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Olaru M, Cernera S, Hahn A, Wozny TA, Anso J, de Hemptinne C, Little S, Neumann WJ, Abbasi-Asl R, Starr PA. Motor network gamma oscillations in chronic home recordings predict dyskinesia in Parkinson's disease. Brain 2024:awae004. [PMID: 38195196 DOI: 10.1093/brain/awae004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/17/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024] Open
Abstract
In Parkinson's disease, imbalances between "antikinetic" and "prokinetic" patterns of neuronal oscillatory activity are related to motor dysfunction. Invasive brain recordings from the motor network have suggested that medical or surgical therapy can promote a prokinetic state by inducing narrowband gamma rhythms (65-90 Hz). Excessive narrowband gamma in the motor cortex promotes dyskinesia in rodent models, but the relationship between narrowband gamma and dyskinesia in humans has not been well established. To assess this relationship, we used a sensing-enabled deep brain stimulator system, attached to both motor cortex and basal ganglia (subthalamic or pallidal) leads, paired with wearable devices that continuously tracked motor signs in the contralateral upper limbs. We recorded 984 hours of multisite field potentials in 30 hemispheres of 16 subjects with Parkinson's disease (2/16 female, mean age 57 ± 12 years) while at home on usual antiparkinsonian medications. Recordings were done two to four weeks after implantation, prior to starting therapeutic stimulation. Narrowband gamma was detected in the precentral gyrus, subthalamic nucleus, or both structures on at least one side of 92% of subjects with a clinical history of dyskinesia. Narrowband gamma was not detected in the globus pallidus. Narrowband gamma spectral power in both structures co-fluctuated similarly with contralateral wearable dyskinesia scores (mean correlation coefficient of ρ=0.48 with a range of 0.12-0.82 for cortex, ρ=0.53 with a range of 0.5-0.77 for subthalamic nucleus). Stratification analysis showed the correlations were not driven by outlier values, and narrowband gamma could distinguish "on" periods with dyskinesia from "on" periods without dyskinesia. Time lag comparisons confirmed that gamma oscillations herald dyskinesia onset without a time lag in either structure when using 2-minute epochs. A linear model incorporating the three oscillatory bands (beta, theta/alpha, and narrowband gamma) increased the predictive power of dyskinesia for several subject hemispheres. We further identified spectrally distinct oscillations in the low gamma range (40-60 Hz) in three subjects, but the relationship of low gamma oscillations to dyskinesia was variable. Our findings support the hypothesis that excessive oscillatory activity at 65-90 Hz in the motor network tracks with dyskinesia similarly across both structures, without a detectable time lag. This rhythm may serve as a promising control signal for closed-loop deep brain stimulation using either cortical or subthalamic detection.
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Affiliation(s)
- Maria Olaru
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, CA 94158, USA
| | - Stephanie Cernera
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, CA 94158, USA
| | - Amelia Hahn
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, CA 94158, USA
| | - Thomas A Wozny
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, CA 94158, USA
| | - Juan Anso
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, CA 94158, USA
| | - Coralie de Hemptinne
- Department of Neurology, University of Florida Gainesville, Gainesville, FL 32611, USA
| | - Simon Little
- Weill Institute for Neurosciences, University of California San Francisco, CA 94158, USA
| | - 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 10117, Germany
| | - Reza Abbasi-Asl
- Weill Institute for Neurosciences, University of California San Francisco, CA 94158, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Philip A Starr
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, CA 94158, USA
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Kwong J, Lin J, Leriche R, Wozny TA, Shaughnessy A, Schmitgen A, Shirvalkar P. Quantifying Pain Location and Intensity with Multimodal Pain Body Diagrams. J Vis Exp 2023. [PMID: 37486137 DOI: 10.3791/65334] [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: 07/25/2023] Open
Abstract
To quantify an individual's subjective pain severity, standardized pain rating scales such as the numeric rating scale (NRS), visual analog scale (VAS), or McGill pain questionnaire (MPQ) are commonly used to assess pain on a numerical scale. However, these scales are often biased and fail to capture the complexity of pain experiences. In contrast, clinical practice often requires patients to report areas of pain by drawing on a body diagram, which is an effective but qualitative tool. The method presented here extracts quantifiable metrics from pain body diagrams (PBDs) which are validated against the NRS, VAS, and MPQ pain scales. By using a novel pressure-hue transformation on a digital tablet, different drawing pressures applied with a digital stylus can be represented as different hues on a PBD. This produces a visually intuitive diagram of hues ranging from green to blue to red, representing mild to moderate to most painful regions, respectively. To quantify each PBD, novel pain metrics were defined: (1) PBD mean intensity, which equals the sum of each pixel's hue value divided by the number of colored pixels, (2) PBD coverage, which equals the number of colored pixels divided by the total number of pixels on the body, and (3) PBD sum intensity, which equals the sum of all pixels' hue values. Using correlation and information theory analyses, these PBD metrics were shown to have high concordance with standardized pain metrics, including NRS, VAS and MPQ. In conclusion, PBDs can provide novel spatial and quantitative information that can be repeatedly measured and tracked over time to comprehensively characterize a participant's pain experience.
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Affiliation(s)
- Jereen Kwong
- Anesthesiology (Division of Pain Management), University of California, San Francisco
| | - Joanna Lin
- Neurological Surgery and UCSF Weill Institute of Neurosciences, University of California, San Francisco
| | - Ryan Leriche
- Neurological Surgery and UCSF Weill Institute of Neurosciences, University of California, San Francisco
| | - Thomas A Wozny
- Neurological Surgery and UCSF Weill Institute of Neurosciences, University of California, San Francisco
| | - Ana Shaughnessy
- Neurological Surgery and UCSF Weill Institute of Neurosciences, University of California, San Francisco
| | - Ashlyn Schmitgen
- Neurological Surgery and UCSF Weill Institute of Neurosciences, University of California, San Francisco
| | - Prasad Shirvalkar
- Anesthesiology (Division of Pain Management) and Neurological Surgery and UCSF Weill Institute of Neurosciences, University of California, San Francisco;
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Andrews JP, Wozny TA, Yue JK, Wang DD. Improved psychotic symptoms following resection of amygdalar low-grade glioma: illustrative case. J Neurosurg Case Lessons 2022; 4:CASE22362. [PMID: 36443957 PMCID: PMC9705519 DOI: 10.3171/case22362] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epilepsy-associated psychoses are poorly understood, and management is focused on treating epilepsy. Chronic, interictal psychosis that persists despite seizure control is typically treated with antipsychotics. Whether resection of a mesial temporal lobe lesion may improve interictal psychotic symptoms that persist despite seizure control remains unknown. OBSERVATIONS In a 52-year-old man with well-controlled epilepsy and persistent comorbid psychosis, brain magnetic resonance imaging (MRI) revealed an infiltrative, intraaxial, T2 fluid-attenuated inversion recovery intense mass of the left amygdala. The patient received an amygdalectomy for oncological diagnosis and surgical treatment of a presumed low-grade glioma. Pathology was ganglioglioma, World Health Organization grade I. Postoperatively, the patient reported immediate resolution of auditory hallucinations. Patient has remained seizure-free on 2 antiepileptic drugs and no antipsychotic pharmacotherapy and reported lasting improvement in his psychotic symptoms. LESSONS This report discusses improvement of psychosis symptoms after resection of an amygdalar glioma, independent of seizure outcome. This case supports a role of the amygdala in psychopathology and suggests that low-grade gliomas of the limbic system may represent, at minimum, partially reversible etiology of psychotic symptoms.
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Affiliation(s)
- John P. Andrews
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and ,Department of Neurosurgery, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Thomas A. Wozny
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and ,Department of Neurosurgery, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - John K. Yue
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and ,Department of Neurosurgery, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Doris D. Wang
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and ,Department of Neurosurgery, San Francisco Veterans Affairs Medical Center, San Francisco, California
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4
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Yue JK, Lee YM, Quintana D, Aabedi AA, Krishnan N, Wozny TA, Andrews JP, Huang MC. Paraparesis caused by intradural thoracic spinal granuloma secondary to organizing hematoma: illustrative case. J Neurosurg Case Lessons 2022; 4:CASE22432. [PMID: 36411545 PMCID: PMC9678799 DOI: 10.3171/case22432] [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] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Spinal granulomas form from infectious or noninfectious inflammatory processes and are rarely present intradurally. Intradural granulomas secondary to hematoma are unreported in the literature and present diagnostic and management challenges. OBSERVATIONS A 70-year-old man receiving aspirin presented with encephalopathy, subacute malaise, and right lower extremity weakness and was diagnosed with polysubstance withdrawal and refractory hypertension requiring extended treatment. Seven days after admission, he reported increased bilateral lower extremity (BLE) weakness. Magnetic resonance imaging showed T2-3 and T7-8 masses abutting the pia, with spinal cord compression at T2-3. He was transferred to the authors' institution, and work-up showed no vascular shunting or malignancy. He underwent T2-3 laminectomies for biopsy/resection. A firm, xanthochromic mass was resected en bloc. Pathology showed organizing hematoma without infection, vascular malformation, or malignancy. Subsequent coagulopathy work-up was unremarkable. His BLE strength significantly improved, and he declined resection of the inferior mass. He completed physical therapy and was cleared for placement in a skilled nursing facility. LESSONS Spinal granulomas can mimic vascular lesions and malignancy. The authors present the first report of paraparesis caused by intradural granuloma secondary to organizing hematoma, preceded by severe refractory hypertension. Tissue diagnosis is critical, and resection is curative. These findings can inform the vigilant clinician for expeditious treatment.
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Affiliation(s)
- John K. Yue
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Young M. Lee
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Daniel Quintana
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Alexander A. Aabedi
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Nishanth Krishnan
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Thomas A. Wozny
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - John P. Andrews
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Michael C. Huang
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
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5
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Lee AT, Han KJ, Nichols N, Sudhakar VR, Burke JF, Wozny TA, Chung JE, Volz MM, Ostrem JL, Martin AJ, Larson PS, Starr PA, Wang DD. Targeting Accuracy and Clinical Outcomes of Awake Vs Asleep Interventional MRI-Guided Deep Brain Stimulation for Parkinson's Disease: The UCSF Experience. Neurosurgery 2022; 91:717-725. [PMID: 36069560 DOI: 10.1227/neu.0000000000002111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Interventional MRI (iMRI)-guided implantation of deep brain stimulator (DBS) leads has been developed to treat patients with Parkinson's disease (PD) without the need for awake testing. OBJECTIVE Direct comparisons of targeting accuracy and clinical outcomes for awake stereotactic with asleep iMRI-DBS for PD are limited. METHODS We performed a retrospective review of patients with PD who underwent awake or iMRI-guided DBS surgery targeting the subthalamic nucleus or globus pallidus interna between 2013 and 2019 at our institution. Outcome measures included Unified Parkinson's Disease Rating Scale Part III scores, levodopa equivalent daily dose, radial error between intended and actual lead locations, stimulation parameters, and complications. RESULTS Of the 218 patients included in the study, the iMRI cohort had smaller radial errors (iMRI: 1.27 ± 0.72 mm, awake: 1.59 ± 0.96 mm, P < .01) and fewer lead passes (iMRI: 1.0 ± 0.16, awake: 1.2 ± 0.41, P < .01). Changes in Unified Parkinson's Disease Rating Scale were similar between modalities, but awake cases had a greater reduction in levodopa equivalent daily dose than iMRI cases (P < .01), which was attributed to the greater number of awake subthalamic nucleus cases on multivariate analysis. Effective clinical contacts used for stimulation, side effect thresholds, and complication rates were similar between modalities. CONCLUSION Although iMRI-DBS may result in more accurate lead placement for intended target compared with awake-DBS, clinical outcomes were similar between surgical approaches. Ultimately, patient preference and surgeon experience with a given DBS technique should be the main factors when determining the "best" method for DBS implantation.
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Affiliation(s)
- Anthony T Lee
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Kasey J Han
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Noah Nichols
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Vivek R Sudhakar
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - John F Burke
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Thomas A Wozny
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Jason E Chung
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Monica M Volz
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Jill L Ostrem
- Department of Neurology, Movement Disorders and Neuromodulation Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Alastair J Martin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Paul S Larson
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Philip A Starr
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Doris D Wang
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
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6
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Agarwal N, Aabedi AA, Torres-Espin A, Chou A, Wozny TA, Mummaneni PV, Burke JF, Ferguson AR, Kyritsis N, Dhall SS, Weinstein PR, Duong-Fernandez X, Pan J, Singh V, Hemmerle DD, Talbott JF, Whetstone WD, Bresnahan JC, Manley GT, Beattie MS, DiGiorgio AM. Decision tree–based machine learning analysis of intraoperative vasopressor use to optimize neurological improvement in acute spinal cord injury. Neurosurg Focus 2022; 52:E9. [DOI: 10.3171/2022.1.focus21743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/20/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Previous work has shown that maintaining mean arterial pressures (MAPs) between 76 and 104 mm Hg intraoperatively is associated with improved neurological function at discharge in patients with acute spinal cord injury (SCI). However, whether temporary fluctuations in MAPs outside of this range can be tolerated without impairment of recovery is unknown. This retrospective study builds on previous work by implementing machine learning to derive clinically actionable thresholds for intraoperative MAP management guided by neurological outcomes.
METHODS
Seventy-four surgically treated patients were retrospectively analyzed as part of a longitudinal study assessing outcomes following SCI. Each patient underwent intraoperative hemodynamic monitoring with recordings at 5-minute intervals for a cumulative 28,594 minutes, resulting in 5718 unique data points for each parameter. The type of vasopressor used, dose, drug-related complications, average intraoperative MAP, and time spent in an extreme MAP range (< 76 mm Hg or > 104 mm Hg) were collected. Outcomes were evaluated by measuring the change in American Spinal Injury Association Impairment Scale (AIS) grade over the course of acute hospitalization. Features most predictive of an improvement in AIS grade were determined statistically by generating random forests with 10,000 iterations. Recursive partitioning was used to establish clinically intuitive thresholds for the top features.
RESULTS
At discharge, a significant improvement in AIS grade was noted by an average of 0.71 levels (p = 0.002). The hemodynamic parameters most important in predicting improvement were the amount of time intraoperative MAPs were in extreme ranges and the average intraoperative MAP. Patients with average intraoperative MAPs between 80 and 96 mm Hg throughout surgery had improved AIS grades at discharge. All patients with average intraoperative MAP > 96.3 mm Hg had no improvement. A threshold of 93 minutes spent in an extreme MAP range was identified after which the chance of neurological improvement significantly declined. Finally, the use of dopamine as compared to norepinephrine was associated with higher rates of significant cardiovascular complications (50% vs 25%, p < 0.001).
CONCLUSIONS
An average intraoperative MAP value between 80 and 96 mm Hg was associated with improved outcome, corroborating previous results and supporting the clinical verifiability of the model. Additionally, an accumulated time of 93 minutes or longer outside of the MAP range of 76–104 mm Hg is associated with worse neurological function at discharge among patients undergoing emergency surgical intervention for acute SCI.
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Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, University of California, San Francisco
| | | | - Abel Torres-Espin
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Austin Chou
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Thomas A. Wozny
- Department of Neurological Surgery, University of California, San Francisco
| | - Praveen V. Mummaneni
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
| | - John F. Burke
- Department of Neurological Surgery, University of California, San Francisco
| | - Adam R. Ferguson
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
- San Francisco Veterans Affairs Healthcare System, San Francisco; and
| | - Nikos Kyritsis
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Sanjay S. Dhall
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Philip R. Weinstein
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
| | - Xuan Duong-Fernandez
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Jonathan Pan
- Department of Neurological Surgery, University of California, San Francisco
- Department of Anesthesia and Perioperative Care, University of California, San Francisco
| | - Vineeta Singh
- Department of Neurological Surgery, University of California, San Francisco
- Department of Neurology, University of California, San Francisco
| | - Debra D. Hemmerle
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Jason F. Talbott
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - William D. Whetstone
- Department of Emergency Medicine, University of California, San Francisco, California
| | - Jacqueline C. Bresnahan
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Michael S. Beattie
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
- San Francisco Veterans Affairs Healthcare System, San Francisco; and
| | - Anthony M. DiGiorgio
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
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7
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Chan AK, Wozny TA, Bisson EF, Pennicooke BH, Bydon M, Glassman SD, Foley KT, Shaffrey CI, Potts EA, Shaffrey ME, Coric D, Knightly JJ, Park P, Wang MY, Fu KMG, Slotkin J, Asher AL, Virk MS, Kerezoudis P, Alvi MA, Guan J, Haid RW, Mummaneni PV. 113 Clinical Presentation Phenotypes of Patients Operated for Lumbar Spondylolisthesis: An Analysis of the Quality Outcomes Database. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_113] [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: 11/19/2022] Open
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8
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Yue JK, Chang D, Caton MT, Haddad AF, Dalle Ore CL, Wozny TA, Oh T, Wang AS, Tonetti DA, Auguste KI, Sun PP, Cooke DL, Hetts SW, Abla AA, Gupta N, Roland JL. The Hybrid Operative Suite with Intraoperative Biplane Rotational Angiography in Pediatric Cerebrovascular Neurosurgery: Utility and Lessons Learned. Pediatr Neurosurg 2022; 57:245-259. [PMID: 35508115 DOI: 10.1159/000524875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The benefits of performing open and endovascular procedures in a hybrid neuroangiography surgical suite include confirmation of treatment results and reduction in number of procedures, leading to improved efficiency of care. Combined procedural suites are infrequently used in pediatric facilities due to technical and logistical limitations. We report the safety, utility, and lessons learned from a single-institution experience using a hybrid suite equipped with biplane rotational digital subtraction angiography and pan-surgical capabilities. METHODS We conducted a retrospective review of consecutive cases performed at our institution that utilized the hybrid neuroangiography surgical suite from February 2020 to August 2021. Demographics, surgical metrics, and imaging results were collected from the electronic medical record. Outcomes, interventions, and nuances for optimizing preoperative/intraoperative setup and postoperative care were presented. RESULTS Eighteen procedures were performed in 17 patients (mean age 13.4 years, range 6-19). Cases included 14 arteriovenous malformations (AVM; 85.7% ruptured), one dural arteriovenous fistula, one mycotic aneurysm, and one hemangioblastoma. The average operative time was 416 min (range 321-745). There were no intraoperative or postoperative complications. All patients were alive at follow-up (range 0.1-14.7 months). Five patients had anticipated postoperative deficits arising from their hemorrhage, and 12 returned to baseline neurological status. Four illustrative cases demonstrating specific, unique applications of the hybrid angiography suite are presented. CONCLUSION The hybrid neuroangiography surgical suite is a safe option for pediatric cerebrovascular pathologies requiring combined surgical and endovascular intervention. Hybrid cases can be completed within the same anesthesia session and reduce the need for return to the operating room for resection or surveillance angiography. High-quality intraoperative angiography enables diagnostic confirmation under a single procedure, mitigating risk of morbidity and accelerating recovery. Effective multidisciplinary planning enables preoperative angiograms to be completed to inform the operative plan immediately prior to definitive resection.
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Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Diana Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael Travis Caton
- Department of Neurointerventional Radiology, University of California, San Francisco, San Francisco, California, USA
| | - Alexander F Haddad
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Cecilia L Dalle Ore
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Thomas A Wozny
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Taemin Oh
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Albert S Wang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Daniel A Tonetti
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Kurtis I Auguste
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Peter P Sun
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Daniel L Cooke
- Department of Neurointerventional Radiology, University of California, San Francisco, San Francisco, California, USA
| | - Steven W Hetts
- Department of Neurointerventional Radiology, University of California, San Francisco, San Francisco, California, USA
| | - Adib A Abla
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Nalin Gupta
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Jarod L Roland
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
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9
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Chan AK, Wozny TA, Bisson EF, Pennicooke BH, Bydon M, Glassman SD, Foley KT, Shaffrey CI, Potts EA, Shaffrey ME, Coric D, Knightly JJ, Park P, Wang MY, Fu KM, Slotkin JR, Asher AL, Virk MS, Kerezoudis P, Alvi MA, Guan J, Haid RW, Mummaneni PV. Classifying Patients Operated for Spondylolisthesis: A K-Means Clustering Analysis of Clinical Presentation Phenotypes. Neurosurgery 2021; 89:1033-1041. [PMID: 34634113 DOI: 10.1093/neuros/nyab355] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/16/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Trials of lumbar spondylolisthesis are difficult to compare because of the heterogeneity in the populations studied. OBJECTIVE To define patterns of clinical presentation. METHODS This is a study of the prospective Quality Outcomes Database spondylolisthesis registry, including patients who underwent single-segment surgery for grade 1 degenerative lumbar spondylolisthesis. Twenty-four-month patient-reported outcomes (PROs) were collected. A k-means clustering analysis-an unsupervised machine learning algorithm-was used to identify clinical presentation phenotypes. RESULTS Overall, 608 patients were identified, of which 507 (83.4%) had 24-mo follow-up. Clustering revealed 2 distinct cohorts. Cluster 1 (high disease burden) was younger, had higher body mass index (BMI) and American Society of Anesthesiologist (ASA) grades, and globally worse baseline PROs. Cluster 2 (intermediate disease burden) was older and had lower BMI and ASA grades, and intermediate baseline PROs. Baseline radiographic parameters were similar (P > .05). Both clusters improved clinically (P < .001 all 24-mo PROs). In multivariable adjusted analyses, mean 24-mo Oswestry Disability Index (ODI), Numeric Rating Scale Back Pain (NRS-BP), Numeric Rating Scale Leg Pain, and EuroQol-5D (EQ-5D) were markedly worse for the high-disease-burden cluster (adjusted-P < .001). However, the high-disease-burden cluster demonstrated greater 24-mo improvements for ODI, NRS-BP, and EQ-5D (adjusted-P < .05) and a higher proportion reaching ODI minimal clinically important difference (MCID) (adjusted-P = .001). High-disease-burden cluster had lower satisfaction (adjusted-P = .02). CONCLUSION We define 2 distinct phenotypes-those with high vs intermediate disease burden-operated for lumbar spondylolisthesis. Those with high disease burden were less satisfied, had a lower quality of life, and more disability, more back pain, and more leg pain than those with intermediate disease burden, but had greater magnitudes of improvement in disability, back pain, quality of life, and more often reached ODI MCID.
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Affiliation(s)
- Andrew K Chan
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Thomas A Wozny
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Erica F Bisson
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Brenton H Pennicooke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kevin T Foley
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, Tennessee, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, Duke University, Durham, North Carolina, USA.,Department of Orthopedic Surgery, Duke University, Durham, North Carolina, USA
| | - Eric A Potts
- Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Mark E Shaffrey
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Domagoj Coric
- Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina, USA
| | - John J Knightly
- Atlantic Neurosurgical Specialists, Morristown, New Jersey, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Kai-Ming Fu
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York, USA
| | | | - Anthony L Asher
- Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina, USA
| | - Michael S Virk
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York, USA
| | | | - Mohammed A Alvi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jian Guan
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Regis W Haid
- Atlanta Brain and Spine Care, Atlanta, Georgia, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
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10
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Krucoff MO, Wozny TA, Lee AT, Rao VR, Chang EF. Operative Technique and Lessons Learned From Surgical Implantation of the NeuroPace Responsive Neurostimulation® System in 57 Consecutive Patients. Neurosurgery 2021. [DOI: 10.1093/neuros/opaa300_s162] [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: 11/12/2022] Open
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11
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Kuzmik GA, Wozny TA, Ammanuel S, Eichler CM, Mummaneni PV, Chou D. Oblique Lumbar Interbody Fusion From L2 to S1: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E438. [PMID: 34409982 DOI: 10.1093/ons/opab283] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/28/2021] [Indexed: 11/14/2022] Open
Abstract
This surgical video demonstrates the technique of an oblique lumbar interbody fusion (OLIF) in the lumbar spine from L2 to L5 as well as an oblique approach to the L5-S1 level. It demonstrates the surgical approach, technical nuances of OLIF, and pearls of the surgery. The video discusses the importance of the release of the disc space to allow for height restoration and deformity correction, endplate preparation to enhance arthrodesis, and appropriate implant sizing. The concept of the approach is the minimally invasive blunt dissection through the abdominal wall musculature and mobilization of the retroperitoneal fat. Unlike the transpsoas approach, the surgery is performed anterior to the psoas, avoiding the lumbar plexus.1 For L5-S1, the approach is still performed in the lateral position but with an oblique approach. A vascular surgeon performs the L5-S1 approach, and the disc space is accessed through the iliac bifurcation.2 The discectomy and interbody fusion are performed similarly to a standard anterior lumbar interbody fusion (ALIF), but in a lateral position and at an oblique angle. The patient consented to this procedure and for filming a video of this case.
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Affiliation(s)
- Gregory A Kuzmik
- Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Thomas A Wozny
- Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Simon Ammanuel
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Charles M Eichler
- Division of Vascular Surgery, Department of Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Dean Chou
- Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA
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12
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Alhourani A, Korzeniewska A, Wozny TA, Lipski WJ, Kondylis ED, Ghuman AS, Crone NE, Crammond DJ, Turner RS, Richardson RM. Subthalamic Nucleus Activity Influences Sensory and Motor Cortex during Force Transduction. Cereb Cortex 2021; 30:2615-2626. [PMID: 31989165 DOI: 10.1093/cercor/bhz264] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 06/04/2019] [Revised: 08/23/2019] [Accepted: 09/17/2019] [Indexed: 12/12/2022] Open
Abstract
The subthalamic nucleus (STN) is proposed to participate in pausing, or alternately, in dynamic scaling of behavioral responses, roles that have conflicting implications for understanding STN function in the context of deep brain stimulation (DBS) therapy. To examine the nature of event-related STN activity and subthalamic-cortical dynamics, we performed primary motor and somatosensory electrocorticography while subjects (n = 10) performed a grip force task during DBS implantation surgery. Phase-locking analyses demonstrated periods of STN-cortical coherence that bracketed force transduction, in both beta and gamma ranges. Event-related causality measures demonstrated that both STN beta and gamma activity predicted motor cortical beta and gamma activity not only during force generation but also prior to movement onset. These findings are consistent with the idea that the STN participates in motor planning, in addition to the modulation of ongoing movement. We also demonstrated bidirectional information flow between the STN and somatosensory cortex in both beta and gamma range frequencies, suggesting robust STN participation in somatosensory integration. In fact, interactions in beta activity between the STN and somatosensory cortex, and not between STN and motor cortex, predicted PD symptom severity. Thus, the STN contributes to multiple aspects of sensorimotor behavior dynamically across time.
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Affiliation(s)
- Ahmad Alhourani
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40292, USA
| | - Anna Korzeniewska
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Thomas A Wozny
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Witold J Lipski
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Efstathios D Kondylis
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Avniel S Ghuman
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.,Brain Institute, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Donald J Crammond
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Robert S Turner
- Brain Institute, University of Pittsburgh, Pittsburgh, PA 15260, USA.,Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA.,Harvard Medical School, Boston, MA 02115, USA
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13
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Krucoff MO, Wozny TA, Lee AT, Rao VR, Chang EF. Operative Technique and Lessons Learned From Surgical Implantation of the NeuroPace Responsive Neurostimulation® System in 57 Consecutive Patients. Oper Neurosurg (Hagerstown) 2021; 20:E98-E109. [PMID: 33074294 DOI: 10.1093/ons/opaa300] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 07/13/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The Responsive Neurostimulation (RNS)® System (NeuroPace, Inc) is an implantable device designed to improve seizure control in patients with medically refractory focal epilepsy. Because it is relatively new, surgical pearls and operative techniques optimized from experience beyond a small case series have yet to be described. OBJECTIVE To provide a detailed description of our operative technique and surgical pearls learned from implantation of the RNS System in 57 patients at our institution. We describe our method for frame-based placement of amygdalo-hippocampal depth leads, open implantation of cortical strip leads, and open installation of the neurostimulator. METHODS We outline considerations for patient selection, preoperative planning, surgical positioning, incision planning, stereotactic depth lead implantation, cortical strip lead implantation, craniotomy for neurostimulator implantation, device testing, closure, and intraoperative imaging. RESULTS The median reduction in clinical seizure frequency was 60% (standard deviation 63.1) with 27% of patients achieving seizure freedom at last follow up (median 23.1 mo). No infections, intracerebral hemorrhages, or lead migrations were encountered. Two patients experienced lead fractures, and four lead exchanges have been performed. CONCLUSION The techniques set forth here will help with the safe and efficient implantation of these new devices.
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Affiliation(s)
- Max O Krucoff
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California.,Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Thomas A Wozny
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Anthony T Lee
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Vikram R Rao
- Department of Neurology and Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, California
| | - Edward F Chang
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
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14
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Wozny TA, Wang DD, Starr PA. Simultaneous cortical and subcortical recordings in humans with movement disorders: Acute and chronic paradigms. Neuroimage 2020; 217:116904. [PMID: 32387742 DOI: 10.1016/j.neuroimage.2020.116904] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 11/20/2022] Open
Abstract
Invasive basal ganglia recordings in humans have significantly advanced our understanding of the neurophysiology of movement disorders. A recent technical advance has been the addition of electrocorticography to basal ganglia recording, for evaluating distributed motor networks. Here we review the rationale, results, and ethics of this multisite recording technique in movement disorders, as well as its application in chronic recording paradigms utilizing implantable neural interfaces that include a sensing function.
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Affiliation(s)
- Thomas A Wozny
- Department of Neurological Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Doris D Wang
- Department of Neurological Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Philip A Starr
- Department of Neurological Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
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15
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Kokkinos V, Sisterson ND, Wozny TA, Richardson RM. Association of Closed-Loop Brain Stimulation Neurophysiological Features With Seizure Control Among Patients With Focal Epilepsy. JAMA Neurol 2020; 76:800-808. [PMID: 30985902 DOI: 10.1001/jamaneurol.2019.0658] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance A bidirectional brain-computer interface that performs neurostimulation has been shown to improve seizure control in patients with refractory epilepsy, but the therapeutic mechanism is unknown. Objective To investigate whether electrographic effects of responsive neurostimulation (RNS), identified in electrocorticographic (ECOG) recordings from the device, are associated with patient outcomes. Design, Setting, and Participants Retrospective review of ECOG recordings and accompanying clinical meta-data from 11 consecutive patients with focal epilepsy who were implanted with a neurostimulation system between January 28, 2015, and June 6, 2017, with 22 to 112 weeks of follow-up. Recorded ECOG data were obtained from the manufacturer; additional system-generated meta-data, including recording and detection settings, were collected directly from the manufacturer's management system using an in-house, custom-built platform. Electrographic seizure patterns were identified in RNS recordings and evaluated in the time-frequency domain, which was locked to the onset of the seizure pattern. Main Outcomes and Measures Patterns of electrophysiological modulation were identified and then classified according to their latency of onset in relation to triggered stimulation events. Seizure control after RNS implantation was assessed by 3 main variables: mean frequency of seizure occurrence, estimated mean severity of seizures, and mean duration of seizures. Overall seizure outcomes were evaluated by the extended Personal Impact of Epilepsy Scale questionnaires, a patient-reported outcome measure of 3 domains (seizure characteristics, medication adverse effects, and quality of life), with a range of possible scores from 0 to 300 in which lower scores indicate worse status, and the Engel scale, which comprises 4 classes (I-IV) in which lower numbers indicate greater improvement. Results Electrocorticographic data from 11 patients (8 female; mean [range] age, 35 [19-65] years; mean [range] duration of epilepsy, 19 [5-37] years) were analyzed. Two main categories of electrophysiological signatures of stimulation-induced modulation of the seizure network were discovered: direct and indirect effects. Direct effects included ictal inhibition and early frequency modulation but were not associated with improved clinical outcomes (odds ratio [OR], 0.67; 95% CI, 0.06-7.35; P > .99). Only indirect effects-those occurring remote from triggered stimulation-were associated with improved clinical outcomes (OR, infinity; 95% CI, -infinity to infinity; P = .02). These indirect effects included spontaneous ictal inhibition, frequency modulation, fragmentation, and ictal duration modulation. Conclusions and Relevance These findings suggest that RNS effectiveness may be explained by long-term, stimulation-induced modulation of seizure network activity rather than by direct effects on each detected seizure.
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Affiliation(s)
- Vasileios Kokkinos
- Brain Modulation Laboratory, Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, Pennsylvania
| | - Nathaniel D Sisterson
- Medical student, Brain Modulation Laboratory, Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Thomas A Wozny
- Brain Modulation Laboratory, Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - R Mark Richardson
- Brain Modulation Laboratory, Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, Pennsylvania.,University of Pittsburgh Brain Institute, Pittsburgh, Pennsylvania
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16
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Alhourani A, Fish KN, Wozny TA, Sudhakar V, Hamilton RL, Richardson RM. GABA bouton subpopulations in the human dentate gyrus are differentially altered in mesial temporal lobe epilepsy. J Neurophysiol 2019; 123:392-406. [PMID: 31800363 DOI: 10.1152/jn.00523.2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Medically intractable temporal lobe epilepsy is a devastating disease, for which surgical removal of the seizure onset zone is the only known cure. Multiple studies have found evidence of abnormal dentate gyrus network circuitry in human mesial temporal lobe epilepsy (MTLE). Principal neurons within the dentate gyrus gate entorhinal input into the hippocampus, providing a critical step in information processing. Crucial to that role are GABA-expressing neurons, particularly parvalbumin (PV)-expressing basket cells (PVBCs) and chandelier cells (PVChCs), which provide strong, temporally coordinated inhibitory signals. Alterations in PVBC and PVChC boutons have been described in epilepsy, but the value of these studies has been limited due to methodological hurdles associated with studying human tissue. We developed a multilabel immunofluorescence confocal microscopy and a custom segmentation algorithm to quantitatively assess PVBC and PVChC bouton densities and to infer relative synaptic protein content in the human dentate gyrus. Using en bloc specimens from MTLE subjects with and without hippocampal sclerosis, paired with nonepileptic controls, we demonstrate the utility of this approach for detecting cell-type specific synaptic alterations. Specifically, we found increased density of PVBC boutons, while PVChC boutons decreased significantly in the dentate granule cell layer of subjects with hippocampal sclerosis compared with matched controls. In contrast, bouton densities for either PV-positive cell type did not differ between epileptic subjects without sclerosis and matched controls. These results may explain conflicting findings from previous studies that have reported both preserved and decreased PV bouton densities and establish a new standard for quantitative assessment of interneuron boutons in epilepsy.NEW & NOTEWORTHY A state-of-the-art, multilabel immunofluorescence confocal microscopy and custom segmentation algorithm technique, developed previously for studying synapses in the human prefrontal cortex, was modified to study the hippocampal dentate gyrus in specimens surgically removed from patients with temporal lobe epilepsy. The authors discovered that chandelier and basket cell boutons in the human dentate gyrus are differentially altered in mesial temporal lobe epilepsy.
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Affiliation(s)
- Ahmad Alhourani
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Kenneth N Fish
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Thomas A Wozny
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Vivek Sudhakar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ronald L Hamilton
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - R Mark Richardson
- Department of Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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17
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Boring MJ, Jessen ZF, Wozny TA, Ward MJ, Whiteman AC, Richardson RM, Ghuman AS. Quantitatively validating the efficacy of artifact suppression techniques to study the cortical consequences of deep brain stimulation with magnetoencephalography. Neuroimage 2019; 199:366-374. [PMID: 31154045 DOI: 10.1016/j.neuroimage.2019.05.080] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/16/2019] [Accepted: 05/29/2019] [Indexed: 11/17/2022] Open
Abstract
Deep brain stimulation (DBS) is an established and effective treatment for several movement disorders and is being developed to treat a host of neuropsychiatric disorders including epilepsy, chronic pain, obsessive compulsive disorder, and depression. However, the neural mechanisms through which DBS produces therapeutic benefits, and in some cases unwanted side effects, in these disorders are only partially understood. Non-invasive neuroimaging techniques that can assess the neural effects of active stimulation are important for advancing our understanding of the neural basis of DBS therapy. Magnetoencephalography (MEG) is a safe, passive imaging modality with relatively high spatiotemporal resolution, which makes it a potentially powerful method for examining the cortical network effects of DBS. However, the degree to which magnetic artifacts produced by stimulation and the associated hardware can be suppressed from MEG data, and the comparability between signals measured during DBS-on and DBS-off conditions, have not been fully quantified. The present study used machine learning methods in conjunction with a visual perception task, which should be relatively unaffected by DBS, to quantify how well neural data can be salvaged from artifact contamination introduced by DBS and how comparable DBS-on and DBS-off data are after artifact removal. Machine learning also allowed us to determine whether the spatiotemporal pattern of neural activity recorded during stimulation are comparable to those recorded when stimulation is off. The spatiotemporal patterns of visually evoked neural fields could be accurately classified in all 8 patients with DBS implants during both DBS-on and DBS-off conditions and performed comparably across those two conditions. Further, the classification accuracy for classifiers trained on the spatiotemporal patterns evoked during DBS-on trials and applied to DBS-off trials, and vice versa, were similar to that of the classifiers trained and tested on either trial type, demonstrating the comparability of these patterns across conditions. Together, these results demonstrate the ability of MEG preprocessing techniques, like temporal signal space separation, to salvage neural data from recordings contaminated with DBS artifacts and validate MEG as a powerful tool to study the cortical consequences of DBS.
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Affiliation(s)
- Matthew J Boring
- Center for Neuroscience at the University of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA; Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Zachary F Jessen
- Medical Scientist Training Program, Northwestern University, Chicago, IL, USA
| | - Thomas A Wozny
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael J Ward
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashley C Whiteman
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - R Mark Richardson
- Center for Neuroscience at the University of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA; Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Avniel Singh Ghuman
- Center for Neuroscience at the University of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA; Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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18
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Sisterson ND, Wozny TA, Kokkinos V, Constantino A, Richardson RM. Closed-Loop Brain Stimulation for Drug-Resistant Epilepsy: Towards an Evidence-Based Approach to Personalized Medicine. Neurotherapeutics 2019; 16:119-127. [PMID: 30378004 PMCID: PMC6361057 DOI: 10.1007/s13311-018-00682-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Closed-loop brain stimulation is one of the few treatments available for patients who are ineligible for traditional surgical resection of the epileptogenic zone, due to having generalized epilepsy, multifocal epilepsy, or focal epilepsy localized to an eloquent brain region. Due to its clinical efficacy and potential to delivery personalized therapy based on an individual's own intracerebral electrophysiology, this treatment is becoming an important part of clinical practice, despite a limited understanding of how to program detection and stimulation parameters for optimal, patient-specific benefit. To bring this challenge into focus, we review the evolution of neural stimulation for epilepsy, provide a technical overview of the RNS System (the only FDA-approved closed-loop device), and discuss the major challenges of working with a closed-loop device. We then propose an evidence-based solution for individualizing therapy that is driven by a bottom-up informatics approach.
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Affiliation(s)
- Nathaniel D Sisterson
- Brain Modulation Lab, Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Thomas A Wozny
- Brain Modulation Lab, Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vasileios Kokkinos
- Brain Modulation Lab, Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
| | - Alexander Constantino
- Brain Modulation Lab, Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - R Mark Richardson
- Brain Modulation Lab, Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
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19
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Lipski WJ, Wozny TA, Alhourani A, Kondylis ED, Turner RS, Crammond DJ, Richardson RM. Dynamics of human subthalamic neuron phase-locking to motor and sensory cortical oscillations during movement. J Neurophysiol 2017; 118:1472-1487. [PMID: 28592690 DOI: 10.1152/jn.00964.2016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 05/01/2017] [Accepted: 06/01/2017] [Indexed: 01/19/2023] Open
Abstract
Coupled oscillatory activity recorded between sensorimotor regions of the basal ganglia-thalamocortical loop is thought to reflect information transfer relevant to movement. A neuronal firing-rate model of basal ganglia-thalamocortical circuitry, however, has dominated thinking about basal ganglia function for the past three decades, without knowledge of the relationship between basal ganglia single neuron firing and cortical population activity during movement itself. We recorded activity from 34 subthalamic nucleus (STN) neurons, simultaneously with cortical local field potentials and motor output, in 11 subjects with Parkinson's disease (PD) undergoing awake deep brain stimulator lead placement. STN firing demonstrated phase synchronization to both low- and high-beta-frequency cortical oscillations, and to the amplitude envelope of gamma oscillations, in motor cortex. We found that during movement, the magnitude of this synchronization was dynamically modulated in a phase-frequency-specific manner. Importantly, we found that phase synchronization was not correlated with changes in neuronal firing rate. Furthermore, we found that these relationships were not exclusive to motor cortex, because STN firing also demonstrated phase synchronization to both premotor and sensory cortex. The data indicate that models of basal ganglia function ultimately will need to account for the activity of populations of STN neurons that are bound in distinct functional networks with both motor and sensory cortices and code for movement parameters independent of changes in firing rate.NEW & NOTEWORTHY Current models of basal ganglia-thalamocortical networks do not adequately explain simple motor functions, let alone dysfunction in movement disorders. Our findings provide data that inform models of human basal ganglia function by demonstrating how movement is encoded by networks of subthalamic nucleus (STN) neurons via dynamic phase synchronization with cortex. The data also demonstrate, for the first time in humans, a mechanism through which the premotor and sensory cortices are functionally connected to the STN.
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Affiliation(s)
- Witold J Lipski
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Thomas A Wozny
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ahmad Alhourani
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Efstathios D Kondylis
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert S Turner
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania; and.,University of Pittsburgh Brain Institute, Pittsburgh, Pennsylvania
| | - Donald J Crammond
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert Mark Richardson
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; .,Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania; and.,University of Pittsburgh Brain Institute, Pittsburgh, Pennsylvania
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Wozny TA, Lipski WJ, Alhourani A, Kondylis ED, Antony A, Richardson RM. Effects of hippocampal low-frequency stimulation in idiopathic non-human primate epilepsy assessed via a remote-sensing-enabled neurostimulator. Exp Neurol 2017; 294:68-77. [PMID: 28495218 DOI: 10.1016/j.expneurol.2017.05.003] [Citation(s) in RCA: 9] [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: 09/05/2016] [Revised: 04/28/2017] [Accepted: 05/06/2017] [Indexed: 01/06/2023]
Abstract
Individuals with pharmacoresistant epilepsy remain a large and under-treated patient population. Continued technologic advancements in implantable neurostimulators have spurred considerable research efforts directed towards the development of novel antiepileptic stimulation therapies. However, the lack of adequate preclinical experimental platforms has precluded a detailed understanding of the differential effects of stimulation parameters on neuronal activity within seizure networks. In order to chronically monitor seizures and the effects of stimulation in a freely-behaving non-human primate with idiopathic epilepsy, we employed a novel simultaneous video-intracranial EEG recording platform using a state-of-the-art sensing-enabled, rechargeable clinical neurostimulator with real-time seizure detection and wireless data streaming capabilities. Using this platform, we were able to characterize the electrographic and semiologic features of the focal-onset, secondarily generalizing tonic-clonic seizures stably expressed in this animal. A series of acute experiments exploring low-frequency (2Hz) hippocampal stimulation identified a pulse width (150μs) and current amplitude (4mA) combination which maximally suppressed local hippocampal activity. These optimized stimulation parameters were then delivered to the seizure onset-side hippocampus in a series of chronic experiments. This long-term testing revealed that the suppressive effects of low-frequency hippocampal stimulation 1) diminish when delivered continuously but are maintained when stimulation is cycled on and off, 2) are dependent on circadian rhythms, and 3) do not necessarily confer seizure protective effects.
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Affiliation(s)
- Thomas A Wozny
- Brain Modulation Lab, Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Witold J Lipski
- Brain Modulation Lab, Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Ahmad Alhourani
- Brain Modulation Lab, Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Efstathios D Kondylis
- Brain Modulation Lab, Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Arun Antony
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, United States; University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA 15213, United States
| | - R Mark Richardson
- Brain Modulation Lab, Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, United States; University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA 15213, United States; University of Pittsburgh Brain Institute, Pittsburgh, PA 15213, United States.
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Alhourani A, Korzeniewska A, Wozny TA, Kondylis E, Lipski WJ, Crammond D, Richardson RM. 209 Movement-Related Dynamics of Beta Band Causal Interactions Between Subthalamic Nucleus and Sensorimotor Cortex Revealed Through Intraoperative Recordings in Parkinson's Disease. Neurosurgery 2016. [DOI: 10.1227/01.neu.0000489778.53428.aa] [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: 11/19/2022] Open
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Alhourani A, Wozny TA, Krishnaswamy D, Pathak S, Walls SA, Ghuman AS, Krieger DN, Okonkwo DO, Richardson RM, Niranjan A. Magnetoencephalography-based identification of functional connectivity network disruption following mild traumatic brain injury. J Neurophysiol 2016; 116:1840-1847. [PMID: 27466136 DOI: 10.1152/jn.00513.2016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/25/2016] [Indexed: 12/30/2022] Open
Abstract
Mild traumatic brain injury (mTBI) leads to long-term cognitive sequelae in a significant portion of patients. Disruption of normal neural communication across functional brain networks may explain the deficits in memory and attention observed after mTBI. In this study, we used magnetoencephalography (MEG) to examine functional connectivity during a resting state in a group of mTBI subjects (n = 9) compared with age-matched control subjects (n = 15). We adopted a data-driven, exploratory analysis in source space using phase locking value across different frequency bands. We observed a significant reduction in functional connectivity in band-specific networks in mTBI compared with control subjects. These networks spanned multiple cortical regions involved in the default mode network (DMN). The DMN is thought to subserve memory and attention during periods when an individual is not engaged in a specific task, and its disruption may lead to cognitive deficits after mTBI. We further applied graph theoretical analysis on the functional connectivity matrices. Our data suggest reduced local efficiency in different brain regions in mTBI patients. In conclusion, MEG can be a potential tool to investigate and detect network alterations in patients with mTBI. The value of MEG to reveal potential neurophysiological biomarkers for mTBI patients warrants further exploration.
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Affiliation(s)
- Ahmad Alhourani
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Thomas A Wozny
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Deepa Krishnaswamy
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sudhir Pathak
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Shawn A Walls
- University of Pittsburgh Medical Center Brain Mapping Center, Pittsburgh, Pennsylvania
| | - Avniel S Ghuman
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Center for the Neural Basis of Cognition and University of Pittsburgh Brain Institute, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Donald N Krieger
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - R Mark Richardson
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Center for the Neural Basis of Cognition and University of Pittsburgh Brain Institute, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;
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Kondylis ED, Randazzo MJ, Alhourani A, Lipski WJ, Wozny TA, Pandya Y, Ghuman AS, Turner RS, Crammond DJ, Richardson RM. Movement-related dynamics of cortical oscillations in Parkinson's disease and essential tremor. Brain 2016; 139:2211-23. [PMID: 27329771 DOI: 10.1093/brain/aww144] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [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: 02/19/2016] [Accepted: 05/04/2016] [Indexed: 11/13/2022] Open
Abstract
Recent electrocorticography data have demonstrated excessive coupling of beta-phase to gamma-amplitude in primary motor cortex and that deep brain stimulation facilitates motor improvement by decreasing baseline phase-amplitude coupling. However, both the dynamic modulation of phase-amplitude coupling during movement and the general cortical neurophysiology of other movement disorders, such as essential tremor, are relatively unexplored. To clarify the relationship of these interactions in cortical oscillatory activity to movement and disease state, we recorded local field potentials from hand sensorimotor cortex using subdural electrocorticography during a visually cued, incentivized handgrip task in subjects with Parkinson's disease (n = 11), with essential tremor (n = 9) and without a movement disorder (n = 6). We demonstrate that abnormal coupling of the phase of low frequency oscillations to the amplitude of gamma oscillations is not specific to Parkinson's disease, but also occurs in essential tremor, most prominently for the coupling of alpha to gamma oscillations. Movement kinematics were not significantly different between these groups, allowing us to show for the first time that robust alpha and beta desynchronization is a shared feature of sensorimotor cortical activity in Parkinson's disease and essential tremor, with the greatest high-beta desynchronization occurring in Parkinson's disease and the greatest alpha desynchronization occurring in essential tremor. We also show that the spatial extent of cortical phase-amplitude decoupling during movement is much greater in subjects with Parkinson's disease and essential tremor than in subjects without a movement disorder. These findings suggest that subjects with Parkinson's disease and essential tremor can produce movements that are kinematically similar to those of subjects without a movement disorder by reducing excess sensorimotor cortical phase-amplitude coupling that is characteristic of these diseases.
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Affiliation(s)
- Efstathios D Kondylis
- 1 Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael J Randazzo
- 1 Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ahmad Alhourani
- 1 Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Witold J Lipski
- 1 Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Thomas A Wozny
- 1 Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yash Pandya
- 1 Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Avniel S Ghuman
- 1 Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA 2 Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA 3 Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA 4 University of Pittsburgh Brain Institute, Pittsburgh, PA, USA
| | - Robert S Turner
- 2 Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA 3 Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA 4 University of Pittsburgh Brain Institute, Pittsburgh, PA, USA
| | - Donald J Crammond
- 1 Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - R M Richardson
- 1 Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA 2 Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA 3 Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA 4 University of Pittsburgh Brain Institute, Pittsburgh, PA, USA
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Kondylis ED, Randazzo MJ, Alhourani A, Wozny TA, Lipski WJ, Crammond DJ, Richardson RM. High frequency activation data used to validate localization of cortical electrodes during surgery for deep brain stimulation. Data Brief 2015; 6:204-7. [PMID: 26862560 PMCID: PMC4707179 DOI: 10.1016/j.dib.2015.11.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/22/2015] [Indexed: 11/05/2022] Open
Abstract
Movement related synchronization of high frequency activity (HFA, 76–100 Hz) is a somatotopic process with spectral power changes occurring during movement in the sensorimotor cortex (Miller et al., 2007) [1]. These features allowed movement-related changes in HFA to be used to functionally validate the estimations of subdural electrode locations, which may be placed temporarily for research in deep brain stimulation surgery, using the novel tool described in Randazzo et al. (2015) [2]. We recorded electrocorticography (ECoG) signals and localized electrodes in the region of the sensorimotor cortex during an externally cued hand grip task in 8 subjects. Movement related HFA was determined for each trial by comparing HFA spectral power during movement epochs to pre-movement baseline epochs. Significant movement related HFA was found to be focal in time and space, occurring only during movement and only in a subset of electrodes localized to the pre- and post-central gyri near the hand knob. To further demonstrate the use of movement related HFA to aid electrode localization, we provide a sample of the electrode localization tool, with data loaded to allow readers to map movement related HFA onto the cortical surface of a sample patient.
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Affiliation(s)
- Efstathios D Kondylis
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, United States
| | - Michael J Randazzo
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, United States
| | - Ahmad Alhourani
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, United States
| | - Thomas A Wozny
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, United States
| | - Witold J Lipski
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, United States
| | - Donald J Crammond
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, United States
| | - R Mark Richardson
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, United States; Department of Neurobiology, University of Pittsburgh School of Medicine, United States; Center for the Neural Basis of Cognition, University of Pittsburgh, United States
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Randazzo MJ, Kondylis ED, Alhourani A, Wozny TA, Lipski WJ, Crammond DJ, Richardson RM. Three-dimensional localization of cortical electrodes in deep brain stimulation surgery from intraoperative fluoroscopy. Neuroimage 2015; 125:515-521. [PMID: 26520771 DOI: 10.1016/j.neuroimage.2015.10.076] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 08/10/2015] [Revised: 10/09/2015] [Accepted: 10/25/2015] [Indexed: 11/28/2022] Open
Abstract
Electrophysiological recordings from subdural electrocorticography (ECoG) electrodes implanted temporarily during deep brain stimulation (DBS) surgeries offer a unique opportunity to record cortical activity for research purposes. The optimal utilization of this important research method relies on accurate and robust localization of ECoG electrodes, and intraoperative fluoroscopy is often the only imaging modality available to visualize electrode locations. However, the localization of a three-dimensional electrode position using a two-dimensional fluoroscopic image is problematic due to the lost dimension orthogonal to the fluoroscopic image, a parallax distortion implicit to fluoroscopy, and variability of visible skull contour among fluoroscopic images. Here, we present a method to project electrodes visible on the fluoroscopic image onto a reconstructed cortical surface by leveraging numerous common landmarks to translate, rotate, and scale coregistered computed tomography (CT) and magnetic resonance imaging (MRI) reconstructed surfaces in order to recreate the coordinate framework in which the fluoroscopic image was acquired, while accounting for parallax distortion. Validation of this approach demonstrated high precision with an average total Euclidian distance between three independent reviewers of 1.65±0.68mm across 8 patients and 82 electrodes. Spatial accuracy was confirmed by correspondence between recorded neural activity over sensorimotor cortex during hand movement. This semi-automated interface reliably estimates the location of temporarily implanted subdural ECoG electrodes visible on intraoperative fluoroscopy to a cortical surface.
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Affiliation(s)
- Michael J Randazzo
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Efstathios D Kondylis
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ahmad Alhourani
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Thomas A Wozny
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Witold J Lipski
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Donald J Crammond
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - R Mark Richardson
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Center for the Neural Basis of Cognition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Alhourani A, McDowell MM, Randazzo MJ, Wozny TA, Kondylis ED, Lipski WJ, Beck S, Karp JF, Ghuman AS, Richardson RM. Network effects of deep brain stimulation. J Neurophysiol 2015; 114:2105-17. [PMID: 26269552 DOI: 10.1152/jn.00275.2015] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 08/10/2015] [Indexed: 11/22/2022] Open
Abstract
The ability to differentially alter specific brain functions via deep brain stimulation (DBS) represents a monumental advance in clinical neuroscience, as well as within medicine as a whole. Despite the efficacy of DBS in the treatment of movement disorders, for which it is often the gold-standard therapy when medical management becomes inadequate, the mechanisms through which DBS in various brain targets produces therapeutic effects is still not well understood. This limited knowledge is a barrier to improving efficacy and reducing side effects in clinical brain stimulation. A field of study related to assessing the network effects of DBS is gradually emerging that promises to reveal aspects of the underlying pathophysiology of various brain disorders and their response to DBS that will be critical to advancing the field. This review summarizes the nascent literature related to network effects of DBS measured by cerebral blood flow and metabolic imaging, functional imaging, and electrophysiology (scalp and intracranial electroencephalography and magnetoencephalography) in order to establish a framework for future studies.
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Affiliation(s)
- Ahmad Alhourani
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael M McDowell
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael J Randazzo
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Thomas A Wozny
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Witold J Lipski
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah Beck
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jordan F Karp
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Avniel S Ghuman
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for the Neural Basis of Cognition, Pittsburgh, Pennsylvania
| | - R Mark Richardson
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for the Neural Basis of Cognition, Pittsburgh, Pennsylvania
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Kondylis ED, Wozny TA, Lipski WJ, Popescu A, DeStefino VJ, Esmaeili B, Raghu VK, Bagic A, Richardson RM. Detection of high-frequency oscillations by hybrid depth electrodes in standard clinical intracranial EEG recordings. Front Neurol 2014; 5:149. [PMID: 25147541 PMCID: PMC4123606 DOI: 10.3389/fneur.2014.00149] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 07/23/2014] [Indexed: 11/13/2022] Open
Abstract
High-frequency oscillations (HFOs) have been proposed as a novel marker for epileptogenic tissue, spurring tremendous research interest into the characterization of these transient events. A wealth of continuously recorded intracranial electroencephalographic (iEEG) data is currently available from patients undergoing invasive monitoring for the surgical treatment of epilepsy. In contrast to data recorded on research-customized recording systems, data from clinical acquisition systems remain an underutilized resource for HFO detection in most centers. The effective and reliable use of this clinically obtained data would be an important advance in the ongoing study of HFOs and their relationship to ictogenesis. The diagnostic utility of HFOs ultimately will be limited by the ability of clinicians to detect these brief, sporadic, and low amplitude events in an electrically noisy clinical environment. Indeed, one of the most significant factors limiting the use of such clinical recordings for research purposes is their low signal to noise ratio, especially in the higher frequency bands. In order to investigate the presence of HFOs in clinical data, we first obtained continuous intracranial recordings in a typical clinical environment using a commercially available, commonly utilized data acquisition system and "off the shelf" hybrid macro-/micro-depth electrodes. These data were then inspected for the presence of HFOs using semi-automated methods and expert manual review. With targeted removal of noise frequency content, HFOs were detected on both macro- and micro-contacts, and preferentially localized to seizure onset zones. HFOs detected by the offline, semi-automated method were also validated in the clinical viewer, demonstrating that (1) this clinical system allows for the visualization of HFOs and (2) with effective signal processing, clinical recordings can yield valuable information for offline analysis.
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Affiliation(s)
- Efstathios D Kondylis
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, PA , USA
| | - Thomas A Wozny
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, PA , USA
| | - Witold J Lipski
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, PA , USA
| | - Alexandra Popescu
- Department of Neurology, University of Pittsburgh Medical Center , Pittsburgh, PA , USA
| | - Vincent J DeStefino
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, PA , USA
| | - Behnaz Esmaeili
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, PA , USA
| | - Vineet K Raghu
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, PA , USA
| | - Anto Bagic
- Department of Neurology, University of Pittsburgh Medical Center , Pittsburgh, PA , USA ; Center for the Neural Basis of Cognition, University of Pittsburgh , Pittsburgh, PA , USA
| | - R Mark Richardson
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, PA , USA ; Center for the Neural Basis of Cognition, University of Pittsburgh , Pittsburgh, PA , USA ; McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, PA , USA
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Cho RY, Walker CP, Polizzotto NR, Wozny TA, Fissell C, Chen CMA, Lewis DA. Development of sensory gamma oscillations and cross-frequency coupling from childhood to early adulthood. ACTA ACUST UNITED AC 2013; 25:1509-18. [PMID: 24334917 DOI: 10.1093/cercor/bht341] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Given the importance of gamma oscillations in normal and disturbed cognition, there has been growing interest in their developmental trajectory. In the current study, age-related changes in sensory cortical gamma were studied using the auditory steady-state response (ASSR), indexing cortical activity entrained to a periodic auditory stimulus. A large sample (n = 188) aged 8-22 years had electroencephalography recording of ASSR during 20-, 30-, and 40-Hz click trains, analyzed for evoked amplitude, phase-locking factor (PLF) and cross-frequency coupling (CFC) with lower frequency oscillations. Both 40-Hz evoked power and PLF increased monotonically from 8 through 16 years, and subsequently decreased toward ages 20-22 years. CFC followed a similar pattern, with strongest age-related modulation of 40-Hz amplitude by the phase of delta oscillations. In contrast, the evoked power, PLF and CFC for the 20- and 30-Hz stimulation were distinct from the 40-Hz condition, with flat or decreasing profiles from childhood to early adulthood. The inverted U-shaped developmental trajectory of gamma oscillations may be consistent with interacting maturational processes-such as increasing fast GABA inhibition that enhances gamma activity and synaptic pruning that decreases gamma activity-that may continue from childhood through to adulthood.
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Affiliation(s)
- Raymond Y Cho
- Department of Psychiatry and Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15213, USA Center for Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Christopher P Walker
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15213, USA Center for Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | | | | | | | - Chi-Ming A Chen
- Department of Psychology, University of Connecticut, Storrs, CT 06269, USA
| | - David A Lewis
- Department of Psychiatry and Center for Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA 15213, USA
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