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Hunter C, Schultz D, Tomycz N, Weisbein J, Miller N, Falowski S, Pope J, Mansouri M, Deer T. ID:16361 Burst Stimulation Therapy Improves Pain Relief and Emotional Well-Being in Patients With Waning SCS Therapy. Neuromodulation 2022. [DOI: 10.1016/j.neurom.2022.02.102] [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: 11/16/2022]
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2
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Kassick AJ, Treat A, Tomycz N, Feasel MG, Kolber BJ, Averick S. Design, synthesis, and biological evaluation of C 6-difluoromethylenated epoxymorphinan Mu opioid receptor antagonists. RSC Med Chem 2022; 13:175-182. [PMID: 35308026 PMCID: PMC8864491 DOI: 10.1039/d1md00285f] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/28/2021] [Indexed: 03/12/2024] Open
Abstract
The recent widespread abuse of high potency synthetic opioids, such as fentanyl, presents a serious threat to individuals affected by substance use disorder. Synthetic opioids generally exhibit prolonged in vivo circulatory half-lives that can outlast the reversal effects of conventional naloxone-based overdose antidotes leading to a life-threatening relapse of opioid toxicity known as renarcotization. In this manuscript, we present our efforts to combat the threat of renarcotization by attempting to extend the half-life of traditional MOR antagonists through the design of novel, fluorinated 4,5-epoxymorphinans possessing increased lipophilicity. Analogues were prepared via a concise synthetic strategy highlighted by decarboxylative Wittig olefination of the C6 ketone to install a bioisosteric 1,1-difluoromethylene unit. C6-difluoromethylenated compounds successfully maintained in vitro potency against an EC90 challenge of fentanyl and were predicted to have enhanced circulatory half-life compared to the current standard of care, naloxone. Subsequent in vivo studies demonstrated the effective blockade of fentanyl-induced anti-nociception in mice.
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Affiliation(s)
- Andrew J Kassick
- Neuroscience Disruptive Research Lab, Allegheny Health Network Research Institute, Allegheny General Hospital Pittsburgh PA 15212 USA
- Neuroscience Institute, Allegheny Health Network, Allegheny General Hospital Pittsburgh PA 15212 USA
| | - Anny Treat
- Department of Neuroscience and Center for Advanced Pain Studies, University of Texas at Dallas Richardson TX 75080 USA
| | - Nestor Tomycz
- Neuroscience Institute, Allegheny Health Network, Allegheny General Hospital Pittsburgh PA 15212 USA
| | - Michael G Feasel
- Research and Technology Division, DEVCOM Chemical Biological Center Aberdeen Proving Ground MD 21010-5424 USA
| | - Benedict J Kolber
- Department of Neuroscience and Center for Advanced Pain Studies, University of Texas at Dallas Richardson TX 75080 USA
| | - Saadyah Averick
- Neuroscience Disruptive Research Lab, Allegheny Health Network Research Institute, Allegheny General Hospital Pittsburgh PA 15212 USA
- Neuroscience Institute, Allegheny Health Network, Allegheny General Hospital Pittsburgh PA 15212 USA
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3
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Richter B, Mace Z, Hays ME, Adhikari S, Pham HQ, Sclabassi RJ, Kolber B, Yerneni SS, Campbell P, Cheng B, Tomycz N, Whiting DM, Le TQ, Nelson TL, Averick S. Development and Characterization of Novel Conductive Sensing Fibers for In Vivo Nerve Stimulation. Sensors (Basel) 2021; 21:s21227581. [PMID: 34833660 PMCID: PMC8619502 DOI: 10.3390/s21227581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 12/11/2022]
Abstract
Advancements in electrode technologies to both stimulate and record the central nervous system’s electrical activities are enabling significant improvements in both the understanding and treatment of different neurological diseases. However, the current neural recording and stimulating electrodes are metallic, requiring invasive and damaging methods to interface with neural tissue. These electrodes may also degrade, resulting in additional invasive procedures. Furthermore, metal electrodes may cause nerve damage due to their inherent rigidity. This paper demonstrates that novel electrically conductive organic fibers (ECFs) can be used for direct nerve stimulation. The ECFs were prepared using a standard polyester material as the structural base, with a carbon nanotube ink applied to the surface as the electrical conductor. We report on three experiments: the first one to characterize the conductive properties of the ECFs; the second one to investigate the fiber cytotoxic properties in vitro; and the third one to demonstrate the utility of the ECF for direct nerve stimulation in an in vivo rodent model.
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Affiliation(s)
- Bertram Richter
- System Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA 15212, USA; (B.R.); (Z.M.); (R.J.S.); (B.C.); (N.T.); (D.M.W.)
| | - Zachary Mace
- System Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA 15212, USA; (B.R.); (Z.M.); (R.J.S.); (B.C.); (N.T.); (D.M.W.)
- Computational Diagnostics, Inc., Pittsburgh, PA 15213, USA
| | - Megan E. Hays
- Department of Chemistry, Oklahoma State University, Stillwater, OK 74078, USA; (M.E.H.); (S.A.); (T.L.N.)
| | - Santosh Adhikari
- Department of Chemistry, Oklahoma State University, Stillwater, OK 74078, USA; (M.E.H.); (S.A.); (T.L.N.)
| | - Huy Q. Pham
- Department of Biomedical Engineering, North Dakota State University, Fargo, ND 58102, USA;
| | - Robert J. Sclabassi
- System Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA 15212, USA; (B.R.); (Z.M.); (R.J.S.); (B.C.); (N.T.); (D.M.W.)
- Computational Diagnostics, Inc., Pittsburgh, PA 15213, USA
| | - Benedict Kolber
- Department of Neuroscience, University of Texas at Dallas, Richardson, TX 75080, USA;
| | - Saigopalakrishna S. Yerneni
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15217, USA; (S.S.Y.); (P.C.)
| | - Phil Campbell
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15217, USA; (S.S.Y.); (P.C.)
| | - Boyle Cheng
- System Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA 15212, USA; (B.R.); (Z.M.); (R.J.S.); (B.C.); (N.T.); (D.M.W.)
| | - Nestor Tomycz
- System Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA 15212, USA; (B.R.); (Z.M.); (R.J.S.); (B.C.); (N.T.); (D.M.W.)
| | - Donald M. Whiting
- System Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA 15212, USA; (B.R.); (Z.M.); (R.J.S.); (B.C.); (N.T.); (D.M.W.)
| | - Trung Q. Le
- Department of Industrial and Manufacturing Engineering, North Dakota State University, Fargo, ND 58102, USA
- Correspondence: (T.Q.L.); (S.A.)
| | - Toby L. Nelson
- Department of Chemistry, Oklahoma State University, Stillwater, OK 74078, USA; (M.E.H.); (S.A.); (T.L.N.)
| | - Saadyah Averick
- System Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA 15212, USA; (B.R.); (Z.M.); (R.J.S.); (B.C.); (N.T.); (D.M.W.)
- Correspondence: (T.Q.L.); (S.A.)
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Kassick A, Wu M, Luengas D, Ebqa’ai M, Tharika Nirmani LP, Tomycz N, Nelson TL, Pravetoni M, Raleigh MD, Averick S. Covalently Loaded Naloxone Nanoparticles as a Long-Acting Medical Countermeasure to Opioid Poisoning. ACS Pharmacol Transl Sci 2021; 4:1654-1664. [PMID: 34661081 PMCID: PMC8506606 DOI: 10.1021/acsptsci.1c00168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Indexed: 01/27/2023]
Abstract
The mu opioid receptor antagonist naloxone has been a vital, long-standing countermeasure in the ongoing battle against opioid use disorders (OUD) and toxicity. However, due to its distinctive short elimination half-life, naloxone has shown diminished efficacy in cases of synthetic opioid poisoning as larger or repeated doses of the antidote have been required to achieve adequate reversal of severe respiratory depression and prevent episodes of renarcotization. This report describes the synthesis, characterization, and in vivo evaluation of a novel, nanoparticle-based naloxone formulation that provides extended protection against the toxic effects of the powerful synthetic opioid fentanyl. The strategy was predicated on a modified two-step protocol involving the synthesis and subsequent nanoprecipitation of a poly(lactic-co-glycolic acid) polymer scaffold bearing a covalently linked naloxone chain end (drug loading ∼7% w/w). Pharmacokinetic evaluation of the resulting covalently loaded naloxone nanoparticles (cNLX-NP) revealed an elimination half-life that was 34 times longer than high dose free naloxone (10 mg/kg) in male Sprague-Dawley rats. This enhancement was further demonstrated by cNLX-NP in subsequent in vivo studies affording protection against fentanyl-induced respiratory depression and antinociception for up to 48 h following a single intramuscular injection. These discoveries support further investigation of cNLX-NP as a potential therapeutic to reverse overdose and prevent renarcotization from fentanyl and its potent analogs.
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Affiliation(s)
- Andrew
J. Kassick
- Neuroscience
Disruptive Research Lab, Allegheny Health
Network Research Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, United States
- Neuroscience
Institute, Allegheny Health Network, Allegheny
General Hospital, Pittsburgh, Pennsylvania 15212, United States
| | - Mariah Wu
- Department
of Pharmacology, University of Minnesota
Medical School Twin Cities, Minneapolis, Minnesota 55455, United States
| | - Diego Luengas
- Department
of Pharmacology, University of Minnesota
Medical School Twin Cities, Minneapolis, Minnesota 55455, United States
| | - Mohammad Ebqa’ai
- Department
of Chemistry, Oklahoma State University, Stillwater, Oklahoma 74078, United States
| | - L. P. Tharika Nirmani
- Department
of Chemistry, Oklahoma State University, Stillwater, Oklahoma 74078, United States
| | - Nestor Tomycz
- Neuroscience
Institute, Allegheny Health Network, Allegheny
General Hospital, Pittsburgh, Pennsylvania 15212, United States
| | - Toby L. Nelson
- Department
of Chemistry, Oklahoma State University, Stillwater, Oklahoma 74078, United States
| | - Marco Pravetoni
- Department
of Pharmacology, University of Minnesota
Medical School Twin Cities, Minneapolis, Minnesota 55455, United States
| | - Michael D. Raleigh
- Department
of Pharmacology, University of Minnesota
Medical School Twin Cities, Minneapolis, Minnesota 55455, United States
| | - Saadyah Averick
- Neuroscience
Disruptive Research Lab, Allegheny Health
Network Research Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, United States
- Neuroscience
Institute, Allegheny Health Network, Allegheny
General Hospital, Pittsburgh, Pennsylvania 15212, United States
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Schnitzler A, Mir P, Brodsky MA, Verhagen L, Groppa S, Alvarez R, Evans A, Blazquez M, Nagel S, Pilitsis JG, Pötter-Nerger M, Tse W, Almeida L, Tomycz N, Jimenez-Shahed J, Libionka W, Carrillo F, Hartmann CJ, Groiss SJ, Glaser M, Defresne F, Karst E, Cheeran B, Vesper J. Directional Deep Brain Stimulation for Parkinson's Disease: Results of an International Crossover Study With Randomized, Double-Blind Primary Endpoint. Neuromodulation 2021; 25:817-828. [PMID: 34047410 DOI: 10.1111/ner.13407] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 12/23/2020] [Revised: 02/11/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Published reports on directional deep brain stimulation (DBS) have been limited to small, single-center investigations. Therapeutic window (TW) is used to describe the range of stimulation amplitudes achieving symptom relief without side effects. This crossover study performed a randomized double-blind assessment of TW for directional and omnidirectional DBS in a large cohort of patients implanted with a DBS system in the subthalamic nucleus for Parkinson's disease. MATERIALS AND METHODS Participants received omnidirectional stimulation for the first three months after initial study programming, followed by directional DBS for the following three months. The primary endpoint was a double-blind, randomized evaluation of TW for directional vs. omnidirectional stimulation at three months after initial study programming. Additional data recorded at three- and six-month follow-ups included stimulation preference, therapeutic current strength, Unified Parkinson's Disease Rating Scale (UPDRS) part III motor score, and quality of life. RESULTS The study enrolled 234 subjects (62 ± 8 years, 33% female). TW was wider using directional stimulation in 183 of 202 subjects (90.6%). The mean increase in TW with directional stimulation was 41% (2.98 ± 1.38 mA, compared to 2.11 ± 1.33 mA for omnidirectional). UPDRS part III motor score on medication improved 42.4% at three months (after three months of omnidirectional stimulation) and 43.3% at six months (after three months of directional stimulation) with stimulation on, compared to stimulation off. After six months, 52.8% of subjects blinded to stimulation type (102/193) preferred the period with directional stimulation, and 25.9% (50/193) preferred the omnidirectional period. The directional period was preferred by 58.5% of clinicians (113/193) vs. 21.2% (41/193) who preferred the omnidirectional period. CONCLUSION Directional stimulation yielded a wider TW compared to omnidirectional stimulation and was preferred by blinded subjects and clinicians.
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Affiliation(s)
- Alfons Schnitzler
- Department of Neurology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Pablo Mir
- Clinical Neurology and Neurophysiology Department, Movement Disorders Unit, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital, CSIC/University of Seville, Seville, Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Seville, Spain
| | - Matthew A Brodsky
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Leonard Verhagen
- Department of Neurological Sciences, Rush University, Chicago, IL, USA
| | - Sergiu Groppa
- Johannes Gutenberg University of Mainz, Clinic of Neurology, Mainz, Germany
| | - Ramiro Alvarez
- Department of Neurology, Hospital Trias i Pujol, Badalona, Spain
| | - Andrew Evans
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - Marta Blazquez
- Department of Neurology, Hospital Universitario Central de Asturias, Spain
| | - Sean Nagel
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical Center, New York, NY, USA
| | | | - Winona Tse
- Department of Neurology, Mount Sinai Hospital, New York, NY, USA
| | - Leonardo Almeida
- Department of Neurology, Shands at University of Florida, Gainesville, FL, USA
| | - Nestor Tomycz
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Witold Libionka
- Department of Neurology, Copernicus Hospital, Gdansk, Poland
| | - Fatima Carrillo
- Clinical Neurology and Neurophysiology Department, Movement Disorders Unit, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital, CSIC/University of Seville, Seville, Spain
| | - Christian J Hartmann
- Department of Neurology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Stefan Jun Groiss
- Department of Neurology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Martin Glaser
- Department of Neurosurgery, Johannes Gutenberg University of Mainz, Mainz, Germany
| | | | - Edward Karst
- Abbott, Medical and Clinical Affairs, Plano, TX, USA
| | | | - Jan Vesper
- Department of Neurosurgery, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
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6
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France CP, Ahern GP, Averick S, Disney A, Enright HA, Esmaeli-Azad B, Federico A, Gerak LR, Husbands SM, Kolber B, Lau EY, Lao V, Maguire DR, Malfatti MA, Martinez G, Mayer BP, Pravetoni M, Sahibzada N, Skolnick P, Snyder EY, Tomycz N, Valdez CA, Zapf J. Countermeasures for Preventing and Treating Opioid Overdose. Clin Pharmacol Ther 2020; 109:578-590. [PMID: 33113208 DOI: 10.1002/cpt.2098] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/15/2020] [Indexed: 02/06/2023]
Abstract
The only medication available currently to prevent and treat opioid overdose (naloxone) was approved by the US Food and Drug Administration (FDA) nearly 50 years ago. Because of its pharmacokinetic and pharmacodynamic properties, naloxone has limited utility under some conditions and would not be effective to counteract mass casualties involving large-scale deployment of weaponized synthetic opioids. To address shortcomings of current medical countermeasures for opioid toxicity, a trans-agency scientific meeting was convened by the US National Institute of Allergy and Infectious Diseases/National Institutes of Health (NIAID/NIH) on August 6 and 7, 2019, to explore emerging alternative approaches for treating opioid overdose in the event of weaponization of synthetic opioids. The meeting was initiated by the Chemical Countermeasures Research Program (CCRP), was organized by NIAID, and was a collaboration with the National Institute on Drug Abuse/NIH (NIDA/NIH), the FDA, the Defense Threat Reduction Agency (DTRA), and the Biomedical Advanced Research and Development Authority (BARDA). This paper provides an overview of several presentations at that meeting that discussed emerging new approaches for treating opioid overdose, including the following: (1) intranasal nalmefene, a competitive, reversible opioid receptor antagonist with a longer duration of action than naloxone; (2) methocinnamox, a novel opioid receptor antagonist; (3) covalent naloxone nanoparticles; (4) serotonin (5-HT)1A receptor agonists; (5) fentanyl-binding cyclodextrin scaffolds; (6) detoxifying biomimetic "nanosponge" decoy receptors; and (7) antibody-based strategies. These approaches could also be applied to treat opioid use disorder.
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Affiliation(s)
- Charles P France
- Department of Pharmacology, Addiction Research, Treatment and Training Center of Excellence, University of Texas Health Science Center, San Antonio, Texas, USA
| | | | - Saadyah Averick
- Neuroscience Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Alex Disney
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | | | - Babak Esmaeli-Azad
- CellCure (Stem Cell Division of CiBots, Inc.), San Diego, California, USA
| | - Arianna Federico
- CellCure (Stem Cell Division of CiBots, Inc.), San Diego, California, USA
| | - Lisa R Gerak
- Department of Pharmacology, Addiction Research, Treatment and Training Center of Excellence, University of Texas Health Science Center, San Antonio, Texas, USA
| | | | | | - Edmond Y Lau
- Lawrence Livermore National Laboratory, Livermore, California, USA
| | - Victoria Lao
- Lawrence Livermore National Laboratory, Livermore, California, USA
| | - David R Maguire
- Department of Pharmacology, Addiction Research, Treatment and Training Center of Excellence, University of Texas Health Science Center, San Antonio, Texas, USA
| | | | - Girardo Martinez
- CellCure (Stem Cell Division of CiBots, Inc.), San Diego, California, USA
| | - Brian P Mayer
- Lawrence Livermore National Laboratory, Livermore, California, USA
| | - Marco Pravetoni
- Department of Pharmacology, Center for Immunology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | - Phil Skolnick
- Opiant Pharmaceuticals, Inc., Santa Monica, California, USA
| | - Evan Y Snyder
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California, USA
| | - Nestor Tomycz
- Neuroscience Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Carlos A Valdez
- Lawrence Livermore National Laboratory, Livermore, California, USA
| | - Jim Zapf
- CellCure (Stem Cell Division of CiBots, Inc.), San Diego, California, USA
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7
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LeMoyne R, Mastroianni T, Whiting D, Tomycz N. Parametric evaluation of deep brain stimulation parameter configurations for Parkinson's disease using a conformal wearable and wireless inertial sensor system and machine learning. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:3606-3611. [PMID: 33018783 DOI: 10.1109/embc44109.2020.9175408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Deep brain stimulation enables highly specified patient-unique therapeutic intervention ameliorating the symptoms of Parkinson's disease. Inherent to the efficacy of deep brain stimulation is the acquisition of an optimal parameter configuration. Using conventional methods, the optimization process for tuning the deep brain stimulation system parameters can intrinsically induce strain on clinical resources. An advanced means of quantifying Parkinson's hand tremor and distinguishing between parameter settings would be highly beneficial. The conformal wearable and wireless inertial sensor system, such as the BioStamp nPoint, has a volumetric profile on the order of a bandage that readily enables convenient quantification of Parkinson's disease hand tremor. Furthermore, the BioStamp nPoint has been certified by the FDA as a 510(k) medical device for acquisition of medical grade data. Parametric variation of the amplitude parameter for deep brain stimulation can be quantified through the BioStamp nPoint conformal wearable and wireless inertial sensor system mounted to the dorsum of the hand. The acquired inertial sensor signal data can be wirelessly transmitted to a secure Cloud computing environment for post-processing. The quantified inertial sensor data for the parametric study of the effects of varying amplitude can be distinguished through machine learning classification. Software automation through Python can consolidate the inertial sensor data into a suitable feature set format. Using the multilayer perceptron neural network considerable machine learning classification accuracy is attained to distinguish multiple parametric settings of amplitude for deep brain stimulation, such as 4.0 mA, 2.5 mA, 1.0 mA, and 'Off' status representing a baseline. These findings constitute an advance toward the pathway of attaining real-time closed loop automated parameter configuration tuning for treatment of Parkinson's disease using deep brain stimulation.
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Schnitzler A, Mir P, Brodsky M, Verhagen L, Groppa S, Alvarez R, Evans A, Blazquez M, Nagel S, Pilitsis J, Pötter-Nerger M, Tse W, Almeida L, Tomycz N, Jimenez-Shahed J, Carrillo F, Hartmann C, Groiss S, Defresne F, Karst E, Cheeran B, Vesper J. Directional versus omnidirectional Deep Brain Stimulation: Results of a multi-cente prospective blinded crossover study. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.084] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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9
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LeMoyne R, Mastroianni T, Whiting D, Tomycz N. Deep Brain Stimulation for the Treatment of Movement Disorder Regarding Parkinson’s Disease and Essential Tremor with Device Characterization. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/978-981-13-5808-1_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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10
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Kovaliov M, Cohen-Karni D, Burridge KA, Mambelli D, Sloane S, Daman N, Xu C, Guth J, Kenneth Wickiser J, Tomycz N, Page RC, Konkolewicz D, Averick S. Grafting strategies for the synthesis of active DNase I polymer biohybrids. Eur Polym J 2018. [DOI: 10.1016/j.eurpolymj.2018.07.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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11
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Bergman J, Dupré D, Tomycz N. New Programming Modes of Spinal Cord Stimulation for Chronic Pain: A Systematic Review of Outcomes with Burst and High-Frequency Technology. IJNS 2018. [DOI: 10.1055/s-0038-1668494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
AbstractSpinal cord stimulation (SCS) is a well-established, evidence-based treatment for chronic pain. For decades, implantation of tonic SCS systems has relied on epidural electric lead placement to overlap regions of pain with paresthesias to achieve maximal postoperative pain relief. During the course of tonic SCS treatment, tolerances to the stimulation frequency may develop, leading to reduced efficacy. Recent developments in novel programming modes, such as high-frequency 10 kHz (HF10) and burst, stray from tonic SCS in their electrical stimulation delivery patterns and unique ability to deliver SCS without engendering paresthesias. To date, no review has analyzed outcomes of both HF10 SCS and burst SCS for chronic back and limb pain. This article aims to review all HF10 and burst SCS prospective observational and randomized controlled trials for chronic back and limb pain. The literature search identified 21 papers—10 HF10 SCS papers, 9 burst SCS papers, and 2 papers assessing both HF10 and burst SCS concurrently. Burst SCS and HF10 SCS have been subjected to randomized controlled studies and have used similar patient pain score reporting on a visual analog scale (VAS) and numeric rating scale (NRS). Results from these studies have reported significant reductions in axial back pain and limb pain in patients sustained for up 20 months with burst SCS treatment and up to 36 months with HF10 SCS. Both novel programming modes show promise as viable treatments for those suffering from chronic pain and/or patients who may no longer be responders to tonic SCS.
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Affiliation(s)
- Jeffrey Bergman
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | - Derrick Dupré
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | - Nestor Tomycz
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
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12
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Mao G, Gigliotti MJ, Angle C, Whiting D, Tomycz N. Craniotomy for subdural hematoma after deep brain stimulation surgery: Outcomes and satisfaction in a case series of two patients. Clin Neurol Neurosurg 2018; 170:53-57. [PMID: 29729543 DOI: 10.1016/j.clineuro.2018.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/07/2018] [Accepted: 04/22/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine whether salvage of DBS hardware is beneficial for Parkinson's Disease (PD) patients by looking at follow-up patient's outcomes and satisfaction after their craniotomy operation. PATIENTS AND METHODS This was a retrospective review of a prospective, single-center deep brain stimulation (DBS) database between 2002-2016 identifying patients with PD who developed subdural hematomas (SDH) due to trauma after their DBS surgery. Of the 636 DBS cases that were performed, 3 PD-DBS patients with significant traumatic SDH managed via craniotomy were identified. Out of these 3 patients, only 2 permitted outcome analysis. At follow-up, functional and neurologic status, UPDRS motor score, and overall satisfaction with DBS were assessed. RESULTS Two patients were followed for a period of 10 and 9 months. At last follow-up, the DBS settings in patient 1 increased from a stimulation amplitude of 3.5 V to 4.5 V on the right and 3.3 V to 6.0 V on the left with an increase in the pulse width as well (70-80 ms and 80-140 ms on the right and left, respectively). Stimulation frequency remained 160 Hz on the right while increasing from 145 to 160 Hz on the left. Patient 2 experienced an increase in stimulation amplitude from 4.5 V to 4.8 V on the right while remaining the same on the left. Pulse width increased from 60 to 70 ms bilaterally as well as the frequency (160-185 Hz bilaterally). Despite craniotomy, both patients experienced substantial improvement in UPDRS motor score with DBS at last follow-up (53-25 and 20-17 for patient 1 and 2, respectively). At last follow-up, CT imaging provided evidence of complete SDH resolution with no persistent hemorrhage, mass effect or any obvious lead displacement. Patients expressed satisfaction with DBS and affirmed that they would undergo surgery again for the same outcome. CONCLUSION Patients with PD are at higher risk for falls and may experience an increased risk of falling associated with SDH in the post-operative period after DBS implantation. Despite brain shift from SDH potentially distorting DBS leads, DBS implants still provided significant benefit in patients requiring craniotomy for SDH and patient satisfaction with DBS remained high. Salvage of DBS hardware is recommended since significant symptomatic improvement with DBS programming may still be attainable even in the setting of emergent craniotomy for SDH.
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Affiliation(s)
- Gordon Mao
- Allegheny General Hospital, Department of Neurosurgery, 420 East North Avenue, Pittsburgh, PA, 15212, USA.
| | - Michael J Gigliotti
- Allegheny General Hospital, Department of Neurosurgery, 420 East North Avenue, Pittsburgh, PA, 15212, USA
| | - Cindy Angle
- Allegheny General Hospital, Department of Neurosurgery, 420 East North Avenue, Pittsburgh, PA, 15212, USA
| | - Donald Whiting
- Allegheny General Hospital, Department of Neurosurgery, 420 East North Avenue, Pittsburgh, PA, 15212, USA
| | - Nestor Tomycz
- Allegheny General Hospital, Department of Neurosurgery, 420 East North Avenue, Pittsburgh, PA, 15212, USA
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Dupré DA, Tomycz N, Whiting D, Oh M. Spinal Cord Stimulator Explantation: Motives for Removal of Surgically Placed Paddle Systems. Pain Pract 2017; 18:500-504. [DOI: 10.1111/papr.12639] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Derrick A. Dupré
- Department of Neurosurgery; Allegheny General Hospital; Pittsburgh Pennsylvania U.S.A
| | - Nestor Tomycz
- Department of Neurosurgery; Allegheny General Hospital; Pittsburgh Pennsylvania U.S.A
| | - Donald Whiting
- Department of Neurosurgery; Allegheny General Hospital; Pittsburgh Pennsylvania U.S.A
| | - Michael Oh
- Department of Neurosurgery; Allegheny General Hospital; Pittsburgh Pennsylvania U.S.A
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Kovaliov M, Li S, Korkmaz E, Cohen-Karni D, Tomycz N, Ozdoganlar OB, Averick S. Extended-release of opioids using fentanyl-based polymeric nanoparticles for enhanced pain management. RSC Adv 2017. [DOI: 10.1039/c7ra08450a] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Fentanyl-terminated polyesters provide linear release of therapeutics with an effective antinociceptive effect in vivo.
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Affiliation(s)
- Marina Kovaliov
- Neuroscience Disruptive Research Lab
- Allegheny Health Network Research Institute
- Allegheny General Hospital
- Pittsburgh
- USA
| | - Shaohua Li
- Neuroscience Disruptive Research Lab
- Allegheny Health Network Research Institute
- Allegheny General Hospital
- Pittsburgh
- USA
| | - Emrullah Korkmaz
- Department of Mechanical Engineering
- Carnegie Mellon University
- Pittsburgh
- USA
| | - Devora Cohen-Karni
- Neuroscience Disruptive Research Lab
- Allegheny Health Network Research Institute
- Allegheny General Hospital
- Pittsburgh
- USA
| | - Nestor Tomycz
- Neuroscience Institute
- Allegheny Health Network
- Allegheny General Hospital
- Pittsburgh
- USA
| | - O. Burak Ozdoganlar
- Department of Mechanical Engineering
- Carnegie Mellon University
- Pittsburgh
- USA
- Department of Biomedical Engineering
| | - Saadyah Averick
- Neuroscience Disruptive Research Lab
- Allegheny Health Network Research Institute
- Allegheny General Hospital
- Pittsburgh
- USA
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Li S, Cohen-Karni D, Kovaliov M, Tomycz N, Cheng B, Whiting D, Averick S. Synthesis and biological evaluation of fentanyl acrylic derivatives. RSC Adv 2017. [DOI: 10.1039/c7ra01346a] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Synthesis and biological evaluation of fentanyl acrylic derivatives.
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Affiliation(s)
- Shaohua Li
- Neuroscience Disruptive Research Lab
- Allegheny Health Network Research Institute
- Allegheny General Hospital
- Pittsburgh
- USA
| | - Devora Cohen-Karni
- Neuroscience Disruptive Research Lab
- Allegheny Health Network Research Institute
- Allegheny General Hospital
- Pittsburgh
- USA
| | - Marina Kovaliov
- Neuroscience Disruptive Research Lab
- Allegheny Health Network Research Institute
- Allegheny General Hospital
- Pittsburgh
- USA
| | - Nestor Tomycz
- Neuroscience Institute
- Allegheny Health Network
- Allegheny General Hospital
- Pittsburgh
- USA
| | - Boyle Cheng
- Neuroscience Institute
- Allegheny Health Network
- Allegheny General Hospital
- Pittsburgh
- USA
| | - Donald Whiting
- Neuroscience Institute
- Allegheny Health Network
- Allegheny General Hospital
- Pittsburgh
- USA
| | - Saadyah Averick
- Neuroscience Disruptive Research Lab
- Allegheny Health Network Research Institute
- Allegheny General Hospital
- Pittsburgh
- USA
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Abstract
The authors review the history of deep brain stimulation (DBS) in patients for treating obesity, describe current DBS targets in the brain, and discuss potential DBS targets and nontraditional stimulation parameters that may improve the effectiveness of DBS for ameliorating obesity. Deep brain stimulation for treating obesity has been performed both in animals and in humans with intriguing preliminary results. The brain is an attractive target for addressing obesity because modulating brain activity may permit influencing both sides of the energy equation--caloric intake and energy expenditure.
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Affiliation(s)
- Derrick A Dupré
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Nestor Tomycz
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Michael Y Oh
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Donald Whiting
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
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Abstract
A posterior fossa intradiploic epidermoid cyst was removed from the calvarium of an otherwise healthy 34-year-old woman after work up for dizziness and blurry vision. The patient admitted to a history of a firm papule that occurred occasionally after a trauma sustained to the region years prior. The authors propose that trauma and cutaneous stigmata are potential associations with intradiploic epidermoid cysts.
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Affiliation(s)
- Derrick Andrew Dupre
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Cunfeng Pu
- Department of Pathology, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Alex Yu
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Nestor Tomycz
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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LeMoyne R, Tomycz N, Mastroianni T, McCandless C, Cozza M, Peduto D. Implementation of a smartphone wireless accelerometer platform for establishing deep brain stimulation treatment efficacy of essential tremor with machine learning. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2015:6772-6775. [PMID: 26737848 DOI: 10.1109/embc.2015.7319948] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Essential tremor (ET) is a highly prevalent movement disorder. Patients with ET exhibit a complex progressive and disabling tremor, and medical management often fails. Deep brain stimulation (DBS) has been successfully applied to this disorder, however there has been no quantifiable way to measure tremor severity or treatment efficacy in this patient population. The quantified amelioration of kinetic tremor via DBS is herein demonstrated through the application of a smartphone (iPhone) as a wireless accelerometer platform. The recorded acceleration signal can be obtained at a setting of the subject's convenience and conveyed by wireless transmission through the Internet for post-processing anywhere in the world. Further post-processing of the acceleration signal can be classified through a machine learning application, such as the support vector machine. Preliminary application of deep brain stimulation with a smartphone for acquisition of a feature set and machine learning for classification has been successfully applied. The support vector machine achieved 100% classification between deep brain stimulation in `on' and `off' mode based on the recording of an accelerometer signal through a smartphone as a wireless accelerometer platform.
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Tormenti M, Tomycz N, Wang T, Fernandez-Miranda J, Snyderman C, Gardner P. Endoscopic Endonasal Resection for Olfactory Groove Meningiomas. Skull Base 2011. [DOI: 10.1055/s-2011-1274280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tomycz N, Prevedello D, Gardner P, Zanation A, Snyderman C, Carrau R, Stefko S, Kassam A. The Endoscopic Endonasal Approach as the Focus of a Multicorridor Operative Strategy for Skull Base Meningiomas: Experience from 100 Cases. Skull Base 2008. [DOI: 10.1055/s-2008-1093200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Walsh E, Saha S, Rao V, Ghanem M, Raiji M, Wiese D, Hammoud J, Bakleh M, Nelson J, Tomycz N. Thyroid cancer (Ca) found during radioguided parathyroidectomy (RP) in hyperparathyroid patients. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.17011] [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: 11/20/2022] Open
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Abstract
Thirty-four patients, most with a low-renin "essential" hypertension, and seven normal subjects were placed on diuretic therapy for 4 to 5 weeks. In the normal subjects, infusion of a highly specific, competitive angiotensin II analogue (1-sar-8-ala-angiotensin II, saralasin) did not significantly change recumbent blood pressure either before or after diuretic administration. In contrast, the hypertensive patients as a group had a low stimulated plasma renin activity before diuretic therapy and a rise in blood pressure during saralasin infusion. After therapy, the stimulated plasma renin activity was higher and saralasin produced a fall in blood pressure in some patients who were still hypertensive. The results suggest that short-term diuretic therapy, which is thought to act through its natriuretic effects, can convert some patients with essential hypertension, many with a low or a low-normal stimulated plasma renin activity, to individuals whose hypertension is supported by angiotensin II. The fall in blood pressure to saralsin infusion after diuretic therapy was directly proportional to the height to which diuretics elevated the stimulated plasma renin activity.
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