The Neurostimulation Appropriateness Consensus Committee (NACC)®: Recommendations for Spinal Cord Stimulation Long-term Outcome Optimization and Salvage Therapy.

INTRODUCTION: The International Neuromodulation Society (INS) has recognized a need to establish best practices for optimizing implantable devices and salvage when ideal outcomes are not realized. This group has established the Neurostimulation Appropriateness Consensus Committee (NACC)® to offer guidance on matters needed for both our members and the broader community of those affected by neuromodulation devices. MATERIALS AND METHODS: The executive committee of the INS nominated faculty for this NACC® publication on the basis of expertise, publications, and career work on the issue. In addition, the faculty was chosen in consideration of diversity and inclusion of different career paths and demographic categories. Once chosen, the faculty was asked to grade current evidence and along with expert opinion create consensus recommendations to address the lapses in information on this topic. RESULTS: The NACC® group established informative and authoritative recommendations on the salvage and optimization of care for those with indwelling devices. The recommendations are based on evidence and expert opinion and will be expected to evolve as new data are generated for each topic. CONCLUSIONS: NACC® guidance should be considered for any patient with less-than-optimal outcomes with a stimulation device implanted for treating chronic pain. Consideration should be given to these consensus points to salvage a potentially failed device before explant.

Multimodal neurocognitive markers of frontal lobe epilepsy: Insights from ecological text processing.

The pressing call to detect sensitive cognitive markers of frontal lobe epilepsy (FLE) remains poorly addressed. Standard frameworks prove nosologically unspecific (as they reveal deficits that also emerge across other epilepsy subtypes), possess low ecological validity, and are rarely supported by multimodal neuroimaging assessments. To bridge these gaps, we examined naturalistic action and non-action text comprehension, combined with structural and functional connectivity measures, in 19 FLE patients, 19 healthy controls, and 20 posterior cortex epilepsy (PCE) patients. Our analyses integrated inferential statistics and data-driven machine-learning classifiers. FLE patients were selectively and specifically impaired in action comprehension, irrespective of their neuropsychological profile. These deficits selectively and specifically correlated with (a) reduced integrity of the anterior thalamic radiation, a subcortical structure underlying motoric and action-language processing as well as epileptic seizure spread in this subtype; and (b) hypoconnectivity between the primary motor cortex and the left-parietal/supramarginal regions, two putative substrates of action-language comprehension. Moreover, machine-learning classifiers based on the above neurocognitive measures yielded 75% accuracy rates in discriminating individual FLE patients from both controls and PCE patients. Briefly, action-text assessments, combined with structural and functional connectivity measures, seem to capture ecological cognitive deficits that are specific to FLE, opening new avenues for discriminatory characterizations among epilepsy types.

Structural and functional motor-network disruptions predict selective action-concept deficits: Evidence from frontal lobe epilepsy.

Built on neurodegenerative lesions models, the disrupted motor grounding hypothesis (DMGH) posits that motor-system alterations selectively impair action comprehension. However, major doubts remain concerning the dissociability, neural signatures, and etiological generalizability of such deficits. Few studies have compared action-concept outcomes between disorders affecting and sparing motor circuitry, and none has examined their multimodal network predictors via data-driven approaches. Here, we first assessed action- and object-concept processing in patients with frontal lobe epilepsy (FLE), patients with posterior cortex epilepsy (PCE), and healthy controls. Then, we examined structural and functional network signatures via diffusion tensor imaging and resting-state connectivity measures. Finally, we used these measures to predict behavioral performance with an XGBoost machine learning regression algorithm. Relative to controls, FLE (but not PCE) patients exhibited selective action-concept deficits together with structural and functional abnormalities along motor networks. The XGBoost model reached a significantly large effect size only for action-concept outcomes in FLE, mainly predicted by structural (cortico-spinal tract, anterior thalamic radiation, uncinate fasciculus) and functional (M1-parietal/supramarginal connectivity) motor networks. These results extend the DMGH, suggesting that action-concept deficits are dissociable markers of frontal/motor (relative to posterior) disruptions, directly related to the structural and functional integrity of motor networks, and traceable beyond canonical movement disorders.

Optical character recognition reading aid for the visually impaired.

OBJECTIVE: An optical character recognition (OCR) reading machine is a significant help for visually impaired patients. MATERIALS AND METHODS: An OCR reading machine is used. DISCUSSION: This instrument can provide a significant help in order to improve the quality of life of patients with low vision or blindness.

Impacto de la Pandemia de COVID-19 en la Práctica de la Neuromodulación en Argentina / Impact of the COVID-19 Pandemic on the Practice of Neuromodulation in Argentina

Introducción: El objetivo de este estudio fue evaluar el impacto de la pandemia de Covid-19 en la práctica de la Neuromodulación en Argentina. Material y Métodos: Se envió una encuesta a los profesionales que practican la Neuromodulación en Argentina entre el 19 de julio al 20 de agosto de 2020. Se determinó el impacto de Covid-19 a nivel profesional y personal. Todas las variables fueron comparadas y analizadas. Resultados: Veinticuatro profesionales respondieron a la encuesta completa. La mayoría de ellos eran varones (87,5%), en el grupo de edad de 45 a 59 años (37,5%), con 15 o más años de experiencia (45,83%). Los neurocirujanos fueron la mayoría (87,5%), siendo las técnicas ablativas la práctica predominante (26,47%). La gran mayoría informó una disminución de las prácticas quirúrgicas (83,33%), entre el 50 y el 74% de ellas (40%), siendo la decisión del financiador la razón única más citada (43,47%) y la Estimulación Cerebral Profunda, la técnica quirúrgica más afectada (41,6%). El 100% de los entrevistados declaró que los pacientes habían sido perjudicados por la suspensión de cirugías y que los ingresos económicos se redujeron de alguna manera, también en el 100% de los encuestados. A nivel personal, ninguno de los profesionales reportaron haber sido diagnosticados de la enfermedad. Sin embargo, el 37,5% sufrió algún otro tipo de daño a nivel físico y el 20,83% informó secuelas psicológicas, especialmente ansiedad. Conclusión: La actual pandemia de Covid-19 ha tenido un impacto muy significativo en la práctica de la Neuromodulación en Argentina, tanto a nivel profesional como personal. Este impacto debe ser tenido en cuenta en el futuro, en caso de una nueva pandemia, para prevenir los efectos nocivos que se registraron en este estudio

Background: The objective of this study was to evaluate the impact of the Covid-19 outbreak in the practice of Neuromodulation in Argentina. Methods: A survey was sent to Argentina neuromodulation practitioners from July 19 to August 20, 2020. The impact of Covid-19 on the professional and personal level were determined. All variables were compared and analyzed. Results: Twenty-four practitioners responded to the complete survey. Most of them were male (87.5%), in the 45-59 year age group (37.5%), with 15 or more years of experience (45.83%). Neurosurgeons were in the majority (87.5%), with ablative techniques being the predominant practice (26.47%). The great majority reported a decrease in surgical practices (83.33%), between 50 and 74% of them (40%), with the decision of the financer being the most cited reason (43.47%), and Deep Brain Stimulation the most affected surgical technique (41.6%). 100% of the interviewed declared that the patients had been harmed by the suspension of surgeries, and that the economic income was reduced in some way in 100% of the interviewed. On a personal level, none of the professionals reported having been diagnosed with the disease. However, 37.5% suffered physical manifestations, and 20.83% reported psychological sequelae, especially anxiety. Conclusion: The current Covid-19 pandemic yielded a significant impact on the daily work practice as well as on the personal level of practitioners in neuromodulation in Argentina. This impact must be taken into account in the long term to avoid further harmful effects and their sequels and to take appropriate preventive measures in the event of another pandemic

Microvascular anatomy of the cerebellar parafloccular perforating space.

OBJECTIVE: The cerebellopontine angle is a common site for tumor growth and vascular pathologies requiring surgical manipulations that jeopardize cranial nerve integrity and cerebellar and brainstem perfusion. To date, a detailed study of vessels perforating the cisternal surface of the middle cerebellar peduncle-namely, the paraflocculus or parafloccular perforating space-has yet to be published. In this report, the perforating vessels of the anterior inferior cerebellar artery (AICA) in the parafloccular space, or on the cisternal surface of the middle cerebellar peduncle, are described to elucidate their relevance pertaining to microsurgery and the different pathologies that occur at the cerebellopontine angle. METHODS: Fourteen cadaveric cerebellopontine cisterns (CPCs) were studied. Anatomical dissections and analysis of the perforating arteries of the AICA and posterior inferior cerebellar artery at the parafloccular space were recorded using direct visualization by surgical microscope, optical histology, and scanning electron microscope. A comprehensive review of the English-language and Spanish-language literature was also performed, and findings related to anatomy, histology, physiology, neurology, neuroradiology, microsurgery, and endovascular surgery pertaining to the cerebellar flocculus or parafloccular spaces are summarized. RESULTS: A total of 298 perforating arteries were found in the dissected specimens, with a minimum of 15 to a maximum of 26 vessels per parafloccular perforating space. The average outer diameter of the cisternal portion of the perforating arteries was 0.11 ± 0.042 mm (mean ± SD) and the average length was 2.84 ± 1.2 mm. Detailed schematics and the surgical anatomy of the perforating vessels at the CPC and their clinical relevance are reported. CONCLUSIONS: The parafloccular space is a key entry point for many perforating vessels toward the middle cerebellar peduncle and lateral brainstem, and it must be respected and protected during surgical approaches to the cerebellopontine angle.

Neuromodulatory effect of progesterone on the dopaminergic, glutamatergic, and GABAergic activities in a male rat model of Parkinson's disease.

OBJECTIVES: Progesterone has been reported to have a neuroprotective role in depression-like rats in a hemiparkinsonian model of the disease. In this work, we investigate if this hormone affects the three principal neurochemicals striatal systems (dopaminergic, glutamatergic, and GABAergic) that are involved in the physiopathology of the disease in a hemiparkinsonim male rat model at 8 weeks post-chemical injury. METHODS: For this purpose, we design three experimental groups: (1) sham group; (2) hemiparkinsonian group; and (3) hemiparkinsonian group subcutaneously injected with progesterone at 7 days post-chemical injury. Animals were tested in an automated rotational device at 8 weeks post-chemical injury. After behavioral test, K(+)-evoked [(3)H]-dopamine, [(3)H]-glutamate, and [(3)H]-gamma aminobutyric acid release from striatum slices were analyzed by superfusion experiments. RESULTS: The hemiparkinsonian group showed distinctive alterations that are produced by neurodegeneration of left nigrostriatal dopaminergic pathway by 6-hydroxydopamine hydrobromide (6-OHDA). On the other hand, the administration of progesterone 7 days after the injection of the neurotoxin was able to (1) improve the K(+)-evoked [(3)H]-dopamine release from the damaged striata (left); (2) avoid significant increase in the K(+)-evoked [(3)H]-glutamate release from the left striata; and (3) progesterone does not modify the K(+)-evoked [(3)H]-gamma aminobutyric acid release from the left striata. DISCUSSION: These results suggest that progesterone does have neuroprotective and neuromodulatory effects on striatal neurotransmission systems in the hemiparkinsonian male rats. The possible mechanisms would involve genomic and non-genomic actions of this neuroactive steroid which would modulate the activity of dopaminergic, glutamatergic, and GABAergic pathways.

Evaluación de la exposición a campos electromagnéticos de radiofrecuencia en ámbitos académicos / Exposure assessment of radiofrecuency electromagnetic fields in academic areas

Introducción: Las radiaciones no ionizantes no poseen el nivel de energía requerido para producir ionización en los tejidos o causar daño al DNA, pero pueden generar efectos térmicos y no térmicos en la salud de los seres humanos que son actualmente motivo de estudio y discusión. Gran parte de la actividad cotidiana en ámbitos académicos se desarrolla bajo la influencia de innumerables radiaciones. Objetivo: Evaluar y determinar el nivel de exposición a las radiaciones no ionizantes en ámbitos académicos de la Universidad Nacional de La Plata, Argentina. Metodología: Las mediciones fueron realizadas mediante el instrumento marca Narda® NBM 550 con sonda de medición isotrópica en la banda de 100 kHz a 3 GHz. Se realizaron mediciones exteriores (outdoor) en diferentes facultades de la Universidad Nacional de La Plata. En la facultad de Ciencias Médicas se efectuaron mediciones interiores (indoor). En esta última se seleccionaron tres ambientes para determinar las principales fuentes de emisión. Resultados: Los valores máximos obtenidos de las mediciones se encontraron por debajo del valor máximo permitido de 0,2 mW/cm2. En la facultad de Ciencias Médicas se realizaron mediciones específicas en dos lugares de alto tránsito y uno de varias horas de permanencia en el lugar de exposición. El procesamiento de los datos reveló que las mediciones específicas a 20 cm de los artefactos eléctricos de iluminación fueron superiores al máximo permitido. Discusión: Si bien los resultados de las mediciones exteriores realizadas en los diversos ámbitos académicos se encuentran dentro de los valores permitidos, es recomendable que las mediciones se efectúen en forma anual, además de instalar fuentes de bajas emisiones

Introduction: Non-ionizing radiation does not have the level of energy required to produce ionization in tissues or cause DNA damage, but can generate thermal and non-thermal effects on human health that are currently the subject of study and discussion. Much of the daily activity in academic areas is performed under the influence of innumerable radiations. Objective: Evaluate the exposure levels to non-ionizing radiation in academic and sensitive areas in different faculties of the National University of La Plata, Argentina. Methodology: The measurements were made using the Narda® NBM 550 instrument with an isotropic measurement probe in the 100 kHz band at 3 GHz. Seven exterior measurements were taken (outdoor) in different Faculties: In the Faculty of Medical Sciences internal (indoor) measurements were made. Of the latter, three environments were selected to determine the main sources of emission. Results: The maximum values obtained from the external and internal measurements were found below the maximum value of 0.2 mW / cm2. At the Faculty of Medical Sciences, specific measurements were made on two sites of high circulation and on one of several hours of permanence at the place of exposure. Data processing revealed that the specific measurements at 20 cm of the electric lighting fixtures were higher than the maximum allowed. Discussion: It can be inferred that although the results of the external measurements made in the different academic fields are within the allowed values, it is recommended that the measurements be made annually and the use of low emission sources

Lesiones craneofaciales producidas en hockey sobre patines / Cranio-facial injuries due to roller hockey playing

Objetivo. Los principales objetivos son obtener registros estadísticos acerca de la incidencia, mecanismos, severidad y tipo más frecuente de lesiones cráneo faciales debido a la práctica de hockey sobre patines, para mostrar el grado de rudeza de este deporte, evaluando la necesidad de revisar las reglas del juego y sugerir nuevas medidas de seguridad. Material y método. Presentamos las cifras estadísticas obtenidas de 119 partidos del Campeonato Mendocino (Argentina) jugado entre 2004 y 2005, con un seguimiento de 18 meses. Se utilizó un test standard Resultados. Encontramos 85 lesiones en 54 partidos; el 59% fueron producidas en la primer mitad del juego, el 41% restante en el segundo tiempo; los forwards recibieron el 48% de las lesiones, los backs 44% y los arqueros 9%. Las estructuras afectadas fueron: cara (61%), región frontal, (15%), columna cervical (7%), región parietal (6%), región temporal (6%) y región occipital (5%). La mayoría involucra estructuras faciales donde: labios (37%), nariz (25%), órbita (21%) y mentón (11%). Las lesiones fueron debidas al palo (39%), el codo (24%), la pelota (21%), el patín (5%), la cabeza (4%), la pared (4%) y finalmente, el hombro (1%).Un 26% de los jugadores lastimados no pudieron seguir jugando; 26% de los lesionados necesitaron intervención médica en el campo de juego; 16% fueron trasladados al hospital (70% permanecieron en observación); 64% de las lesiones fueron contusión, 36% heridas cortantes (sutira quirúrgica 77% y química 33%); 3% de las lesiones estuvieron asociadas con pérdida de la conciencia; se registraron 8 fracturas.Conclusión. Estos datos epidemiológicos confirman la necesidad de revisar y reconsiderar las reglas del juego y su seguridad.

Objectives: Research on this topic is carried out because no statistical records are available in order to conduct epidemiological studies. The main objectives are to obtain statistical records regarding the incidence, mechanisms, severity, and most frequent cranio-facial injuries due to the practice of roller hockey, to show the degree of roughness of this sport, assessing the need to revise the rules of the game, suggesting new safety precautions for this sport. Material and Method: The methodology is based on statistical figures obtained from 119 matches of the Mendoza (Argentina)Championship played between 2004 and 2005, with a follow up of 18 months. A standard test was used. Results: We found 85 injuries in 54 matches; 59% of the lesions were produced in the first half of the game, the 41% remaining inthe second half; the forwards received 48% of the lesions, the back 44% and the goalkeepers 9%. The affected structures were: face (61%), frontal region (15%), cervical spine (7%), parietal region (6%), temporal region (6%) and occipital region (5%). Mostinvolved facial structures were: lips (37%), nose (25%), eye socket (21%) and chin (11%). The injuries were due to the stick (39%), the elbow (24%), the ball (21%), the skate (5%), the head (4%), the wall (4%) and last the shoulder (1%). A 26% of injured players were not able to continue playing; 26% of injured players needed medical intervention on the game field; 16% were taken to a hospital (70%remained under observation); 64% of lesions were contusion, 36% were cutting wounds (surgical suture 77% and chemical suture 33%); 3% of lesions were associated with loss of consciousness; 8 fractures were registered. Conclusion: Epidemiological data confirm the need to revise and reconsider the rules of the game and their safety.