occurrence of hardware failure in patients undergoing neuromodulation. We report here a case of subclinical cable twisting jeopardizing Twiddler's syndrome in a patient with Parkinson's disease who underwent DBS surgery targeting the globus pallidus internus (GPI). Case Description A 70-year-old woman with a 7-year history of Parkinson's disease refractory to medication was referred to our department for treatment of involuntary movements of the left hand and leg. She underwent right GPI DBS implantation. Left GPI DBS implantation was subsequently planned to manage resting tremors that developed in the right leg after the first surgery at around one year after the first surgery. During a routine check-up before the second surgery, we incidentally detected Twiddler's syndrome. The patient showed no neurological deficits in the left extremities, the same as before right GPI DBS. We performed left GPI DBS concomitantly with the revision of the implantable pulse generator and extension wire. Conclusion Twiddler's syndrome is a rare complication of DBS. Subclinical risk of cable twisting jeopardizing Twiddler's syndrome is rarely detected without clinical indications of hardware failure. Neurosurgeons should be cognizant of and regularly monitor the implanted device in case serious complications occur.
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Affiliation(s)
- Galih Indra Permana
- Department of Neurosurgery, Dr. Moewardi General Hospital, Surakarta, Indonesia
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University Hospital, Fukuoka, Japan
| | - Hideaki Tanaka
- Department of Neurosurgery, Fukuoka University Hospital, Fukuoka, Japan
| | - Ryuji Matsushita
- Department of Neurosurgery, Fukuoka University Hospital, Fukuoka, Japan
| | | | - Hiroshi Abe
- Department of Neurosurgery, Fukuoka University Hospital, Fukuoka, Japan
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Johnson KA, Dosenbach NUF, Gordon EM, Welle CG, Wilkins KB, Bronte-Stewart HM, Voon V, Morishita T, Sakai Y, Merner AR, Lázaro-Muñoz G, Williamson T, Horn A, Gilron R, O'Keeffe J, Gittis AH, Neumann WJ, Little S, Provenza NR, Sheth SA, Fasano A, Holt-Becker AB, Raike RS, Moore L, Pathak YJ, Greene D, Marceglia S, Krinke L, Tan H, Bergman H, Pötter-Nerger M, Sun B, Cabrera LY, McIntyre CC, Harel N, Mayberg HS, Krystal AD, Pouratian N, Starr PA, Foote KD, Okun MS, Wong JK. Proceedings of the 11th Annual Deep Brain Stimulation Think Tank: pushing the forefront of neuromodulation with functional network mapping, biomarkers for adaptive DBS, bioethical dilemmas, AI-guided neuromodulation, and translational advancements. Front Hum Neurosci 2024; 18:1320806. [PMID: 38450221 PMCID: PMC10915873 DOI: 10.3389/fnhum.2024.1320806] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
The Deep Brain Stimulation (DBS) Think Tank XI was held on August 9-11, 2023 in Gainesville, Florida with the theme of "Pushing the Forefront of Neuromodulation". The keynote speaker was Dr. Nico Dosenbach from Washington University in St. Louis, Missouri. He presented his research recently published in Nature inn a collaboration with Dr. Evan Gordon to identify and characterize the somato-cognitive action network (SCAN), which has redefined the motor homunculus and has led to new hypotheses about the integrative networks underpinning therapeutic DBS. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers, and researchers (from industry and academia) can freely discuss current and emerging DBS technologies, as well as logistical and ethical issues facing the field. The group estimated that globally more than 263,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. This year's meeting was focused on advances in the following areas: cutting-edge translational neuromodulation, cutting-edge physiology, advances in neuromodulation from Europe and Asia, neuroethical dilemmas, artificial intelligence and computational modeling, time scales in DBS for mood disorders, and advances in future neuromodulation devices.
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Affiliation(s)
- Kara A. Johnson
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Nico U. F. Dosenbach
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Evan M. Gordon
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Cristin G. Welle
- Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States
| | - Kevin B. Wilkins
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Helen M. Bronte-Stewart
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yuki Sakai
- ATR Brain Information Communication Research Laboratory Group, Kyoto, Japan
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Amanda R. Merner
- Center for Bioethics, Harvard Medical School, Boston, MA, United States
| | - Gabriel Lázaro-Muñoz
- Center for Bioethics, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Theresa Williamson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
| | - Andreas Horn
- Department of Neurology, Center for Brain Circuit Therapeutics, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, United States
- MGH Neurosurgery and Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | | | | | - Aryn H. Gittis
- Biological Sciences and Center for Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Simon Little
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Nicole R. Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network (UHN), University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
| | - Abbey B. Holt-Becker
- Restorative Therapies Group Implantables, Research, and Core Technology, Medtronic Inc., Minneapolis, MN, United States
| | - Robert S. Raike
- Restorative Therapies Group Implantables, Research, and Core Technology, Medtronic Inc., Minneapolis, MN, United States
| | - Lisa Moore
- Boston Scientific Neuromodulation Corporation, Valencia, CA, United States
| | | | - David Greene
- NeuroPace, Inc., Mountain View, CA, United States
| | - Sara Marceglia
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Lothar Krinke
- Newronika SPA, Milan, Italy
- Department of Neuroscience, West Virginia University, Morgantown, WV, United States
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Hagai Bergman
- Edmond and Lily Safar Center (ELSC) for Brain Research and Department of Medical Neurobiology (Physiology), Institute of Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Monika Pötter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Laura Y. Cabrera
- Neuroethics, Department of Engineering Science and Mechanics, Philosophy, and Bioethics, and the Rock Ethics Institute, Pennsylvania State University, State College, PA, United States
| | - Cameron C. McIntyre
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
- Department of Neurosurgery, Duke University, Durham, NC, United States
| | - Noam Harel
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Helen S. Mayberg
- Department of Neurology, Neurosurgery, Psychiatry, and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andrew D. Krystal
- Departments of Psychiatry and Behavioral Science and Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Nader Pouratian
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Philip A. Starr
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Kelly D. Foote
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Michael S. Okun
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Joshua K. Wong
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
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Permana GI, Morishita T, Tanaka H, Iida H, Fujioka S, Abe H. Microlesion Effect Induced by Electrode Implantation in the Posteroventral Globus Pallidus Interna for Severe Dystonic Tics. Tremor Other Hyperkinet Mov (N Y) 2024; 14:5. [PMID: 38249547 PMCID: PMC10798164 DOI: 10.5334/tohm.837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Background Tourette syndrome (TS) is a neurologic condition characterized by motor and phonic tics. Dystonic tics, including blepharospasm, are considered atypical or unusual in severe TS. Case Report We report a severe case of TS with facial dystonic tics resembling blepharospasm in which the microlesion effect and a sustained therapeutic effect was observed with bilateral globus pallidus interna (GPi) deep brain stimulation (DBS). Discussion Bilateral GPi DBS can be beneficial for blepharospasm-like tics and severe symptoms of TS. The improvements seen can be explained by the microlesion effect induced by DBS lead placement in the GPi.
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Affiliation(s)
- Galih Indra Permana
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
- Department of Neurosurgery, Dr. Moewardi General Academic Hospital, Central Java, Indonesia
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hideaki Tanaka
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hitoshi Iida
- Department of Psychiatry, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Shinsuke Fujioka
- Department of Neurology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Morishita T, Sakai Y, Iida H, Yoshimura S, Fujioka S, Oda K, Tanaka SC, Abe H. Precision Mapping of Thalamic Deep Brain Stimulation Lead Positions Associated With the Microlesion Effect in Tourette Syndrome. Neurosurgery 2023; 93:875-883. [PMID: 37057914 PMCID: PMC10476847 DOI: 10.1227/neu.0000000000002484] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/10/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND The microlesion effect refers to the improvement of clinical symptoms after deep brain stimulation (DBS) lead placement and is suggested to indicate optimal lead placement. Very few studies have reported its implications in neuropsychiatric disorders. OBJECTIVE To evaluate the magnitude of the microlesion effect in Tourette syndrome and the relationship between the microlesion effect and the anatomic location of implanted DBS leads. METHODS Six male patients were included. Their median age at surgery and follow-up period were 25 years (range, 18-47) and 12 months (range, 6-24), respectively. All patients were videotaped pre- and postoperatively, and tic frequencies were counted. We also analyzed the precision of lead placement and evaluated the normative connectome associated with the microlesion area. RESULTS The microlesion effect was observed as an improvement in tic symptoms in all patients, and the long-term clinical outcomes were favorable. The median motor tic frequency was 20.2 tics/min (range, 9.7-60) at baseline and decreased to 3.2 tics/min (1.2-11.3) in patients on postoperative day 1 ( P = .043) and to 5.7 tics/min (range, 1.9-16.6) in patients on postoperative day 7 ( P = .028). Phonic tic tended to improve immediately after surgery although the changes were not significant. Image analyses revealed that the precise position of the electrode was directed toward the anteromedial centromedian nucleus. Normative connectome analysis demonstrated connections between improvement-related areas and wide areas of the prefrontal cortex. CONCLUSION This study shows that the microlesion effect may seem as an immediate improvement after optimal DBS lead placement in patients with Tourette syndrome.
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Affiliation(s)
- Takashi Morishita
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yuki Sakai
- ATR Brain Information Communication Research Laboratory Group, Kyoto, Japan
| | - Hitoshi Iida
- Department of Psychiatry, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Saki Yoshimura
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Shinsuke Fujioka
- Department of Neurology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kazunori Oda
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Saori C. Tanaka
- ATR Brain Information Communication Research Laboratory Group, Kyoto, Japan
- Division of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Hasegawa H, Matsuda A, Morishita T, Madsen LB, Jensen F, Tolstikhin OI, Hishikawa A. Dissociative ionization and Coulomb explosion of CH 4 in two-color asymmetric intense laser fields. Phys Chem Chem Phys 2023; 25:25408-25419. [PMID: 37706318 DOI: 10.1039/d3cp02337k] [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] [Indexed: 09/15/2023]
Abstract
Directional fragment ejection from a tetrahedral molecule CH4 in linearly polarized two-color (ω and 2ω) asymmetric intense laser fields (50 fs, 1.4 × 1014 W cm-2, 800 nm and 400 nm) has been studied by three-dimensional ion coincidence momentum imaging. The H+ fragment produced from dissociative ionization, CH4 → H+ + CH3 + e-, is preferentially ejected on the larger amplitude side of the laser electric fields. Comparison with theoretical predictions by weak-field asymptotic theory shows that the observed asymmetry can be understood by the orientation selective tunneling ionization from the triply degenerated highest occupied molecular orbital (1t2) of CH4. A similar directional ejection of H+ was also observed for the low kinetic energy components of the two-body Coulomb explosion, CH4 → H+ + CH3+ + 2e-. On the other hand, the fragment ejection in the opposite direction were observed for the high energy component, as well as H2+ produced from the Coulomb explosion CH4 → H2+ + CH2+ + 2e-. Possible origins of the characteristic fragmentation are discussed.
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Affiliation(s)
- H Hasegawa
- Graduate School of Science, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi, 464-8602, Japan.
| | - A Matsuda
- Graduate School of Science, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi, 464-8602, Japan.
| | - T Morishita
- Institute for Advanced Science, The University of Electro-Communications, 1-5-1 Chofu-ga-oka, Chofu-shi, Tokyo 182-8585, Japan
| | - L B Madsen
- Department of Physics and Astronomy, Aarhus University, 8000 Aarhus C, Denmark
| | - F Jensen
- Department of Chemistry, Aarhus University, 8000 Aarhus C, Denmark
| | - O I Tolstikhin
- Moscow Institute of Physics and Technology, Dolgoprudny 141700, Russia
| | - A Hishikawa
- Graduate School of Science, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi, 464-8602, Japan.
- Research Center for Materials Science, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi, 464-8602, Japan
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Kusakabe T, Oda K, Kobayashi H, Kawano D, Yoshinaga S, Fukumoto H, Takemoto K, Morishita T, Abe H. Disappearance of a moyamoya-related distal anterior cerebral artery aneurysm after target bypass revascularization: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23200. [PMID: 37486894 PMCID: PMC10555570 DOI: 10.3171/case23200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/19/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Aneurysm formation is a complication of moyamoya disease (MMD). Distal anterior cerebral artery (ACA) aneurysms account for approximately 1% of MMD-related aneurysms. We report a case of target bypass for adult patients with MMD who presented with intracranial hemorrhage due to rupture of a distal ACA aneurysm, whose disappearance was confirmed postoperatively. OBSERVATIONS A 45-year-old woman presented with sudden-onset headache and loss of consciousness. Head computed tomography showed hemorrhage in the genu of the corpus callosum with intraventricular extension. Digital subtraction angiography (DSA) revealed Suzuki stage III MMD and a left A3 segment aneurysm. Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass and STA-ACA target bypass were performed to reduce hemodynamic stress on the left ACA. DSA 6 months after surgery showed patency of both bypasses and disappearance of the aneurysm. At the 20-month follow-up, the patient was asymptomatic and neurologically intact. LESSONS Bypass revascularization may be an effective treatment to reduce hemodynamic stress and eliminate MMD-related aneurysms.
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Suzuki K, Oda K, Horio Y, Kawano D, Hirao N, Amamoto T, Kobayashi H, Takemoto K, Morishita T, Abe H. Presence of intra-aneurysmal thrombi with delayed coil migration after embolization of an aneurysmal subarachnoid hemorrhage: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE23196. [PMID: 37399142 PMCID: PMC10550549 DOI: 10.3171/case23196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/30/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Coil migration is a rare, but notable complication of endovascular treatment. Risk factors include communicating segment aneurysms, aneurysmal shape, and technical factors. Although cerebral blood flow obstruction caused by early coil migration requires urgent coil removal, delayed coil migration is often asymptomatic, making it difficult to determine a treatment strategy. OBSERVATIONS A 47-year-old woman was referred to the institute with acute-onset headache. She was diagnosed with subarachnoid hemorrhage due to rupture of the right internal carotid artery-posterior communicating artery aneurysm and underwent endovascular coil embolization. Following the procedure, the patient showed no obvious complications; however, 14 days later, images showed coil migration to the distal side, leading to surgical removal. Right frontotemporal craniotomy was performed, and the remaining coil was removed. The aneurysm was clipped again, and blood flow was confirmed. The patient was discharged 12 days after the craniotomy with transient oculomotor nerve palsy. At the 15-month follow-up, there was no aneurysm recurrence and the oculomotor nerve palsy showed improvement. LESSONS Retrieval of the migrated coil by craniotomy is an effective remedial measure; however, intraoperative complications are common. Early detection, established protocols, and prompt treatment decisions are important for preventing undesirable outcomes.
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Takeda K, Oda K, Fukumoto H, Kobayashi H, Morishita T, Takemoto K, Iwaasa M, Abe H. Repeated coil embolization of traumatic basilar artery pseudoaneurysm accompanied by bilateral traumatic internal carotid artery stenosis following severe head injury in a pediatric patient: A case report and literature review. Surg Neurol Int 2023; 14:199. [PMID: 37404524 PMCID: PMC10316180 DOI: 10.25259/sni_267_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/26/2023] [Indexed: 07/06/2023] Open
Abstract
Background Few cases of pediatric traumatic intracranial aneurysms (pTICAs) in the posterior circulation involving the basilar artery (BA) following severe head trauma have been reported. Here, we describe a pediatric case of traumatic BA pseudoaneurysm accompanied by bilateral traumatic internal carotid artery (ICA) stenosis following blunt head trauma. Case Description A 16-year-old boy presented to our emergency department after being hit by a car. The patient was initially diagnosed with multiple skull base fractures underlying traumatic subarachnoid hemorrhage and left acute epidural hematoma. Seven days following emergency craniectomy, magnetic resonance imaging revealed bilateral ICA stenosis, BA stenosis, and BA pseudoaneurysm. We decided to perform coil embolization, resulting in body filling and a volume embolization ratio of 15.7%. Twenty-eight days after coil embolization, digital subtraction angiography revealed aneurysmal rupture. We performed repeated coil embolization, resulting in body filling and a volume embolization ratio of 20.9%. Conclusion We reported a pediatric case of traumatic BA pseudoaneurysm accompanied by bilateral traumatic ICA stenosis following a severe head injury treated with repeated coil embolization. Considering the risk of further brain injury due to high incidence of rupture, early vascular survey and appropriate treatment may be the most important prognostic factors in pTICAs.
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Affiliation(s)
| | - Kazunori Oda
- Corresponding author: Kazunori Oda, Department of Neurosurgery, Fukuoka University, Fukuoka, Japan.
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10
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Yoshinaga T, Fukumoto H, Kawano D, Kobayashi H, Fukuda K, Morishita T, Inoue T, Abe H. Case report: isolated trochlear nerve palsy associated with posterior cerebral artery aneurysm. Acta Neurochir (Wien) 2023; 165:1027-1030. [PMID: 36864353 DOI: 10.1007/s00701-023-05530-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/15/2023] [Indexed: 03/04/2023]
Abstract
We describe a case of isolated trochlear nerve palsy caused by an unruptured posterior cerebral artery (PCA) aneurysm in an 82-year-old male who consulted an ophthalmologist after developing diplopia. Magnetic resonance angiography showed a left PCA aneurysm in the ambient cistern, and T2WI showed an aneurysm compressing the left trochlear nerve to the cerebellar tentorium. Digital subtraction angiography revealed that the lesion was located between the left P2a segment. We attributed this isolated trochlear palsy to left PCA unruptured aneurysm pressure. Thus, we performed stent-assisted coil embolization. The aneurysm was obliterated, and trochlear nerve palsy improved completely.
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Affiliation(s)
- Taisuke Yoshinaga
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hironori Fukumoto
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
| | - Dai Kawano
- Department of Neurosurgery, Fukuoka University Hospital, Fukuoka, Japan
| | | | - Kenji Fukuda
- Department of Neurosurgery, Hakujuji Hospital, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University Hospital, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Hakujuji Hospital, Fukuoka, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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11
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Horio Y, Miki K, Kawano D, Amamoto T, Fukumoto H, Kobayashi H, Takemoto K, Morishita T, Abe H. Manual superficial temporal artery compression using a circular plastic material for embolization of meningioma: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22395. [PMID: 36692069 PMCID: PMC10550705 DOI: 10.3171/case22395] [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] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/12/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND In meningiomas that occur in the high-convexity region, the superficial temporal artery (STA) frequently feeds the tumor, and when embolizing from the middle meningeal artery (MMA), the embolic material may not reach the tumor vessels because of the pressure gradient resulting from the STA blood flow, resulting in inadequate embolization. In this case, a circular plastic material was used to apply circumferential pressure around the parietal foramen to control blood flow to the tumor. OBSERVATIONS A 45-year-old male underwent head magnetic resonance imaging that revealed a 2.2-cm meningioma in the right high-convexity region. Preoperative embolization was performed. When N-butyl-2-cyanoacrylate was injected from the right MMA while using a circular plastic material to compress the skin around the parietal foramen through which the bilateral STAs (the tumor feeders) flow, it was able to fully penetrate the tumor vessel and occlude the other feeders in a retrograde manner. The patient underwent tumor removal after embolization uneventfully. LESSONS Manual compression of the STA using a circular plastic material is useful when the tumor is fed by the STA through the parietal foramen and is also applicable to transarterial embolization of dural arteriovenous fistulas fed by the STA or occipital artery.
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Affiliation(s)
- Yoshinobu Horio
- Department of Neurosurgery, Fukuoka University, Fukuoka, Japan; and
| | - Koichi Miki
- Department of Neurosurgery, Hiraoyama Hospital, Fukuoka, Japan
| | - Dai Kawano
- Department of Neurosurgery, Fukuoka University, Fukuoka, Japan; and
| | - Takaaki Amamoto
- Department of Neurosurgery, Fukuoka University, Fukuoka, Japan; and
| | | | | | | | | | - Hiroshi Abe
- Department of Neurosurgery, Fukuoka University, Fukuoka, Japan; and
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12
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Oda K, Morishita T, Tanaka H, Kobayashi H, Abe H. Case report: Radiofrequency thalamotomy as palliative care for Holmes tremor in a patient with terminal cancer and cardiac pacemaker. Surg Neurol Int 2022; 13:484. [PMID: 36324913 PMCID: PMC9610373 DOI: 10.25259/sni_618_2022] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/27/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Herein, we present a case report of a patient with Holmes tremor due to thalamic infarction with end-stage pancreatic cancer who underwent successful computed tomography (CT)-guided ventralis intermedius nucleus (Vim) thalamotomy as palliative care. Case Description: A 78-year-old man with gradually worsening involuntary movements on the left side of his body 2 years after a right thalamic infarction was referred to our institute. He had a history of chronic atrial fibrillation for which he was implanted with a cardiac pacemaker not compatible with magnetic resonance imaging. He also received adjuvant therapy for pancreatic cancer. As the involuntary movements interfered with his daily life, the patient elected for neurosurgical treatment despite having terminal cancer. Although the prognosis for pancreatic cancer was considered to be more than 6 months at the time of surgery, we performed CT-guided Vim thalamotomy under local anesthesia without pulse generator implantation considering the patient’s general condition. The involuntary movements of the left side of the body reduced following surgery, thus improving his quality of life (QOL). However, 6 months after thalamotomy, the patient died of pancreatic cancer. Conclusion: Thalamotomy significantly reduced the involuntary movements immediately after the procedure. Therefore, thalamotomy can be performed under local anesthesia without the use of any device and may contribute to the improvement of QOL in terminal patients.
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13
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Oda K, Morishita T, Yatsugi A, Miki K, Uchiyama T, Tanaka H, Abe H, Inoue T. Pain Relief Following Selective Tibial Neurotomy for Spastic Equinus Foot Secondary to Stroke and Traumatic Brain Injury. World Neurosurg 2022; 166:e583-e589. [PMID: 35863641 DOI: 10.1016/j.wneu.2022.07.053] [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: 05/12/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Selective tibial neurotomy (STN) has been indicated for spastic equinus foot (SEF); however, the impact of this procedure on quality of life and activities of daily living has not been evaluated in detail. This study aimed to evaluate the surgical outcomes of STN and its effect on SEF accompanied by pain. METHODS We evaluated 26 patients (mean age: 59.6 ± 15.2 years; 14 men and 12 women) who underwent STN for SEF, 10 of whom complained of spontaneous pain preoperatively. We used the following scales for clinical evaluation: the Modified Ashworth Scale, Medical Research Council (MRC), 10-m walking test, Functional Independence Measure, and numeric rating scale for pain. These scales were evaluated preoperatively and postoperatively. Differences in clinical characteristics were compared between the 10 patients with pain and the 16 patients without pain. RESULTS Significant differences were observed in all evaluation scale scores except for the Functional Independence Measure, and no serious adverse events were reported. Pain intensity was significantly improved from 6.4 ± 2.0 to 2.7 ± 2.3 (P < 0.05). An analysis showed that the preoperative mean Medical Research Council score of ankle movement was significantly lower in patients with pain but recovered to the same level postoperatively at the 6-month follow-up. CONCLUSIONS Our study showed significant improvements in spasticity and its associated symptoms, and STN effectively addressed spastic pain and motor weakness. Among various treatment modalities, STN may be positively indicated for patients with spastic pain in the lower leg.
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Affiliation(s)
- Kazunori Oda
- Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan.
| | - Aya Yatsugi
- Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan; Department of Rehabilitation, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Koichi Miki
- Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Takuya Uchiyama
- Department of Neurosurgery, Kindai University, Faculty of Medicine, Higashiosaka, Osaka, Japan
| | - Hideaki Tanaka
- Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
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14
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Draaisma L, Wessel M, Moyne M, Morishita T, Hummel F. Targeting the frontoparietal network using bifocal transcranial alternating current stimulation during a motor sequence learning task in healthy older adults. Brain Stimul 2022; 15:968-979. [DOI: 10.1016/j.brs.2022.06.012] [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: 02/08/2022] [Revised: 06/13/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
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15
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Hayashi Y, Mishima T, Fujioka S, Morishita T, Inoue T, Nagamachi S, Tsuboi Y. Unilateral GPi-DBS Improves Ipsilateral and Axial Motor Symptoms in Parkinson’s Disease as Evidenced by a Brain Perfusion Single Photon Emission Computed Tomography Study. Front Hum Neurosci 2022; 16:888701. [PMID: 35634204 PMCID: PMC9130959 DOI: 10.3389/fnhum.2022.888701] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/07/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Deep brain stimulation (DBS) is an effective treatment for advanced Parkinson’s disease (PD) with the targeting bilateral subthalamic nucleus or globus pallidus internus (STN or GPi-DBS). So far, detailed studies on the efficacy of unilateral STN-DBS for motor symptoms have been reported, but few studies have been conducted on unilateral GPi-DBS. Materials and Methods Seventeen patients with Parkinson’s disease (PwPD) who underwent unilateral GPi-DBS were selected. We conducted comparison analyses between scores obtained 6–42 months pre- and postoperatively using the following measurement tools: the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) part III, the Hoehn and Yahr stage, the presence/absence of dyskinesia, Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), Geriatric Depression Scale (GDS), levodopa equivalent dose (LED), and cerebral blood flow by single photon emission computed tomography (SPECT). Patient backgrounds were compared between four cohorts with favorable (good responders, ≥50% improvement) and unfavorable (poor responders, <50% improvement) postoperative outcome. Results Significant improvement was observed postoperatively in the following: total MDS-UPDRS Part III scores during the off period, contralateral scores, ipsilateral scores, and axial scores. Similarly, the Hoehn and Yahr stages during the off period, and GDS also showed significant decrease. In contrast, LED, MMSE, and FAB remained unchanged while the number of patients who scored positive for dyskinesia decreased by 40%. Abnormal cerebral blood flow preoperatively seen in the cerebral cortex had normalized in the total score-based good responder cohort. In the ipsilateral score-based good responder cohort, cerebral blood flow increased in the contralateral frontal lobe including in the premotor cortex, contralateral to the DBS. Compared to the poor responders, postoperative good responders demonstrated significantly higher preoperative MMSE scores. Discussion Unilateral GPi-DBS therapy was effective in improving contralateral, ipsilateral, and axial motor symptoms of patients with advanced PD; in particular, it was found to be especially beneficial in PwPD whose cognitive function was unimpaired; the treatment efficacy rivaled that of bilateral counterparts up till at least 6 months postoperatively. Finally, normalization of preoperative abnormalities in cerebral blood flow and increased cerebral blood flow in the contralateral frontal lobe indicated the beneficial potential of this therapy on ipsilateral motor symptoms.
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Affiliation(s)
- Yuka Hayashi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takayasu Mishima
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- *Correspondence: Takayasu Mishima,
| | - Shinsuke Fujioka
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shigeki Nagamachi
- Department of Radiology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- Yoshio Tsuboi,
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16
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Oda K, Amamoto T, Enomoto T, Kobayashi H, Morishita T, Iwaasa M, Abe H, Inoue T. Favorable management of symptomatic cerebellar hemangioblastoma presenting with obstructive hydrocephalus during pregnancy: A case report and literature review. Surg Neurol Int 2022; 13:174. [PMID: 35509572 PMCID: PMC9062972 DOI: 10.25259/sni_105_2022] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Cerebellar hemangioblastoma is a highly vascular benign tumor and the growth rate of hemangioblastomas is believed to often accelerate during pregnancy; however, the reason for this rapid increase in size remains poorly understood. There are several case reports of symptomatic hemangioblastoma during pregnancy; however, the favorable management strategy has not been well established. Case Description: A 35-year-old woman, gravida 2 para 1, with no significant medical history presented with vertigo and difficulty walking at around 11 weeks of pregnancy and was referred to our institute at 30 weeks of gestation because of worsening symptoms. Brain magnetic resonance imaging revealed a 5.6 cm cystic lesion with a mural nodule in the right cerebellar hemisphere and the lesion blocked cerebrospinal fluid drainage from the fourth ventricle and brainstem, resulting in obstructive hydrocephalus. After obtaining the patient’s consent, a multidisciplinary team consisting of obstetricians and neurosurgeons decided to perform resection of the intracranial lesion following delivery of the fetus by emergency cesarean section in view of the symptoms of increased intracranial pressure. The patient’s general condition was confirmed to be stable postoperatively and she was discharged on the 16th day of her hospitalization without any neurological deficits or fetal complications. Conclusion: Urgent tumor resection combined with cesarean section can be planned once fetal lung maturity is confirmed. Most cases of symptomatic hemangioblastoma during pregnancy have an uneventful gestational course and a favorable outcome for both mother and child.
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17
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Fujise H, Uemura M, Hasegawa H, Ikeya D, Matsuda A, Morishita T, Madsen LB, Jensen F, Tolstikhin OI, Hishikawa A. Helicity-dependent dissociative tunneling ionization of CF 4 in multicycle circularly polarized intense laser fields. Phys Chem Chem Phys 2022; 24:8962-8969. [PMID: 35380001 DOI: 10.1039/d1cp05858d] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Dissociative tunneling ionization of tetrafluoromethane (CF4) in circularly polarized ultrashort intense laser fields (35 fs, 0.8 × 1014 W cm-2, 1035 nm), CF4 → CF4+ + e- → CF3+ + F + e-, has been studied by three-dimensional electron-ion coincidence momentum imaging. The photoelectron angular distribution in the recoil frame revealed that the dissociative tunneling ionization occurs efficiently when the laser electric field points from F to C. The obtained results are qualitatively consistent with the theoretical predictions by the weak-field asymptotic theory (WFAT) for tunneling ionization from the highest and next-highest occupied molecular orbitals, HOMO (1t1), and HOMO-1 (4t2), respectively. On the other hand, the angular distribution shows clear dependences on the polarization helicity, indicating that the breaking of the C-F bonds is sensitive to the helicity of the multicycle circularly polarized laser fields.
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Affiliation(s)
- H Fujise
- Department of Chemistry, Graduate School of Science, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi 464-8602, Japan.
| | - M Uemura
- Department of Chemistry, Graduate School of Science, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi 464-8602, Japan.
| | - H Hasegawa
- Department of Chemistry, Graduate School of Science, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi 464-8602, Japan.
| | - D Ikeya
- Department of Chemistry, Graduate School of Science, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi 464-8602, Japan.
| | - A Matsuda
- Department of Chemistry, Graduate School of Science, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi 464-8602, Japan.
| | - T Morishita
- Institute for Advanced Science, The University of Electro-Communications, 1-5-1 Chofu-ga-oka, Chofu-shi, Tokyo 182-8585, Japan
| | - L B Madsen
- Department of Physics and Astronomy, Aarhus University, 8000 Aarhus C, Denmark
| | - F Jensen
- Department of Chemistry, Aarhus University, 8000 Aarhus C, Denmark
| | - O I Tolstikhin
- Moscow Institute of Physics and Technology, Dolgoprudny 141700, Russia
| | - A Hishikawa
- Department of Chemistry, Graduate School of Science, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi 464-8602, Japan. .,Research Center for Materials Science, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi 464-8602, Japan
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18
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Enomoto T, Morishita T, Tooru Inoue HA. In Reply to the Letter to the Editor Regarding ''Functional Prognosis Following Temporal Bone Chondroblastoma Resection: A Systematic Review and a Case Illustration''. World Neurosurg 2022; 160:119. [PMID: 35364665 DOI: 10.1016/j.wneu.2022.01.066] [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] [Received: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Toshiyuki Enomoto
- Department of Neurosurgery, Faculty of Medicine Fukuoka University, Fukuoka, Japan.
| | - Takashi Morishita
- Department of Neurosurgery, Faculty of Medicine Fukuoka University, Fukuoka, Japan
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19
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Matsuo Y, Tanaka H, Morishita T, Enatsu R, Inoue T. Vagus nerve stimulation for bilateral temporal lobe epilepsy caused by fractionated radiation therapy: A case report. Interdisciplinary Neurosurgery 2022. [DOI: 10.1016/j.inat.2021.101429] [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: 10/19/2022] Open
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20
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Hirao N, Morishita T, Saita K, Takagi T, Fujioka S, Inoue T. Radiofrequency Ventro-oral Thalamotomy for Post-stroke Focal Dystonia in a Pediatric Patient. NMC Case Rep J 2022; 8:445-450. [PMID: 35079502 PMCID: PMC8769475 DOI: 10.2176/nmccrj.cr.2020-0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/22/2020] [Indexed: 11/20/2022] Open
Abstract
Dystonia is a movement disorder that has various treatment options. For primary dystonia, stereotactic procedures such as deep brain stimulation (DBS) have demonstrated favorable outcomes. For secondary dystonia, however, the treatment outcomes remain inconclusive, and the heterogeneous etiological background is considered to contribute to the poor outcomes of the disease. Here, we report a rare pediatric case of post-stroke focal dystonia treated with conventional radiofrequency ventro-oral (Vo) thalamotomy. The patient was an 11-year-old girl with secondary focal dystonia in her right hand. The dystonia was considered to result from a stroke lesion in the putamen due to vasculitis following varicella-zoster virus infection. We hypothesized that the infarction of the putamen resulted in hyperactivity in the thalamus, and, thus, performed a radiofrequency Vo thalamotomy. Markedly decreased muscle tone in her right hand was noted immediately after surgery. However, the improvement was temporary, as her symptoms returned to baseline level by the 6-month follow-up. Although the observed improvement was temporary in this case, our findings may elucidate the possible mechanisms of secondary focal dystonia. Further studies are needed to establish an effective surgical treatment for secondary focal dystonia.
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Affiliation(s)
- Noriko Hirao
- Department of Neurosurgery, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Kazuya Saita
- Department of Neurosurgery, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Tomohiro Takagi
- Department of Neurosurgery, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Shinsuke Fujioka
- Department of Neurology, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University, Fukuoka, Fukuoka, Japan
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21
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Oda K, Morishita T, Shibata S, Tanaka H, Hirai N, Inoue T. Case report: Favorable outcomes of spinal cord stimulation in complex regional pain syndrome Type II consistent with thermography findings. Surg Neurol Int 2022; 12:598. [PMID: 34992915 PMCID: PMC8720445 DOI: 10.25259/sni_959_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Complex regional pain syndrome (CRPS) is a chronic pain disorder that develops as a consequence of trauma to one or more limbs. Despite the availability of multiple modalities to diagnose CRPS, a gold standard technique for definitive diagnosis is lacking. Moreover, there are limited reports describing the use of spinal cord stimulation (SCS) to treat CRPS Type II, given the low prevalence of this condition. Herein, we present the case of a patient with CRPS Type II with novel thermography findings who underwent SCS for pain management after an Achilles tendon repair surgery. Case Description: A 38-year-old woman was referred to our institute because of chronic left leg pain after Achilles tendon rupture repair surgery. Her case was diagnosed as CRPS Type II based on the International Association for the Study of Pain diagnostic criteria. After an epidural block, thermography showed a significant increase in the body surface temperature of the foot on the observed side. She was subsequently treated with SCS, following which her pain ameliorated. She reported no pain flare-ups or new neurological deficits over 2 years of postoperative follow-up assessments. Conclusion: SCS could be a useful surgical treatment for medication refractory CRPS Type II as supported by our thermography findings. We may refine surgical indication for permanent implantation of SCS with the presented method.
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Affiliation(s)
- Kazunori Oda
- Department of Neurosurgery, Fukuoka University, Fukuoka, Japan
| | | | - Shiho Shibata
- Department of Anesthesiology, Fukuoka University, Fukuoka, Japan
| | - Hideaki Tanaka
- Department of Neurosurgery, Fukuoka University, Fukuoka, Japan
| | - Norimasa Hirai
- Department of Anesthesiology, Fukuoka University, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University, Fukuoka, Japan
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22
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Kozaki T, Horio Y, Fukuda K, Yoshinaga S, Morishita T, Iwaasa M, Abe H, Inoue T. Endovascular treatment for a ruptured aneurysm in the posterior inferior cerebellar artery feeding a torcular dural arteriovenous fistula: Case report. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2021.101329] [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: 11/28/2022] Open
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23
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Miyagawa K, Enomoto T, Morishita T, Aoki M, Nonaka M, Abe H, Nabeshima K, Inoue T. Functional Prognosis following Temporal Bone Chondroblastoma Resection: A Systematic Review and A Case Illustration. World Neurosurg 2021; 158:e287-e297. [PMID: 34737097 DOI: 10.1016/j.wneu.2021.10.174] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Ken Miyagawa
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Toshiyuki Enomoto
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
| | - Takashi Morishita
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Mikiko Aoki
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Masani Nonaka
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Kobayashi H, Morishita T, Yoshinaga S, Enomoto T, Fukumoto H, Abe H, Inoue T. Enlargement of preexisting superficial temporal artery pseudo-aneurysm co-incidental to mask wearing during the Covid-19 pandemic. Interdiscip Neurosurg 2021; 27:101396. [PMID: 34660208 PMCID: PMC8513390 DOI: 10.1016/j.inat.2021.101396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/04/2021] [Accepted: 10/09/2021] [Indexed: 11/27/2022]
Abstract
The superficial temporal artery (STA) pseudo-aneurysm is usually associated with trauma. We report a unique case of an STA pseudo-aneurysm that developed due to mask wearing during the Covid-19 pandemic. A 70-year-old female presented with a 3-month history of a rapidly growing pseudo-aneurysm of the right STA. Over the past 3 months the patient had been wearing a mask for the prevention of Covid-19. The STA aneurysm was located exactly at a pressure point created by the rubber mask. Therefore, we assumed that an enlargement of the preexisting aneurysm had taken pace due to irritation from the elastic band of the mask. Surgical excision of the aneurysm and reconstruction of the STA using STA-STA bypass were performed. To our knowledge, we here report the first case of an STA pseudo-aneurysm that was potentially affected indirectly by the Covid-19 pandemic. Clinicians should be cautious about the preexisting medical condition that is potentially worsened by mask band compression.
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Affiliation(s)
- Hiromasa Kobayashi
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shintarou Yoshinaga
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Toshiyuki Enomoto
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hironori Fukumoto
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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25
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Morishita T, Sakai Y, Mishima T, Umemoto G, Okun MS, Tanaka SC, Tsuboi Y, Inoue T. Case Report: GPi DBS for Non-parkinsonian Midline Tremor: A Normative Connectomic Comparison to a Failed Thalamic DBS. Front Hum Neurosci 2021; 15:709552. [PMID: 34413730 PMCID: PMC8369152 DOI: 10.3389/fnhum.2021.709552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/25/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: The clinical efficacy of deep brain stimulation (DBS) for midline tremor has been heterogenous. Here, we present an atypical case with facial and palatal tremor treated with DBS. We aimed to show the difference between the fibers affected by stimulation of the two targets [globus pallidus interna (GPi) and ventral intermediate (Vim) thalamic nucleus] using a normative connectome analysis. Case Report: A 76-year-old woman with a 4-year history of severe facial and palatal tremor due to craniofacial dystonia. Following a failed bilateral Vim DBS, explantation of preexisting leads and implantation of bilateral GPi leads resulted in the resolution of tremor symptoms following a failed bilateral Vim DBS. We performed a normative connectome analysis using the volume of tissue activated (VTA) as a region of interest. The results revealed that the fiber tracts associated with VTA of GPi DBS had connections with the facial area of the motor cortex while the Vim DBS did not. Conclusion: This case study suggests the possibility that GPi DBS may be considered for midline tremor, and that the normative connectome analysis may possibly offer clues as to the structures underpinning a positive response. We may refine targets for some of the more difficult to control symptoms such as the midline tremor in this case.
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Affiliation(s)
- Takashi Morishita
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yuki Sakai
- Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International, Kyoto, Japan
| | - Takayasu Mishima
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - George Umemoto
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka, Japan
| | - Michael S Okun
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Saori C Tanaka
- Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International, Kyoto, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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26
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Morishita T, Tanaka H, Inoue T. [Surgical Technique of Ventral Intermediate Thalamic Deep Brain Stimulation]. No Shinkei Geka 2021; 49:810-819. [PMID: 34376613 DOI: 10.11477/mf.1436204459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Deep brain stimulation(DBS)of ventral intermediate(Vim)thalamic nucleus is an established procedure for tremor disorders, however, there are technical variations among specialists. The most common indications of Vim DBS are essential tremor(ET)and tremor dominant Parkinson's disease(PD), and less commonly other tremor disorders including Holmes tremor are treated with the same procedure. The variations of the surgical technique exist in the preoperative imagings and planning of the DBS electrode trajectory. In this review, we explain about the basic concept of Vim DBS and our surgical method.
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27
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Morishita T, Sakai Y, Iida H, Yoshimura S, Ishii A, Fujioka S, Tanaka SC, Inoue T. Neuroanatomical considerations for optimizing thalamic deep brain stimulation in Tourette syndrome. J Neurosurg 2021; 136:231-241. [PMID: 34359039 DOI: 10.3171/2021.2.jns204026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) of the centromedian thalamic nucleus has been reportedly used to treat severe Tourette syndrome, yielding promising outcomes. However, it remains unclear how DBS electrode position and stimulation parameters modulate the specific area and related networks. The authors aimed to evaluate the relationships between the anatomical location of stimulation fields and clinical responses, including therapeutic and side effects. METHODS The authors collected data from 8 patients with Tourette syndrome who were treated with DBS. The authors selected the active contact following threshold tests of acute side effects and gradually increased the stimulation intensity within the therapeutic window such that acute and chronic side effects could be avoided at each programming session. The patients were carefully interviewed, and stimulation-induced side effects were recorded. Clinical outcomes were evaluated using the Yale Global Tic Severity Scale, the Yale-Brown Obsessive-Compulsive Scale, and the Hamilton Depression Rating Scale. The DBS lead location was evaluated in the normalized brain space by using a 3D atlas. The volume of tissue activated was determined, and the associated normative connective analyses were performed to link the stimulation field with the therapeutic and side effects. RESULTS The mean follow-up period was 10.9 ± 3.9 months. All clinical scales showed significant improvement. Whereas the volume of tissue activated associated with therapeutic effects covers the centromedian and ventrolateral nuclei and showed an association with motor networks, those associated with paresthesia and dizziness were associated with stimulation of the ventralis caudalis and red nucleus, respectively. Depressed mood was associated with the spread of stimulation current to the mediodorsal nucleus and showed an association with limbic networks. CONCLUSIONS This study addresses the importance of accurate implantation of DBS electrodes for obtaining standardized clinical outcomes and suggests that meticulous programming with careful monitoring of clinical symptoms may improve outcomes.
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Affiliation(s)
- Takashi Morishita
- 1Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka
| | - Yuki Sakai
- 2ATR Brain Information Communication Research Laboratory Group, Kyoto.,6Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Iida
- 3Department of Psychiatry, Fukuoka University Faculty of Medicine, Fukuoka
| | - Saki Yoshimura
- 1Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka
| | - Atsushi Ishii
- 4Department of Pediatrics, Fukuoka University Faculty of Medicine, Fukuoka
| | - Shinsuke Fujioka
- 5Department of Neurology, Fukuoka University Faculty of Medicine, Fukuoka; and
| | - Saori C Tanaka
- 2ATR Brain Information Communication Research Laboratory Group, Kyoto
| | - Tooru Inoue
- 1Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka
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Oiwa K, Fujita K, Lee S, Morishita T, Tsukasaki H, Negoro E, Hara T, Tsurumi H, Ueda T, Yamauchi T. Prognostic impact of six versus eight cycles of standard regimen in patients with diffuse large B-cell lymphoma: propensity score-matching analysis. ESMO Open 2021; 6:100210. [PMID: 34271313 PMCID: PMC8287142 DOI: 10.1016/j.esmoop.2021.100210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Background R-CHOP-21 has been the standard treatment for diffuse large B-cell lymphoma (DLBCL), but there is a paucity of evidence focusing on the number of cycles of regimens. Patients and methods We conducted a retrospective study to compare the effectiveness of six cycles of standard regimens versus eight cycles for overall survival (OS) in DLBCL patients using propensity score matching, in consideration of relative dose intensity (RDI). Results A total of 685 patients with newly diagnosed DLBCL were identified in three institutions from 2007 to 2017. Patients treated using six cycles of standard regimens were matched by propensity scores with those treated using eight cycles. A 1 : 1 propensity score matching yielded 138 patient pairs. Eight cycles did not significantly improve OS in the conventional Cox proportional hazards model (hazard ratio 0.849, 95% confidence interval 0.453-1.588, P = 0.608). Restricted cubic spline Cox models for OS confirmed that the effect of the number of cycles was not modified by total average RDI, the International Prognostic Index, and age. Occurrence of adverse events did not differ between six and eight cycles. Conclusion Even considering the impact of RDI, six cycles of the initial standard regimen for DLBCL is not inferior to eight cycles. The optimal number of cycles of standard regimens including R-CHOP-21 for newly diagnosed DLBCL has not been determined. This study was conducted to verify whether six cycles or eight cycles of standard regimen improved the prognosis of DLBCL. Propensity score matching and a Cox hazards model with restricted cubic spline were used in this study. No survival benefit of eight cycles compared with six cycles was seen, even taking into account RDI. Prognosis was no better with eight cycles of (R-)CHOP-21 or THP-COP-21 than with six cycles, after age and IPI modifications.
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Affiliation(s)
- K Oiwa
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan; Department of Hematology and Oncology, Nagoya City University, Aichi, Japan
| | - K Fujita
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan; Department of Hematology, Matsunami General Hospital, Gifu, Japan
| | - S Lee
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan; Department of Hematology, Matsunami General Hospital, Gifu, Japan.
| | - T Morishita
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Kyoto, Japan
| | - H Tsukasaki
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan; Department of Hematology, Fukui Red Cross Hospital, Fukui, Japan
| | - E Negoro
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan
| | - T Hara
- Department of Hematology, Matsunami General Hospital, Gifu, Japan
| | - H Tsurumi
- Department of Hematology, Matsunami General Hospital, Gifu, Japan
| | - T Ueda
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan
| | - T Yamauchi
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan
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29
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Horio Y, Ogata T, Abe H, Fukuda K, Morishita T, Higashi T, Inoue T. Factors Predictive of Enlargement of Dissecting Aneurysms in the Vertebral Artery. World Neurosurg 2021; 151:e935-e942. [PMID: 34020061 DOI: 10.1016/j.wneu.2021.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To elucidate the incidence rate of enlargement of vertebral artery dissecting aneurysms (VADAs) during the acute phase and factors associated with enlargement. METHODS Of 115 patients with unilateral intracranial vertebral artery dissection who did not experience subarachnoid hemorrhage, 64 with the pearl sign of vertebral artery dissection (VADA without stenosis) participated in the study. We performed initial magnetic resonance imaging to diagnose VADA and subsequent magnetic resonance imaging to evaluate VADA enlargement. The presence of a hyperintense intramural signal was confirmed using T1-weighted three-dimensional turbo spin-echo imaging. Enlargement of VADAs between the initial and subsequent examinations was evaluated via magnetic resonance angiography and defined as the end point. We studied the rate of VADA enlargement using Kaplan-Meier curve analysis. After independent variables were determined, the Cox proportional hazards model was applied in multivariable analysis to identify the factors significantly associated with VADA enlargement. RESULTS Of 64 patients (mean age, 55.7 ± 13.0 years; 44 men and 20 women), 15 exhibited VADA enlargement. Kaplan-Meier curve analysis indicated that 24.8% of VADA enlargements were detected 30 days after initial magnetic resonance imaging. The Cox proportional hazards model revealed that young age (hazard ratio 0.953, P = 0.043) and the presence of hyperintense intramural signal (hazard ratio 2.841, P = 0.033) were significantly associated with VADA enlargement. CONCLUSIONS VADAs enlarged by approximately 25% until day 30 after the initial examination. Younger age and the presence of hyperintense intramural signal were significantly associated with VADA enlargement.
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Affiliation(s)
- Yoshinobu Horio
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Toshiyasu Ogata
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
| | - Hiroshi Abe
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kenji Fukuda
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Toshio Higashi
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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30
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Okuno T, Takada D, Shin JH, Morishita T, Itoshima H, Kunisawa S, Imanaka Y. Impact of the early stage of the coronavirus disease 2019 pandemic on surgical volume in Japan. Br J Surg 2021; 108:e173-e174. [PMID: 33793774 PMCID: PMC7929118 DOI: 10.1093/bjs/znab028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/08/2020] [Accepted: 01/11/2021] [Indexed: 11/14/2022]
Affiliation(s)
- T Okuno
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - D Takada
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - J-H Shin
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - T Morishita
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - H Itoshima
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - S Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Y Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
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31
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Fujioka S, Morishita T, Takano K, Takahashi N, Kurihara K, Nishida A, Mishima T, Suenaga M, Matsunaga Y, Tsuboi Y. A novel diagnostic marker for progressive supranuclear palsy targeting atrophy of the subthalamic nucleus. J Neurol Sci 2021; 423:117366. [PMID: 33714084 DOI: 10.1016/j.jns.2021.117366] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 01/30/2021] [Accepted: 02/18/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Despite great progress in radiological diagnostic tools for neurodegenerative disorders, their diagnostic accuracy has been unsatisfactory. One of the pathological hallmarks of progressive supranuclear palsy (PSP) is atrophy of the subthalamic nucleus, which has not attracted much attention for imaging analysis. METHODS The clinical data of patients with PSP, multiple system atrophy (MSA), Parkinson's disease (PD), and corticobasal syndrome (CBS) who underwent brain magnetic resonance imaging at our department between June 2019 and March 2020 were retrospectively reviewed. The volumes of the subthalamic nucleus and of the whole cerebrum were then analyzed and compared among the disorders. RESULTS Fourteen PSP-Richardson syndrome (RS), 14 MSA, 14 PD, and 8 CBS patients were assessed. The mean volume of the bilateral subthalamic nuclei was smaller in PSP patients (0.148 ± 0.012 cm3) than in MSA (0.183 ± 0.026 cm3; p < 0.001), PD (0.209 ± 0.031 cm3; p < 0.001), and CBS (0.180 ± 0.056 cm3; p < 0.001) patients. The volume of the whole cerebrum was not significantly different among the disorders. Using an STN volume cut-off of 0.01925, the sensitivity and specificity for differential diagnosis between PSP and the other disorders were 0.846 and 0.972, respectively. CONCLUSION Subthalamic nucleus volume may be a useful diagnostic marker for PSP; it may easily differentiate it from other neurodegenerative parkinsonian disorders.
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Affiliation(s)
- Shinsuke Fujioka
- Department of Neurology, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Japan.
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Japan.
| | - Koichi Takano
- Department of Radiology, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Japan.
| | - Nobutaka Takahashi
- Department of Neurology, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Japan
| | - Kanako Kurihara
- Department of Neurology, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Japan.
| | - Akihiro Nishida
- Department of Neurology, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Japan
| | - Takayasu Mishima
- Department of Neurology, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Japan.
| | - Midori Suenaga
- Department of Pharmaceutical Science, Tokushima Bunri University, 180 Nishihama, Yamashiro-cho, Tokushima, Japan.
| | - Yoichi Matsunaga
- Department of Neurosurgery, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Japan.
| | - Yoshi Tsuboi
- Department of Neurology, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Japan.
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Kotani N, Morishita T, Inoue T. Potential role of biofeedback therapy for Parkinson's disease. Neural Regen Res 2021; 16:2021-2022. [PMID: 33642387 PMCID: PMC8343337 DOI: 10.4103/1673-5374.308095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Naoya Kotani
- Department of Neurosurgery, Fukuoka University Faculty of Medicine; Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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33
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Saita K, Morishita T, Arima H, Ogata T, Inoue T. Qualitative and Comparative Cortical Activity Data Analyses from a Functional Near-Infrared Spectroscopy Experiment Applying Block Design. J Vis Exp 2020. [PMID: 33346202 DOI: 10.3791/61836] [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] [Indexed: 10/31/2022] Open
Abstract
Neuroimaging studies play a pivotal role in the evaluation of pre- vs. post-interventional neurological conditions such as in rehabilitation and surgical treatment. Among the many neuroimaging technologies used to measure brain activity, functional near-infrared spectroscopy (fNIRS) enables the evaluation of dynamic cortical activities by measuring the local hemoglobin levels similar to functional magnetic resonance imaging (fMRI). Also, due to lesser physical restriction in fNIRS, multiple variants of sensorimotor tasks can be evaluated. Many laboratories have developed several methods for fNIRS data analysis; however, despite the fact that the general principles are the same, there is no universally standardized method. Here, we present the qualitative and comparative analytic methods of data obtained from a multi-channel fNIRS experiment using a block design. For qualitative analysis, we used a software for NIRS as a mass-univariate approach based on the generalized linear model. The NIRS-SPM analysis shows qualitative results for each session by visualizing the activated area during the task. In addition, the non-invasive three-dimensional digitizer can be used to estimate the fNIRS channel locations relative to the brain. To corroborate the NIRS-SPM findings, the amplitude of the changes in hemoglobin levels induced by the sensorimotor task can be statistically analyzed by comparing the data obtained from two different sessions (before and after intervention) of the same study subject using a multi-channel hierarchical mixed model. Our methods can be used to measure the pre- vs. post-intervention analysis in a variety of neurological disorders such as movement disorders, cerebrovascular diseases, and neuropsychiatric disorders.
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Affiliation(s)
- Kazuya Saita
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University; Department of Rehabilitation Medicine, Fukuoka University Hospital;
| | - Takashi Morishita
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University;
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University
| | | | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University
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34
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Kotani N, Morishita T, Saita K, Kamada S, Maeyama A, Abe H, Yamamoto T, Shiota E, Inoue T. Feasibility of supplemental robot-assisted knee flexion exercise following total knee arthroplasty. J Back Musculoskelet Rehabil 2020; 33:413-421. [PMID: 31561326 DOI: 10.3233/bmr-181482] [Citation(s) in RCA: 6] [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: 02/04/2023]
Abstract
BACKGROUND The Hybrid Assistive Limb (HAL) is a robotic exoskeleton designed to support impaired limbs. OBJECTIVE We aimed to evaluate whether active exercise using a single-joint HAL (HAL-SJ) following total knee arthroplasty can facilitate the recovery of knee flexion. METHODS Twenty-two patients who underwent total knee arthroplasty were randomly allocated to the HAL-SJ group (n= 12) or conventional physical therapy (CPT) group (n= 10). On postoperative day 5, patients performed active knee flexion exercises either with or without HAL-SJ assistance every second day. Outcome measures included active and passive knee flexion range of motion (ROM), muscle strength, and pain intensity, as assessed by the visual analog scale, and were assessed on postoperative days 5 (pre-treatment) and 10 (post-treatment). Active ROM was measured at 6 months postoperatively; further long-term follow-up was performed by telephone interview. RESULTS Both groups showed significant improvement between postoperative days 5 and 10 in all outcome measures. Improvements in active ROM (p< 0.01), passive ROM (p< 0.01), muscle strength (p< 0.01), and pain (p< 0.01) were significantly greater in the HAL-SJ group than in the CPT group. Long-term outcomes were also significantly better in the HAL-SJ group. CONCLUSIONS HAL therapy enables patients to perform painless active movements and facilitates the recovery of knee function.
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Affiliation(s)
- Naoya Kotani
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan.,Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kazuya Saita
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan.,Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Satoshi Kamada
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan.,Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Akira Maeyama
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Etsuji Shiota
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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35
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Sato Y, Uzui H, Aiki Y, Aoyama D, Yamaguchi J, Nodera M, Shiomi Y, Hasegawa K, Ikeda H, Tama N, Fukuoka Y, Morishita T, Ishida K, Miyazaki S, Tada H. Effects of PCSK9 inhibitor on adverse limb outcomes in patients with critical limb ischemia. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2375] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9-I), evolocumab, reduced the risk of cardiovascular event in patients with peripheral artery disease in FOURIER trial. However, the effects of evolocumab on favorable limb outcomes in patients with critical limb ischemia (CLI) is still unclear.
Purpose
The aim of this study was to evaluate the impacts of evolocumab on favorable limb outcomes and lipid profile in patients with CLI.
Methods
This was a single center, prospective observational study. A total of 39 patients with CLI were enrolled between November 2016 to May 2019. The subjects were divided into 2 groups based on evolocumab administration: evolocumab-treated group: E group (mean 69.4±11.7 years, n=14) and evolocumab non-treated group: Non-E group (mean 74.0±8.8 years, n=25). Baseline characteristics were assessed at admission. Lipid profile was evaluated at admission, 1, 3, 6, 12 and 18 months. The primary outcome was defined 18-month amputation-free survival (AFS). The secondary outcomes were defined 18-month overall survival (OS) and wound-free limb salvage. Mean follow-up period was 18±11 months.
Results
The patients in E group had greater reduction in levels of LDL cholesterol and non-HDL cholesterol than those in Non-E group over time. The reduction in MDA-LDL level was maintained at 1, 3, 6, 12 months, respectively. The 18-month AFS rate in the E-group was significantly higher than those in the Non-E group (log-rank p=0.02). The patients receiving evolocumab had a lower hazard regarding AFS (hazard ratio, 0.12; 95% confidence interval, 0.02–0.94; P=0.043) and a higher proportion of wound-free limb salvage at 12 months (E group [92%] vs Non-E group [57%], P=0.034) and 18 months (92% vs 52%, P=0.03). Otherwise, evolocumab administration was not associated with 18-month OS (log-rank p=0.053).
Conclusions
Evolocumab administration may be associated with the favorable outcome of 18-month AFS in the patients with CLI. Additionally, long-term administration of evolocumab over 12 months may improve wound-free limb salvage.
Effects of evolocumab on limb outcomes
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Sato
- University of Fukui, Fukui, Japan
| | - H Uzui
- University of Fukui, Fukui, Japan
| | - Y Aiki
- University of Fukui, Fukui, Japan
| | - D Aoyama
- University of Fukui, Fukui, Japan
| | | | - M Nodera
- University of Fukui, Fukui, Japan
| | - Y Shiomi
- University of Fukui, Fukui, Japan
| | | | - H Ikeda
- University of Fukui, Fukui, Japan
| | - N Tama
- University of Fukui, Fukui, Japan
| | | | | | - K Ishida
- University of Fukui, Fukui, Japan
| | | | - H Tada
- University of Fukui, Fukui, Japan
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36
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Enatsu R, Kitagawa M, Morishita T, Sasagawa A, Kuribara T, Hirano T, Arihara M, Mikami T, Mikuni N. Effect of Cycling Thalamosubthalamic Stimulation on Tremor Habituation and Rebound in Parkinson Disease. World Neurosurg 2020; 144:64-67. [PMID: 32841798 DOI: 10.1016/j.wneu.2020.08.141] [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: 06/29/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Deep brain stimulation is an effective treatment for severe tremor in essential tremor and Parkinson disease (PD). However, progressive loss of the beneficial effects of deep brain stimulation may occur due to several factors. CASE DESCRIPTION We assessed the effects of different temporal patterns of cycling stimulation in the posterior subthalamic area, subthalamic nucleus, and the ventral intermediate nucleus of the thalamus in 3 PD patients with early decline of tremor suppression associated with severe tremor rebound. CONCLUSIONS Certain temporal patterns of cycling (10 seconds on/1 second off or 30 seconds on/5 seconds off, soft start off) were useful for treating tremor habituation and rebound and showed long-term tremor suppression. Cycling stimulation may prevent tremor habituation in PD patients with severe tremor rebound.
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Affiliation(s)
- Rei Enatsu
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Mayumi Kitagawa
- Department of Neurology, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Sapporo, Japan
| | - Ayaka Sasagawa
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomoyoshi Kuribara
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tsukasa Hirano
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masayasu Arihara
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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37
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Miki K, Nonaka M, Kobayashi H, Horio Y, Abe H, Morishita T, Iwaasa M, Inoue T. Optimal surgical indications of endoscopic surgery for traumatic acute subdural hematoma in elderly patients based on a single-institution experience. Neurosurg Rev 2020; 44:1635-1643. [PMID: 32700161 DOI: 10.1007/s10143-020-01351-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/26/2020] [Revised: 06/19/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023]
Abstract
Recently, treatment of acute subdural hematoma (ASDH) by minimally invasive surgery with endoscopy has been successfully demonstrated. However, few case series are available on this procedure for ASDH, and the surgical indication has not been established. We retrospectively analyzed the data of patients (n = 26) aged 65 years or older who underwent endoscopic surgery (ES) for ASDH at our institution between January 2011 and March 2019. We then evaluated the surgical outcomes and procedure-related complications in patients who underwent ES. The mean hematoma reduction rate was over 90%. Percentage of favorable outcomes at discharge was 69.2% in ES-treated patients. The presence of a skull fracture, subarachnoid hemorrhage, midline shift/subdural hematoma thickness ratio > 1.0, and early surgery were associated with postoperative IPHs in patients who underwent ES or conventional surgery for ASDH. The present study revealed that ES for elderly patients with ASDH is likely to be an efficient and safe procedure when patients are selected appropriately. However, ES is not recommended in patients with significant IPHs on initial CT scan. Additionally, ES should be carefully considered in cases with the factors, where IPHs may progress following surgery.
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Affiliation(s)
- Koichi Miki
- Department of Neurosurgery, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Masani Nonaka
- Department of Neurosurgery, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Hiromasa Kobayashi
- Department of Neurosurgery, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yoshinobu Horio
- Department of Neurosurgery, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Mitsutoshi Iwaasa
- Department of Emergency and Critical Care, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
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38
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Hyakutake K, Morishita T, Saita K, Ogata T, Uehara Y, Shiota E, Inoue T. Feasibility of single and combined with other treatments using transcranial direct current stimulation for chronic stroke: A pilot study. SAGE Open Med 2020; 8:2050312120940546. [PMID: 32685151 PMCID: PMC7346695 DOI: 10.1177/2050312120940546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/17/2020] [Indexed: 11/15/2022] Open
Abstract
Objectives This pilot study aimed to investigate the safety and efficacy of transcranial direct current stimulation (tDCS) for chronic stroke in adult and pediatric patients. We also aimed to verify the efficacy of botulinum toxin A and peripheral neuromuscular electrical stimulation combined therapy involving bilateral tDCS in adult patients with chronic stroke. Methods We conducted a pilot study applying an unblinded, non-randomized design. Eleven patients were recruited, and classified into three groups. Group I-a involved bilateral transcranial direct current stimulation and intensive occupational therapy for chronic stroke in adult patients. Group I-b involved bilateral tDCS and intensive occupational therapy for chronic stroke in pediatric patients. Group II involved bilateral tDCS, peripheral neuromuscular electrical stimulation, and intensive occupational therapy after botulinum toxin A injection for chronic stroke in adult patients. Clinical evaluations to assess motor function and spasticity were performed at baseline as well as in 2-week and 4-month follow-up visits. The questionnaire included questions regarding the presence of tDCS side effects, such as headache, redness, pain, itching, and fever. Results There were clinically meaningful changes in total Fugl-Meyer Assessment Upper Extremity (FMA-UE) scores at the 2-week follow-up and in the Action Research Arm Test (ARAT) scores at 4-month follow-up in Group I-b. In addition, Group II showed significant improvement in total FMA-UE scores in the 2-week follow-up (p < 0.05) but not on the ARAT scores (p > 0.05). However, Group II showed improvements in total Motor Activity Log scores at both follow-up visits (p < 0.05). No serious adverse events were reported. Conclusion The results of this study indicate that tDCS therapy is a potential treatment in pediatric patients with chronic stroke. Furthermore, our data indicate that botulinum toxin A and peripheral neuromuscular electrical stimulation combined therapy may enhance the efficacy of tDCS on motor function.
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Affiliation(s)
- Koichi Hyakutake
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.,Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kazuya Saita
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.,Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Toshiyasu Ogata
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yoshinari Uehara
- Center for Preventive, Anti-aging Regenerative Medicine, Fukuoka University Hospital, Fukuoka, Japan.,Graduate School of Sports and Health Sciences, Fukuoka University, Fukuoka, Japan
| | - Etsuji Shiota
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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39
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Zhang C, Ramirez-Zamora A, Meng F, Lin Z, Lai Y, Li D, Chang J, Morishita T, Inoue T, Fujioka S, Oyama G, Coyne T, Voon V, Doshi PK, Wu Y, Liu J, Patel B, Almeida L, Wagle Shukla AA, Hu W, Foote K, Zhang J, Sun B, Okun MS. An International Survey of Deep Brain Stimulation Utilization in Asia and Oceania: The DBS Think Tank East. Front Hum Neurosci 2020; 14:162. [PMID: 32733215 PMCID: PMC7357800 DOI: 10.3389/fnhum.2020.00162] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/14/2020] [Indexed: 01/19/2023] Open
Abstract
Introduction: To evaluate the current utilization and challenges in fully implementing the use of deep brain stimulation (DBS) treatment in Asia and Oceania. Methods: We conducted a medical literature search to identify DBS research performed by investigators with a primary affiliation in Asian and Oceania countries between March 1, 2013, and March 1, 2019, followed by an international survey-based study. Additionally, we obtained added information regarding the DBS challenges and opportunities from the technology/industry perspective within China and Japan. We also described the current situation of DBS in India. Results: Most publications (390/494; 78.95%) in the English language originated from East Asia. In West Asia, Turkey, Israel, and Iran accounted for most DBS publications. We found no publications from the remaining 35 Asian countries. Lack of community referrals to tertiary centers was identified as the most common limitation for the widespread use of DBS in Asia (68.97%). In China, despite an increasing number of centers performing DBS surgeries, most of them accomplished less than 10 cases per year. In contrast, the number of DBS cases in Japan has been decreasing. Centers offering DBS surgeries as well as corresponding fellowship training in India are limited. Conclusion: Appropriate referrals, access, infrastructure, and the presence of full multidisciplinary DBS teams are common limitations of DBS in Asia. Most centers in China, Japan, and India performed less than 10 cases per year and a future study is expected to address the impact on quality in centers performing such few cases.
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Affiliation(s)
- Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Adolfo Ramirez-Zamora
- Norman Fixel Institute of Neurological Diseases, Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Fangang Meng
- Department of Neurosurgery, Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhengyu Lin
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijie Lai
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinwoo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University, Fukuoka, Japan
| | | | - Genko Oyama
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Terry Coyne
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
| | - Valerie Voon
- Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Paresh K Doshi
- Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, India
| | - Yiwen Wu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bhavana Patel
- Norman Fixel Institute of Neurological Diseases, Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Leonardo Almeida
- Norman Fixel Institute of Neurological Diseases, Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Aparna A Wagle Shukla
- Norman Fixel Institute of Neurological Diseases, Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Wei Hu
- Norman Fixel Institute of Neurological Diseases, Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Kelly Foote
- Norman Fixel Institute of Neurological Diseases, Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Jianguo Zhang
- Department of Neurosurgery, Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bomin Sun
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Michael S Okun
- Norman Fixel Institute of Neurological Diseases, Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States
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40
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Saita K, Morishita T, Hyakutake K, Ogata T, Fukuda H, Kamada S, Inoue T. Feasibility of Robot-assisted Rehabilitation in Poststroke Recovery of Upper Limb Function Depending on the Severity. Neurol Med Chir (Tokyo) 2020; 60:217-222. [PMID: 32173715 PMCID: PMC7174245 DOI: 10.2176/nmc.oa.2019-0268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The single-joint Hybrid Assistive Limb (HAL-SJ) robot is an exoskeleton-type suit developed for the neurorehabilitation of upper limb function. Several studies have addressed the usefulness of the robot; however, the appropriate patient selection remains unclear. In this study, we evaluated the effectiveness of the HAL-SJ exoskeleton in improving upper limb function in the subacute phase after a stroke, as a function of the severity of arm paralysis. Our analysis was based on a retrospective review of 35 patients, treated using the HAL-SJ exoskeleton in the subacute phase after their stroke, between October 2014 and December 2018. The severity of upper limb impairment was quantified using the Brunnstrom recovery stage (BRS) as follows: severe, BRS score 1–2, n = 10; moderate, BRS 3–4, n = 12; and mild, BRS 5–6, n = 13. The primary endpoint was the improvement in upper limb function, from baseline to post-intervention, measured using the Fugl-Meyer assessment upper limb motor score (ΔFMA-UE; range 0–66). The ΔFMA-UE score was significant for all three severity groups (P <0.05). The magnitude of improvement was greater in the moderate group than in the mild group (P <0.05). The greatest improvement was attained for patients with a moderate level of upper limb impairment at baseline. Our findings support the feasibility of the HAL-SJ to improve upper limb function in the subacute phase after a stroke with appropriate patient selection. This study is the first report showing the effect of robot-assisted rehabilitation using the HAL-SJ, according to the severity of paralysis in acute stroke patients with upper extremity motor deficits.
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Affiliation(s)
- Kazuya Saita
- Department of Neurosurgery, Fukuoka University Hospital.,Department of Rehabilitation, Fukuoka University Hospital
| | | | - Koichi Hyakutake
- Department of Neurosurgery, Fukuoka University Hospital.,Department of Rehabilitation, Fukuoka University Hospital
| | | | - Hiroyuki Fukuda
- Department of Neurosurgery, Fukuoka University Hospital.,Department of Rehabilitation, Fukuoka University Hospital
| | - Satoshi Kamada
- Department of Rehabilitation, Fukuoka University Hospital
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University Hospital
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41
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Kotani N, Morishita T, Yatsugi A, Fujioka S, Kamada S, Shiota E, Tsuboi Y, Inoue T. Biofeedback Core Exercise Using Hybrid Assistive Limb for Physical Frailty Patients With or Without Parkinson's Disease. Front Neurol 2020; 11:215. [PMID: 32328021 PMCID: PMC7160316 DOI: 10.3389/fneur.2020.00215] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/09/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction: Elderly people often exhibit "frailty," and motor dysfunction occurs. Several studies have reported about the relationship between motor dysfunction and frailty in Parkinson's disease (PD). This study aimed to test whether the core exercise using the hybrid assistive limb lumbar type for care support (HAL-CB02) may improve the motor functions in frailty patients with or without PD and to explore the optimal patient selection from the frailty cohort. Materials and Methods: We recruited 16 frailty patients (PD = 8; non-PD = 8). The participants performed core exercise and squats using HAL-CB02 for five sessions a week. Outcome measures were 10-m walking test, step length, timed up-and-go test, 30-s chair stand test, and visual analog scale. Evaluation was conducted at baseline, post-exercise, and 1- and 3-month follow-ups. Results: Both PD and non-PD patients showed significant improvement in all evaluation items post-exercise. Moreover, no significant difference was found in the improvement value between the two groups. Conclusions: Our results suggest that biofeedback exercise with HAL-CB02 is a safe and promising treatment for frailty patients. Motor dysfunction in PD patients may be partly due to physical frailty, and biofeedback exercise with HAL-CB02 is proposed as a treatment option.
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Affiliation(s)
- Naoya Kotani
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan.,Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Aya Yatsugi
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan.,Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Shinsuke Fujioka
- Department of Neurology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Satoshi Kamada
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Etsuji Shiota
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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42
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Draaisma L, Wessel M, Morishita T, Koch P, Maceira Elvira P, Durand-Ruel M, De Boer A, Park C, Hummel F. P36 The effect of gamma cerebellar transcranial alternating current stimulation on learning a novel motor skill. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.147] [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: 10/24/2022]
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43
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Nonaka M, Morishita T, Yamada K, Fujioka S, Higuchi MA, Tsuboi Y, Abe H, Inoue T. Surgical management of adverse events associated with deep brain stimulation: A single-center experience. SAGE Open Med 2020; 8:2050312120913458. [PMID: 32231782 PMCID: PMC7082866 DOI: 10.1177/2050312120913458] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 02/10/2020] [Indexed: 11/26/2022] Open
Abstract
Objectives: Deep brain stimulation is widely used to treat movement disorders and selected neuropsychiatric disorders. Despite the fact, the surgical methods vary among centers. In this study, we aimed to evaluate our own surgical complications and how we performed surgical troubleshooting. Methods: A retrospective chart review was performed to evaluate the clinical data of patients who underwent deep brain stimulation surgery and deep brain stimulation–related procedures at our center between October 2014 and September 2019. We reviewed surgical complications and how surgical troubleshooting was performed, regardless of where the patient underwent the initial surgery. Results: A total of 92 deep brain stimulation lead implantation and 43 implantable pulse generator replacement procedures were performed. Among the 92 lead implantation procedures, there were two intracranial lead replacement surgeries and one deep brain stimulation lead implantation into the globus pallidus to add to existing deep brain stimulation leads in the bilateral subthalamic nuclei. Wound revision for superficial infection of the implantable pulse generator site was performed in four patients. There was neither intracerebral hemorrhage nor severe hardware infection in our series of procedures. An adaptor (extension cable) replacement was performed due to lead fracture resulting from a head trauma in two cases. Conclusion: We report our experience of surgical management of adverse events associated with deep brain stimulation therapy with clinical vignettes. Deep brain stimulation surgery is a safe and effective procedure when performed by a trained neurosurgeon. It is important for clinicians to be aware that there are troubles that are potentially manageable with optimal surgical treatment.
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Affiliation(s)
- Masani Nonaka
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kazumichi Yamada
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shinsuke Fujioka
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | | | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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44
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Fujihara F, Morishita T, Matsumoto J, Tajiri T, Inoue T. [Microneurosurgical Treatment for Refractory Entrapment Neuropathy of Suprascapular Nerve:A Case Report]. No Shinkei Geka 2019; 47:1275-1279. [PMID: 31874949 DOI: 10.11477/mf.1436204115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Suprascapular nerve entrapment is rarely treated by neurosurgeons in Japan. However, it is often observed in post-stroke patients and in cases of accessory nerve injury as a complication of posterior fossa craniotomy. We report a case of suprascapular nerve entrapment due to superior transverse scapular ligament, which was successfully diagnosed and surgically treated. The patient was a 66-year-old female who used be a janitor. She complained of dysesthesia around the shoulder. The diagnosis was made based on the characteristic neurological findings including pain around the scapula, supraspinatus muscle weakness, and favorable but temporary response to suprascapular nerve block. After undergoing conservative management for one and a half year, she decided to undergo the nerve decompression surgery. The surgical treatment was performed under microscope with neuromonitoring. Following surgery, the painful area was dramatically reduced. We believe that suprascapular nerve disorders can be treated with careful neurological evaluation by neurosurgeons.
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Affiliation(s)
- Fumiaki Fujihara
- Department of Neurosurgery, Fukuoka University Faculty of Medicine
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45
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Affiliation(s)
- Takashi Morishita
- Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan.
| | - Koichi Miki
- Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
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46
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Miki K, Abe H, Morishita T, Hayashi S, Yagi K, Arima H, Inoue T. Double-crescent sign as a predictor of chronic subdural hematoma recurrence following burr-hole surgery. J Neurosurg 2019; 131:1905-1911. [DOI: 10.3171/2018.8.jns18805] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/09/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVESubdural hygroma has been reported as a causative factor in the development of a chronic subdural hematoma (CSDH) following a head trauma and/or neurosurgical procedure. In some CSDH cases, the presence of a 2-layered space delineated by the same or similar density of CSF surrounded by a superficial, residual hematoma is seen on CT imaging after evacuation of the hematoma. The aims of the present study were to test the hypothesis that the double-crescent sign (DCS), a unique imaging finding described here, is associated with the postoperative recurrence of CSDH, and to investigate other factors that are related to CSDH recurrence.METHODSThe authors retrospectively analyzed data from 278 consecutive patients who underwent single burr-hole surgery for CSDH between April 2012 and March 2017. The DCS was defined as a postoperative CT finding, characterized by the following 2 layers: a superficial layer demonstrating residual hematoma after evacuation of the CSDH, and a deep layer between the brain’s surface and the residual hematoma, depicted as a low-density space. Correlation of the recurrence of CSDH with the DCS was evaluated by multivariate logistic regression modeling. The authors also investigated other classic predictive factors including age, sex, past history of head injury, hematoma laterality, anticoagulant and antiplatelet therapy administration, preoperative hematoma volume, postoperative residual hematoma volume, and postoperative brain reexpansion rate.RESULTSA total of 277 patients (320 hemispheres) were reviewed. Fifty (18.1%) of the 277 patients experienced recurrence of CSDH within 3 months of surgery. CSDH recurred within 3 months of surgery in 32 of the 104 hemispheres with a positive DCS. Multivariate logistic analyses revealed that the presence of the DCS (OR 3.36, 95% CI 1.72–6.57, p < 0.001), large postoperative residual hematoma volume (OR 2.88, 95% CI 1.24–6.71, p = 0.014), anticoagulant therapy (OR 3.03, 95% CI 1.02–9.01, p = 0.046), and bilateral hematoma (OR 3.57, 95% CI 1.79–7.13, p < 0.001) were significant, independent predictors of CSDH recurrence.CONCLUSIONSIn this study, the authors report that detection of the DCS within 7 days of surgery is an independent predictive factor for CSDH recurrence. They therefore advocate that clinicians should carefully monitor patients for postoperative DCS and subsequent CSDH recurrence.
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Affiliation(s)
- Koichi Miki
- 1Department of Neurosurgery, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka
| | - Hiroshi Abe
- 1Department of Neurosurgery, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka
| | - Takashi Morishita
- 1Department of Neurosurgery, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka
| | - Shuji Hayashi
- 2Department of Neurosurgery, Hakujyuji Hospital, Fukuoka; and
| | - Kenji Yagi
- 1Department of Neurosurgery, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka
| | - Hisatomi Arima
- 3Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tooru Inoue
- 1Department of Neurosurgery, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka
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Wakuta N, Abe H, Fukuda K, Nonaka M, Morishita T, Arima H, Inoue T. Feasibility and Safety of Endoscopic Procedure in Burr-Hole Surgery for Chronic Subdural Hematoma in Patients of Very Advanced Age. World Neurosurg 2019; 134:e1037-e1046. [PMID: 31759155 DOI: 10.1016/j.wneu.2019.11.080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 10/06/2019] [Accepted: 11/13/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The usefulness of endoscopic procedures for chronic subdural hematoma (CSDH) has been described, but the indications in patients of very advanced age have not been analyzed. The aim of this study was to evaluate the feasibility, safety, and usefulness of introduction of an endoscopic procedure for such patients. METHODS We retrospectively analyzed the data of 540 CSDHs treated by burr-hole surgery with endoscopic examination. The safety of the endoscopic procedure was assessed according to postoperative complications, morbidity, and mortality. The outcome was evaluated by statistical comparison among 4 different age-groups, and the recurrence rate and risk factors for recurrence was investigated in patients of very advanced age. RESULTS Postoperative complications occurred in 7 cases (1.5%). The 6-month morbidity and mortality were 13.5% and 4.5%. No complications, morbidity, or mortality associated with the additional endoscopic procedure occurred even in patients of very advanced age. The endoscopic features of trabecular structures and residual septa separating the cavity were also risk factors for recurrence in patients of very advanced age. Releasing of the septa showed the possibility of decreasing the risk of recurrence to 6.6% in patients aged ≥85 years as well as in younger patients. There were some inevitable problems such as prolongation of the surgical time and inadequate endoscopic surgical skill. CONCLUSIONS An endoscopic procedure for CSDH can be safely indicated and useful even in patients aged ≥85 years. However, clinicians should carefully select the patients based on clinical information associated with risk factors for recurrence.
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Affiliation(s)
- Naoki Wakuta
- Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Japan.
| | - Hiroshi Abe
- Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kenji Fukuda
- Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Masani Nonaka
- Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Japan
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Aoyama D, Morishita T, Yamaguchi J, Shiomi Y, Ikeda H, Tama N, Fukuoka Y, Hasegawa K, Kaseno K, Ishida K, Miyazaki S, Uzui H, Tada H. P6339Sequential organ failure assessment score on admission predicts long-time mortality of the patients with acute heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0936] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Despite the remarkable advances in the treatment options of acute heart failure (HF), prognosis assessment remains an ongoing challenge. Previous studies revealed only a moderate accuracy of models predicting mortality. Sequential Organ Failure Assessment (SOFA) Score are widely used in the intensive care unit (ICU) to predict outcome and predicted higher long-time mortality in unselected patients in cardiac ICU. In addition, the American Heart Association Get With the Guidelines–Heart Failure (GWTG-HF) risk score allows for risk stratification of 30-day outcome for patients hospitalized with HF. The purpose of this study was to evaluate whether SOFA score on admission is useful for long-time mortality prediction in acute HF patients and also to assess the discriminative performance as compared with GWTG-HF risk score.
Methods
This was a single-centre, retrospective cohort study. Between January 2007 and December 2016, we screened eligible 661 consecutive patients with acute HF administered at our hospital. SOFA score on admission of 294 patients was able to calculate retrospectively. We enrolled 269 patients who could complete follow up evaluation for more than 1 year. Endpoint was all-cause mortality after admission. Additive information of SOFA score was evaluated by area under the curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI) and decision curve analysis (DCA).
Results
The 269 patients were included in this study (78.5±10.9 years; 136 men; left ventricular ejection fraction [EF], 49.8±16.6%) during a mean follow-up of 32.1±22.3 months. Patients with all-cause death had higher SOFA score (4.2±2.3 versus 2.8±1.8, p<0.001; AUC, 0.689) and GWTG-HF risk score (44.0±7.6 versus 38.1±7.9, P<0.001, AUC, 0.692).
Kaplan-Meier survival analysis demonstrated higher SOFA scores (P<0.001) and GWTG-HF risk scores (P<0.001) appears to be related to increase probabilities of all cause death. A multivariate Cox proportional hazard model were made with adjustment for SOFA score, GWTG-HF risk score, age, gender and ejection fraction. As a result, SOFA score (hazard ratio [HR] 1.227; 95% confidence interval [CI], 1.130 to 1.326; P<0.001), GWTG-HF (HR, 1.054; 95% CI, 1.029 to 1.078; P<0.001) and age (HR, 1.069; 95% CI 1.048 to 1.092; P<0.001) were independent predictors of all cause death and HR of SOFA score was the highest in these parameters. Incorporating SOFA score into GWTG-HF score yielded a significant NRI (0.528 (95% CI 0.291 to 0.765) and IDI (0.046 (95% CI 0.020 to 0.072). In DCA, compared with the reference model, the net benefit for SOFA score model was greater across the range of threshold probabilities.
Conclusions
The SOFA score, simple and validated mortality risk score can predict long-term all-cause mortality in patients with acute HF. Discriminative performance metrics such as NRI, IDI and DCA were improved on incorporation of the SOFA score for prediction of mortality.
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Affiliation(s)
- D Aoyama
- University of Fukui Hospital, Fukui, Japan
| | | | | | - Y Shiomi
- University of Fukui Hospital, Fukui, Japan
| | - H Ikeda
- University of Fukui Hospital, Fukui, Japan
| | - N Tama
- University of Fukui Hospital, Fukui, Japan
| | - Y Fukuoka
- University of Fukui Hospital, Fukui, Japan
| | - K Hasegawa
- University of Fukui Hospital, Fukui, Japan
| | - K Kaseno
- University of Fukui Hospital, Fukui, Japan
| | - K Ishida
- University of Fukui Hospital, Fukui, Japan
| | - S Miyazaki
- University of Fukui Hospital, Fukui, Japan
| | - H Uzui
- University of Fukui Hospital, Fukui, Japan
| | - H Tada
- University of Fukui Hospital, Fukui, Japan
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Miki K, Abe H, Nonaka M, Morishita T, Iwaasa M, Arima H, Inoue T. Impact of Spot Sign Etiology in Supratentorial Intracerebral Hemorrhage on Outcomes of Endoscopic Surgery. World Neurosurg 2019; 133:e281-e287. [PMID: 31518739 DOI: 10.1016/j.wneu.2019.08.244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/07/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The spot sign (SS) in spontaneous intracerebral hemorrhage has been reported to be a predictive factor of poor outcome; however, how SS is related with the clinical outcome remains unclear. We aimed to investigate how etiology associated with SS affects the clinical outcome of endoscopic surgery. METHODS We retrospectively analyzed data from 104 patients (43 women and 61 men, mean age: 64.2 ± 11.0 years) who underwent endoscopic surgery for supratentorial intracerebral hemorrhage. The outcome variables analyzed were in-hospital mortality and modified Rankin scale score at 90 days from onset. RESULTS The prevalence of intraventricular hemorrhage and the mean initial modified Graeb score were greater in SS-positive than in SS-negative patients (100% vs. 47.7%, P < 0.001, and 14.4 ± 5.4 vs. 10.6 ± 6.0, P = 0.03, respectively). Postoperative rebleeding occurred more frequently in SS-positive than -negative patients (25.0% vs. 6.8%, P = 0.045). The in-hospital mortality rate was 7.7% and was not significantly different between the groups (18.8% vs. 5.7%, P = 0.09). There was a significant unfavorable shift in modified Rankin scale scores at 90 days among SS-positive patients compared with SS-negative patients in an analysis with ordinal logistic regression (adjusted common odds ratio, 4.38; 95% confidence interval 0.06-0.79, P = 0.02). CONCLUSIONS Intraventricular hemorrhage and postoperative rebleeding were considered to be associated with the poor outcome in patients with SS. The SS on computed tomography angiography may be valuable in predicting rebleeding and clinical outcome after surgery.
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Affiliation(s)
- Koichi Miki
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Japan.
| | - Masani Nonaka
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Mitsutoshi Iwaasa
- Department of Emergency and Critical Care, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Japan
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Saitoh T, Enatsu R, Kitagawa M, Morishita T, Suzuki Y, Mikami T, Mikuni N. Choreo-ballistic movement after thalamotomy in a patient with Lewy body dementia. J Clin Neurosci 2019; 66:264-266. [DOI: 10.1016/j.jocn.2019.05.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/28/2019] [Indexed: 11/25/2022]
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