End of Life in Boys and Young Men With Duchenne Muscular Dystrophy - The Perspective of Dying Men and Their Families: A Systematic Review and Thematic Synthesis of Qualitative Evidence.

Understanding the perceptions and experiences related to the end of life (EoL) of boys and men with Duchenne muscular dystrophy from their own and/or family perspective is limited based on the available qualitative empirical studies. This systematic review was done with a thematic synthesis of qualitative evidence according to the PRISMA Statement Guidelines and the SPIDER search tool. The review included empirical, qualitative, and relevant full-text studies published in 2000-2023 in the EBSCO Discovery Service, ISI Web of Science, Scopus, PubMed, and ProQuest databases. From o total of eight included qualitative studies, four main key themes were identified: "Being a parent/caregiver" - psychosocial aspects, needs, and experiences; "Communication about EoL with healthcare and other professionals" - positive experiences and personal shortcomings; "Discussions about…" - the issue of EoL, dying and death; and "End of life" - end-of-life care, planning and the need for palliative care.

Vagus nerve stimulation outcome prediction: from simple parameters to advanced models.

Since its approval as an adjunct treatment for refractory partial epilepsy, the positive effects of vagus nerve stimulation (VNS) on seizure frequency and severity have been supported by many studies. Seizure reduction of more than 50 % can be expected in at least 50 % of patients. However, a complete post-VNS seizure freedom is rarely achieved and 25 % of patients do not benefit from VNS. Our study provides an overview of the potential predictors of VNS response, from the most simple and basic data to sophisticated EEG processing studies and functional imaging studying brain connectivity. The data support better outcomes in younger patients with early VNS implantation, in patients with posttraumatic epilepsy or tuberous sclerosis, and in patients without bilateral interictal epileptiform discharges. The variability of heart activity has also been studied with some promising results. Because the generally accepted hypothesis of the VNS mechanism is the modulation of synaptic activity in multiple cortical and subcortical regions of the brain, the studies of brain response to external stimulation and/or of brain connectivity were used for models predicting the effect of VNS in individual patients. Although the predictive value of these models is high, the required special equipment and sophisticated mathematical tools limit their routine use (Ref. 58). Keywords: epilepsy, vagus nerve stimulation, response predictor, EEG.

Mozart effect in epilepsy: Why is Mozart better than Haydn? Acoustic qualities-based analysis of stereoelectroencephalography.

BACKGROUND AND PURPOSE: We aimed to confirm the Mozart effect in epileptic patients using intracerebral electroencephalography recordings and the hypothesis that the reduction of epileptiform discharges (EDs) can be explained by the music's acoustic properties. METHODS: Eighteen epilepsy surgery candidates were implanted with depth electrodes in the temporal medial and lateral cortex. Patients listened to the first movement of Mozart's Sonata for Two Pianos K. 448 and to the first movement of Haydn's Symphony No. 94. Musical features from each composition with respect to rhythm, melody, and harmony were analyzed. RESULTS: Epileptiform discharges in intracerebral electroencephalography were reduced by Mozart's music. Listening to Haydn's music led to reduced EDs only in women; in men, the EDs increased. The acoustic analysis revealed that nondissonant music with a harmonic spectrum and decreasing tempo with significant high-frequency parts has a reducing effect on EDs in men. To reduce EDs in women, the music should additionally be gradually less dynamic in terms of loudness. Finally, we were able to demonstrate that these acoustic characteristics are more dominant in Mozart's music than in Haydn's music. CONCLUSIONS: We confirmed the reduction of intracerebral EDs while listening to classical music. An analysis of the musical features revealed that the acoustic characteristics of music are responsible for suppressing brain epileptic activity. Based on our study, we suggest studying the use of musical pieces with well-defined acoustic properties as an alternative noninvasive method to reduce epileptic activity in patients with epilepsy.

Memory outcomes of temporal lobe surgery in adults aged over 45 years.

OBJECTIVE: It is assumed that temporal lobe resection in older people is associated with worse seizure outcomes and potential postsurgical memory decline. We studied postsurgical memory development and surgical efficacy in patients over 45 years of age compared with younger patients. METHODS: We studied 88 patients (51 male and 37 female) after temporal lobe surgery, which involved hippocampal resection. The patients were evaluated before surgery and in the first (72 patients) and/or third (57 patients) postsurgical year. The Wechsler Memory Scale III test was performed to evaluate the MQ postsurgical development. Engel's classification was used to evaluate the postsurgical seizure outcome. RESULTS: The presurgical MQ (median 88) in ≥45 years age group was significantly lower than in both younger groups (median MQ = 100 for ≤30 years age group, p = 0.002; median MQ = 107 for 31-44 years age group, p = 0.002). Three years after the surgery, the MQ decreased significantly in ≤30 years age group (p = 0.012), while only non-significant MQ decline was observed in both older groups. We found no significant impact of age on the surgical outcome. CONCLUSION: Higher age at the time of surgery does not significantly increase the risk for postsurgical memory decline; however, older patients are more likely to have lowered presurgical MQ. We did not find significant differences in the impact of surgery on seizure outcome among the age groups. Epilepsy surgery appears to be a safe and effective method in the age over 45 years even though an earlier surgery should be preferred.

Successful asymmetrical deep brain stimulation using right subthalamic and left pallidal electrodes in a patient with Parkinson's disease.

PURPOSE: Despite the best efforts of neurologists, the results of pharmacotherapy in the late stages of Parkinson's disease are often disappointing and accompanied by debilitating side effects. Under these circumstances, deep brain stimulation is a viable treatment option. The aim of the meticulous pre-surgical planning is not only precise electrode implantation, but also the avoidance of intraoperative vascular conflicts potentially causing intracerebral bleeding. MATERIAL AND METHODS: In this report, we present a patient with early-onset Parkinson's disease whose cerebral vascular anatomy precluded standard bilateral subthalamic nucleus electrode implantation. Initially, right subthalamic stimulation alone provided a very mild clinical benefit that was not reflected in the patient's quality of life. In this patient, an unusual configuration of intracerebral electrodes with right subthalamic and left pallidal stimulation electrodes was applied 15 months after the initial subthalamic electrode implantation. RESULTS: The procedure has had a highly beneficial long-term effect without any significant complications. The greatest improvement was noted using the setting 1.8 V, 130 Hz, 90 µs at the right side (STN) and 3.7 V, 130 Hz, 120 µs at the left side (GPi). This allowed the patient to return to his daily life activities. CONCLUSIONS: The reported case provides a new perspective of treatment possibilities in complex functional neurosurgical cases requiring exceptional individualisation of the treatment approach.

Title analysis of (systematic) scoping review studies: Chaos or consistency?

The scoping review is one of the alternatives of producing a literature review. However, this approach still lacks a clearly accepted definition, and the scoping terminology is also somewhat fuzzy. Although the methodology of scoping review processing is relatively uniform, terminological chaos appears in the titles of studies with scoping review methodology. This paper presents an analysis of selected published studies with a focus on the content of their titles. A total of 13 thematic dimensions were identified covering the content of titles that show a degree of inconsistency and frequent terminological and methodological "chaos." This study includes a broad scope of themes and areas for which scoping reviews were produced. We would like to recommend to authors (especially scoping review beginners) to - if not necessary or desirable - avoid introducing new concepts and specifications of titles of produced and published scoping review studies. In the case of literature reviews and knowledge synthesis it is necessary to search according to specific keywords and search phrases - more fragmented scoping review terminology makes literature search more difficult or even impossible.

Very high-frequency oscillations: Novel biomarkers of the epileptogenic zone.

OBJECTIVE: In the present study, we aimed to investigate depth electroencephalographic (EEG) recordings in a large cohort of patients with drug-resistant epilepsy and to focus on interictal very high-frequency oscillations (VHFOs) between 500Hz and 2kHz. We hypothesized that interictal VHFOs are more specific biomarkers for epileptogenic zone compared to traditional HFOs. METHODS: Forty patients with focal epilepsy who underwent presurgical stereo-EEG (SEEG) were included in the study. SEEG data were recorded with a sampling rate of 25kHz, and a 30-minute resting period was analyzed for each patient. Ten patients met selected criteria for analyses of correlations with surgical outcome: detection of interictal ripples (Rs), fast ripples (FRs), and VHFOs; resective surgery; and at least 1 year of postoperative follow-up. Using power envelope computation and visual inspection of power distribution matrixes, electrode contacts with HFOs and VHFOs were detected and analyzed. RESULTS: Interictal very fast ripples (VFRs; 500-1,000Hz) were detected in 23 of 40 patients and ultrafast ripples (UFRs; 1,000-2,000Hz) in almost half of investigated subjects (n = 19). VFRs and UFRs were observed only in patients with temporal lobe epilepsy and were recorded exclusively from mesiotemporal structures. The UFRs were more spatially restricted in the brain than lower-frequency HFOs. When compared to R oscillations, significantly better outcomes were observed in patients with a higher percentage of removed contacts containing FRs, VFRs, and UFRs. INTERPRETATION: Interictal VHFOs are relatively frequent abnormal phenomena in patients with epilepsy, and appear to be more specific biomarkers for epileptogenic zone when compared to traditional HFOs. Ann Neurol 2017;82:299-310.

Oscillatory reactivity to effortful cognitive processing in the subthalamic nucleus and internal pallidum: a depth electrode EEG study.

This study investigates how complex motor-cognitive activities are processed in the subthalamic nucleus (STN) and internal globus pallidum (GPi), as adverse neuropsychiatric effects may accompany deep brain stimulation (DBS), mainly in Parkinson's disease (PD) and STN-DBS. Dystonia patients with GPi-DBS electrodes (n = 5) and PD subjects (n = 5) with STN-DBS electrodes performed two tasks: (1) copying letters; and (2) writing any letter other than that appearing on the monitor. The cognitive load of the second task was greater than that of the first. Intracranial local field potentials (LFPs) were analysed. A beta power decrease was the main correlate of the enhanced cognitive load during the second task in both structures, with a lateralization to the left side, mainly in the GPi. A gamma power increase linked with the increased cognitive activity was observed only in the STN. Differences were also observed in the theta and alpha bandpasses. Beta ERD reactivity seems to be essential during the processing of complex motor-cognitive tasks, increases with enhanced cognitive effort, and was observed in both the STN and GPi. Oscillatory reactivity to effortful cognitive processing in other frequency bands was less consistent, with differences between the studied nuclei. Lateralization of activity related to cognitive factors was observed mainly in the GPi.

Atypical handedness in mesial temporal lobe epilepsy.

OBJECTIVE: The main aim of our study was to investigate the handedness of patients with mesial temporal lobe epilepsy (MTLE). We also sought to identify clinical variables that correlated with left-handedness in this population. METHODS: Handedness (laterality quotient) was assessed in 73 consecutive patients with MTLE associated with unilateral hippocampal sclerosis (HS) using the Edinburgh Handedness Inventory. Associations between right- and left-handedness and clinical variables were investigated. RESULTS: We found that 54 (74.0%) patients were right-handed, and 19 (26%) patients were left-handed. There were 15 (36.6%) left-handed patients with left-sided seizure onset compared to 4 (12.5%) left-handed patients with right-sided seizure onset (p=0.030). Among patients with left-sided MTLE, age at epilepsy onset was significantly correlated with handedness (8years of age [median; min-max 0.5-17] in left-handers versus 15years of age [median; min-max 3-30] in right-handers (p<0.001). CONCLUSIONS: Left-sided MTLE is associated with atypical handedness, especially when seizure onset occurs during an active period of brain development, suggesting a bi-hemispheric neuroplastic process for establishing motor dominance in patients with early-onset left-sided MTLE.

Long-term approach to patients with postsurgical seizures.

OBJECTIVE: The main purpose of the study was to analyze the long-term outcomes and therapeutic approaches for patients with seizures within the first year after surgery. The secondary aim of the study was to evaluate the relationship between 1-year outcome and long-term outcome and choice of therapy. METHODS: Our study was a retrospective investigation of the long-term outcomes of 95 patients (33.5% of all surgically treated patients) with seizure recurrence in the first year after surgery. The patients had follow-up visits for >5 years. RESULTS: At the 5-year follow-up visit (FU5), 28 (29.5%) of the 95 patients were completely seizure-free (International League Against Epilepsy (ILAE) class 1), 17 (17.9%) had auras only (ILAE class 2), and 21 (22.1%) were unimproved (ILAE classes 5 and 6). Statistically significant factors for these long-term outcomes were the focus localization of the epilepsy, preoperative MRI findings, and postoperative follow-up results in the first year. The patients with <3 seizure days in the first postoperative year (ILAE 3) represented 53.6% of the seizure-free patients at FU5; the patients with auras in the first year constituted 64.7% of the patients with only auras at FU5; and the patients unimproved in the first year represented 76.2% of the unimproved patients at FU5. SIGNIFICANCE: Postoperative outcome depends to a certain extent on the outcome achieved in the first postoperative year. More than one third of the patients with postoperative seizures reached a long-term seizure-free outcome, and more than half of them did not experience disabling seizures in the last outcome year. The most therapeutic options were used in patients who were minimally influenced by the operation; the majority of patients with considerable improvement because of the operation do not use any other add-on antiepileptic drugs or other kinds of therapy.

Differences between mesial and neocortical magnetic-resonance-imaging-negative temporal lobe epilepsy.

OBJECTIVE: The aim of this study was to assess clinical and electrophysiological differences within a group of patients with magnetic-resonance-imaging-negative temporal lobe epilepsy (MRI-negative TLE) according to seizure onset zone (SOZ) localization in invasive EEG (IEEG). METHODS: According to SOZ localization in IEEG, 20 patients with MRI-negative TLE were divided into either having mesial SOZ-mesial MRI-negative TLE or neocortical SOZ-neocortical MRI-negative TLE. We evaluated for differences between these groups in demographic data, localization of interictal epileptiform discharges (IEDs), and the ictal onset pattern in semiinvasive EEG and in ictal semiology. RESULTS: Thirteen of the 20 patients (65%) had mesial MRI-negative TLE and 7 of the 20 patients (35%) had neocortical MRI-negative TLE. The differences between mesial MRI-negative TLE and neocortical MRI-negative TLE were identified in the distribution of IEDs and in the ictal onset pattern in semiinvasive EEG. The patients with neocortical MRI-negative TLE tended to have more IEDs localized outside the anterotemporal region (p=0.031) and more seizures without clear lateralization of ictal activity (p=0.044). No other differences regarding demographic data, seizure semiology, surgical outcome, or histopathological findings were found. CONCLUSIONS: According to the localization of the SOZ, MRI-negative TLE had two subgroups: mesial MRI-negative TLE and neocortical MRI-negative TLE. The groups could be partially distinguished by an analysis of their noninvasive data (distribution of IEDs and lateralization of ictal activity). This differentiation might have an impact on the surgical approach.

[Surgeons and Neurosurgeons as Nobel Prize Winners]. / Chirurgové a neurochirurgové jako laureáti Nobelovy ceny.

Since 1901 Nobel Prize is awarded for exceptional achievements in physics, chemistry, literature, peace, economy (since 1968) and medicine or physiology. The first aim of the paper is to provide an overview of surgeons - winners of Nobel Prize for medicine or physiology. Although the prominent neurosurgeons were frequently nominated as Nobel Prize candidates, surprisingly no neurosurgeon received this prestigious award so far despite that the results of their research transgressed the relatively narrow limits of neurosurgical speciality.The most prominent leaders in the field of neurosurgery, such as Victor Horsley, Otfrid Foerster, Walter Dandy and Harvey Cushing are discussed from the point of their nominations. The overview of the activity of the Portuguese neurologists and Nobel Prize Winter in 1949 Egas Moniz (occasionally erroneously reported as neurosurgeon) is also provided. Although his work on brain angiography has fundamentally changed the diagnostic possibilities in neurology and neurosurgery, he was eventually awarded Nobel Prize for the introduction of the currently outdated frontal lobotomy.The fact that none of the above mentioned prominent neurosurgeons has not been recognised by Nobel Prize, may be attributed to the fact that their extensive work cannot be captured in a short summary pinpointing its groundbreaking character.

Complex motor-cognitive factors processed in the anterior nucleus of the thalamus: an intracerebral recording study.

Cognitive adverse effects were reported after the deep brain stimulation (DBS) of the anterior nucleus of the thalamus (AN) in epilepsy. As the AN may have an influence on widespread neocortical networks, we hypothesized that the AN, in addition to its participation in memory processing, may also participate in cognitive activities linked with the frontal neocortical structures. The aim of this study was to investigate whether the AN might participate in complex motor-cognitive activities. Three pharmacoresistant epilepsy patients implanted with AN-DBS electrodes performed two tasks involving the writing of single letters: (1) copying letters from a monitor; and (2) writing of any letter other than that appearing on the monitor. The cognitive load of the second task was increased. The task-related oscillatory changes and evoked potentials were assessed. Local event-related alpha and beta desynchronization were more expressed during the second task while the lower gamma synchronization decreased. The local field event-related potentials were elicited by the two tasks without any specific differences. The AN participates in cognitive networks processing complex motor-cognitive tasks. Attention should be paid to executive functions in subjects undergoing AN-DBS.

Mismatch negativity-like potential (MMN-like) in the subthalamic nuclei in Parkinson's disease patients.

An infrequent change to an otherwise repetitive sequence of stimuli leads to the generation of mismatch negativity (MMN), even in the absence of attention. This evoked negative response occurs in the scalp-recorded electroencephalogram (EEG) over the temporal and frontal cortices, 100-250 ms after onset of the deviant stimulus. The MMN is used to detect sensory information processing. The aim of our study was to investigate whether MMN can be recorded in the subthalamic nuclei (STN) as evidence of auditory information processing on an unconscious level within this structure. To our knowledge, MMN has never been recorded in the human STN. We recorded intracerebral EEG using a MMN paradigm in five patients with Parkinson's disease (PD) who were implanted with depth electrodes in the subthalamic nuclei (STN). We found far-field MMN when intracerebral contacts were connected to an extracranial reference electrode. In all five PD patients (and nine of ten intracerebral electrodes), we also found near-field MMN-like potentials when intracerebral contacts were referenced to one another, and in some electrodes, we observed phase reversals in these potentials. The mean time-to-peak latency of the intracerebral MMN-like potentials was 214 ± 38 ms (median 219 ms). We reveal MMN-like potentials in bilateral STN. This finding provides evidence that STN receives sensory (auditory) information from other structures. The question for further research is whether STN receives such signals through a previously described hyperdirect pathway between STN and frontal cortex (a known generator of the MMN potential) and if the STN contributes to sensorimotor integration.

Subthalamic nucleus involvement in executive functions with increased cognitive load: a subthalamic nucleus and anterior cingulate cortex depth recording study.

We studied the appearance of broadband oscillatory changes (ranging 2-45 Hz) induced by a cognitive task with two levels of complexity. The event-related de/synchronizations (ERD/S) in the subthalamic nucleus (STN) and in the anterior cingulate cortex (ACC) were evaluated in an executive function test. Four epilepsy surgery candidates with intracerebral electrodes implanted in the ACC and three Parkinson's disease patients with externalized deep brain stimulation electrodes implanted in the STN participated in the study. A Flanker test (FT) with visual stimuli (arrows) was performed. Subjects reacted to four types of stimuli presented on the monitor by pushing the right or left button: congruent arrows to the right or left side (simple task) and incongruent arrows to the right or left side (more difficult complex task). We explored the activation of STN and the activation of the ACC while processing the FT. Both conditions, i.e. congruent and incongruent, induced oscillatory changes in the ACC and also STN with significantly higher activation during incongruent trial. At variance with the ACC, in the STN not only the ERD beta but also the ERD alpha activity was significantly more activated by the incongruent condition. In line with our earlier studies, the STN appears to be involved in activities linked with increased cognitive load. The specificity and complexity of task-related activation of the STN might indicate the involvement of the STN in processes controlling human behaviour, e.g. in the selection and inhibition of competing alternatives.

Coupling between beta band and high frequency oscillations as a clinically useful biomarker for DBS.

Beta hypersynchrony was recently introduced into clinical practice in Parkinson's disease (PD) to identify the best stimulation contacts and for adaptive deep brain stimulation (aDBS) sensing. However, many other oscillopathies accompany the disease, and beta power sensing may not be optimal for all patients. The aim of this work was to study the potential clinical usefulness of beta power phase-amplitude coupling (PAC) with high frequency oscillations (HFOs). Subthalamic nucleus (STN) local field potentials (LFPs) from externalized DBS electrodes were recorded and analyzed in PD patients (n = 19). Beta power and HFOs were evaluated in a resting-state condition; PAC was then studied and compared with the electrode contact positions, structural connectivity, and medication state. Beta-HFO PAC (mainly in the 200-500 Hz range) was observed in all subjects. PAC was detectable more specifically in the motor part of the STN compared to beta power and HFOs. Moreover, the presence of PAC better corresponds to the stimulation setup based on the clinical effect. PAC is also sensitive to the laterality of symptoms and dopaminergic therapy, where the greater PAC cluster reflects the more affected side and medication "off" state. Coupling between beta power and HFOs is known to be a correlate of the PD "off" state. Beta-HFO PAC seems to be more sensitive than beta power itself and could be more helpful in the selection of the best clinical stimulation contact and probably also as a potential future input signal for aDBS.

Comparing the effects of cortical resection and vagus nerve stimulation in patients with nonlesional extratemporal epilepsy.

The main purpose of this retrospective study was to compare the effects of resective surgery (RESgr-26 patients) and vagus nerve stimulation (VNSgr-35 patients) on seizure frequency (2 and 5years after surgery) in patients with nonlesional extratemporal epilepsy (NLexTLE). We analyzed hospital admission costs directly associated with epilepsy (HACE) in both groups at the same follow-up. The decrease in seizure frequency from the preoperative levels, in both VNSgr and RESgr, was statistically significant (p<0.001). The seizure frequency reduction did not differ significantly between the follow-up visits for either group (p=0.221 at 2years and 0.218 at 5years). A significantly higher number of Engel I and Engel I+II patients were found in RESgr than in VNSgr at both follow-up visits (p=0.04 and 0.007, respectively). Using McHugh classification, we did not find statistically significant differences between both groups at both follow-up visits. Hospital admission costs directly associated with epilepsy/patient/year in both RESgr and VNSgr dropped significantly at 2- and 5-year follow-up visit and this reduction was not statistically different between RESgr and VNSgr (p=0.232). Both VNS and resective surgery cause comparably significant seizure reduction in NLexTLE. Resective surgery leads to a greater number of patients with excellent postoperative outcome (Engel I+II). The HACE reduction is statistically comparable between both groups.

The role of brain shift, patient age, and Parkinson's disease duration in the difference between anatomical and electrophysiological targets for subthalamic stimulation.

INTRODUCTION: Although microrecording is common in subthalamic stimulation, microelectrode monitoring prolongs surgical time and may increase the risk of haemorrhagic complications. The main reason for electrophysiological mapping is the discrepancy between the calculated anatomical and final electrophysiological targets. The aim of this paper is to describe the relationship between anatomical and electrophysiological targets defined as the best electrophysiological recordings from multiple parallel electrode tracts, explaining the target discrepancy with attention paid to the role of brain shift and patient- and disease-related factors. MATERIALS AND METHODS: Subthalamic electrodes were stereotactically implanted in 58 patients using microrecording by means of parallel electrodes at defined distances. The relationship between the final electrode placement to its anatomical trajectory and the relationship between the definitive electrodes implanted on the right and left sides were analysed, as was the influence of patient age, Parkinson's disease duration, and late motor complications duration. RESULTS: Final electrode placement matched the anatomical trajectory in 53.4% of patients on the right side and 43.1% of patients on the left side. Electrode positions were symmetrical in 38.3% of patients. The analysis of left and right electrode positions does not prove a statistically significant prevalence of lateral and posterior final electrode trajectories as could be expected from lateral and posterior movements of the brain caused by brain shift, although there was some tendency for a larger percentage of lateral electrodes on the left side. Age, Parkinson's disease duration, and L-DOPA effect duration were not confirmed as responsible factors. CONCLUSIONS: The difference between anatomical trajectory and final electrode placement supports the use of functional microelectrode monitoring in subthalamic deep brain stimulation. Brain shift is not the only causative factor of the difference. The possible roles of age, Parkinson's disease duration, and late motor complications duration were also not confirmed by study results.

Deep Brain Stimulation during Pregnancy and Delivery: Review of Current Literature.

Deep brain stimulation (DBS) is an established method in the treatment of not only Parkinson's disease motor complications but also dystonia and tremor, and there are data supporting the efficacy of DBS in epilepsy and some psychiatric problems. The alleviation of the neurologic problems may enable females of childbearing age to consider pregnancy because of being able to take care of their child. The aim of the study is to provide a review of the data available on the effect of DBS on the course of pregnancy and delivery in patients suffering from diseases amenable for DBS treatment (Parkinson's disease, dystonia, obsessive compulsive disorder, Tourette's syndrome, epilepsy). Although data available in the literature on pregnancy and childbirth in patients with an implanted active DBS system are limited to small case series and case reports, the number of younger patients implanted with DBS systems will potentially require more attention beyond specialized DBS centers. In emergency deliveries, general obstetricians and neurosurgeons should be provided with a protocol to prevent injuries to the implanted system with potentially devastating consequences for the patient.

The effect of deep brain stimulation in Parkinson's disease reflected in EEG microstates.

Mechanisms of deep brain stimulation (DBS) on cortical networks were explored mainly by fMRI. Advanced analysis of high-density EEG is a source of additional information and may provide clinically useful biomarkers. The presented study evaluates EEG microstates in Parkinson's disease and the effect of DBS of the subthalamic nucleus (STN). The association between revealed spatiotemporal dynamics of brain networks and changes in oscillatory activity and clinical examination were assessed. Thirty-seven patients with Parkinson's disease treated by STN-DBS underwent two sessions (OFF and ON stimulation conditions) of resting-state EEG. EEG microstates were analyzed in patient recordings and in a matched healthy control dataset. Microstate parameters were then compared across groups and were correlated with clinical and neuropsychological scores. Of the five revealed microstates, two differed between Parkinson's disease patients and healthy controls. Another microstate differed between ON and OFF stimulation conditions in the patient group and restored parameters in the ON stimulation state toward to healthy values. The mean beta power of that microstate was the highest in patients during the OFF stimulation condition and the lowest in healthy controls; sources were localized mainly in the supplementary motor area. Changes in microstate parameters correlated with UPDRS and neuropsychological scores. Disease specific alterations in the spatiotemporal dynamics of large-scale brain networks can be described by EEG microstates. The approach can reveal changes reflecting the effect of DBS on PD motor symptoms as well as changes probably related to non-motor symptoms not influenced by DBS.