Improving Documentation of Pain Reassessment after Pain Management Interventions in the NICU.

Background: Neonates exposed to painful procedures require pain assessment and reassessment using nonverbal scales. Nurses perform initial assessments routinely, but reassessment is variable. The goal was to increase pain reassessments in neonates with a previous score of 4 or higher within 60 minutes from 50% to 75% within 12 months. Methods: After identifying key drivers, we tested several interventions using the IHI's Model for Improvement. The outcome measure was the rate of reassessments within 1 hour after scoring ≥4 on the Neonatal Pain Agitation and Sedation Scale (N-PASS). Duration of time between scoring and intervention was documented. Interventions included electronic health record (EHR) changes, direct communication with bedside nurses through text messages and emails, in-person education, and a yearly competency module. The process measure was the number of messages/emails to staff. Sedation scores were the balancing measure. Results: Baseline compliance was 50% with significant variability. A centerline shift occurred after the first intervention. After the first four interventions in the following 3 months, a 29% total increase occurred. Overall time-lapse between reassessments decreased from 102 to 90 minutes. Overall sedation scores decreased from -2.5 during the baseline to -1.7 during the sustain period. The goal of 75% pain reassessments was achieved and sustained for two years. Conclusions: Automated tools such as the trigger report provided data that increased noncompliance visibility. Real-time and personalized reminders and education improved awareness and set the tone for culture change. Electronic health record reminders for reassessments and standardized annual education helped in sustaining change.

Association Between Social Determinants of Health Issues and Maternal Obesity Among American Racial/Ethnic Groups.

Background and Objective: Social determinants of health impact various clinical health outcomes in the population. We conducted this study to examine the impact of adverse social determinants of health (SDOH) characteristics on maternal obesity among hospitalized pregnant women in the US and its potential differential impact on women of different races/ethnicities. Methods: The nationwide pregnancy hospitalization data analyzed in this study were collected through the Nationwide Inpatient Sample (NIS) database during 2016-2018. We conducted descriptive analyses to evaluate the relationship between patient characteristics and maternal obesity. Using the adjusted survey logistic regression model, we calculated the independent association between social determinants of health (SDOH) risk factors and hospitalization characteristics (exposure) and maternal obesity (outcome). Lastly, stratified survey logistic regression models were created for each racial/ethnic group to examine the differential impact in the association between SDOH issues and maternal obesity. Results: The prevalence of SDOH issues was highest in non-Hispanic (NH) Black women (6.59 per 1000 hospitalizations), whereas the prevalence of obesity among those with SDOH issues was highest in Hispanic women (15.3 per 100 hospitalizations). We observed that pregnant women with SDOH issues were 1.15 times as likely (95% CI: 1.05-1.25) to experience maternal obesity compared to those without SDOH issues. Relative to their counterparts without SDOH issues, Hispanics and NH-Others with SDOH issues had increased odds of obesity, whereas NH-White and NH-Black mothers with SDOH had similar odds of obesity (p>0.05). Conclusion and Global Health Implications: In conclusion, pregnant women with SDOH issues had an increased likelihood of obesity diagnosis and the association demonstrated differential impact across racial/ethnic sub-populations. This information has potential utility for counseling and formulation of targeted interventions for pregnant women.

Understanding the Impact of Move Your Way Campaign Exposure on Key Physical Activity Outcomes - Results from a Multi-site Pilot Evaluation.

The Move Your Way® campaign was developed to encourage physical activity contemplators to get active. A pilot test of campaign implementation was conducted and evaluated in eight communities between March and October 2020. A web-based, cross-sectional survey of adults collected pilot campaign outcome data after campaign implementation. Differences in outcomes between exposed and unexposed groups across the communities were compared. A total of n = 5,140 responded to the survey. Across eight communities, those who reported campaign exposure had 7.2 (95% CI, 6.1-8.6) greater odds of being aware of the Physical Activity Guidelines for Americans (Guidelines) compared to unexposed respondents. Additionally, they had greater odds of identifying the correct aerobic and muscle-strengthening dosages and had 1.4 (95% CI, 1.1-1.6) greater odds of reporting meeting both the aerobic and muscle-strengthening Guidelines. In this pilot evaluation, reported exposure to Move Your Way is associated with higher odds of being aware of the Guidelines, knowing recommended dosages, likelihood of becoming more active in the future, higher physical activity self-efficacy, making a recent physical activity behavior change, and higher physical activity levels. The Move Your Way campaign can be used in communities to promote physical activity.

Mediator Subunits MED16, MED14, and MED2 Are Required for Activation of ABRE-Dependent Transcription in Arabidopsis.

The Mediator complex controls transcription of most eukaryotic genes with individual subunits required for the control of particular gene regulons in response to various perturbations. In this study, we reveal the roles of the plant Mediator subunits MED16, MED14, and MED2 in regulating transcription in response to the phytohormone abscisic acid (ABA) and we determine which cis elements are under their control. Using synthetic promoter reporters we established an effective system for testing relationships between subunits and specific cis-acting motifs in protoplasts. Our results demonstrate that MED16, MED14, and MED2 are required for the full transcriptional activation by ABA of promoters containing both the ABRE (ABA-responsive element) and DRE (drought-responsive element). Using synthetic promoter motif concatamers, we showed that ABA-responsive activation of the ABRE but not the DRE motif was dependent on these three Mediator subunits. Furthermore, the three subunits were required for the control of water loss from leaves but played no role in ABA-dependent growth inhibition, highlighting specificity in their functions. Our results identify new roles for three Mediator subunits, provide a direct demonstration of their function and highlight that our experimental approach can be utilized to identify the function of subunits of plant transcriptional regulators.

BMI and related risk factors among U.S. Marshallese with diabetes and their families.

Objective: Examine cross-sectional associations between body mass index (BMI) and related health behaviors, barriers and facilitators to health care, and perceived health status among a sample of U.S. Marshallese adults with Type 2 diabetes and evaluate associations of interest between participants and their family members.Design: Cross-sectional baseline data were analyzed from participants in a diabetes self-management education intervention trial.Setting: Data collection took place in home or community settings through a community-academic partnership in Arkansas.Participants: Study participants consisted of U.S. Marshallese adults with Type 2 diabetes (N = 221) and their family members (N = 211) recruited through community settings.Intervention(s): N/A.Main Outcome Measure(s): Participants' height and weight were measured using standard protocols to calculate BMI (kg/m2). Diet, physical activity, health care access, financial strain related to health care, perceived health status, and health care satisfaction were measured using self-report surveys.Results: Participants' mean BMI was 31.0 (95% CI: 30.2-31.7), with over half of study participants and their family members' BMI falling in the obese category. Participants' BMI was positively associated with spreading health care bill payments over time (ß = 1.75 (SE = 0.87); p = 0.045). Positive associations between participants and their family members were observed for self-reported health status conditions, health care coverage, health care utilization, and health care satisfaction.Conclusion: Study findings highlight the high prevalence of obesity and related risk factors among U.S. Marshallese adults with Type 2 diabetes and emphasize the need for intervention strategies that build upon cultural strengths and target community, policy, systems, and environmental changes to address obesity and chronic disease in this marginalized community.

Mapping of primary somatosensory cortex of the hand area using a high-density electrocorticography grid for closed-loop brain computer interface.

Objective.The ideal modality for generating sensation in sensorimotor brain computer interfaces (BCI) has not been determined. Here we report the feasibility of using a high-density 'mini'-electrocorticography (mECoG) grid in a somatosensory BCI system.Approach.Thirteen subjects with intractable epilepsy underwent standard clinical implantation of subdural electrodes for the purpose of seizure localization. An additional high-density mECoG grid was placed (Adtech, 8 by 8, 1.2 mm exposed, 3 mm center-to-center spacing) over the hand area of primary somatosensory cortex. Following implantation, cortical mapping was performed with stimulation parameters of frequency: 50 Hz, pulse-width: 250µs, pulse duration: 4 s, polarity: alternating, and current that ranged from 0.5 mA to 12 mA at the discretion of the epileptologist. Location of the evoked sensory percepts was recorded along with a description of the sensation. The hand was partitioned into 48 distinct boxes. A box was included if sensation was felt anywhere within the box.Main results.The percentage of the hand covered was 63.9% (± 34.4%) (mean ± s.d.). Mean redundancy, measured as electrode pairs stimulating the same box, was 1.9 (± 2.2) electrodes per box; and mean resolution, measured as boxes included per electrode pair stimulation, was 11.4 (± 13.7) boxes with 8.1 (± 10.7) boxes in the digits and 3.4 (± 6.0) boxes in the palm. Functional utility of the system was assessed by quantifying usable percepts. Under the strictest classification, 'dermatomally exclusive' percepts, the mean was 2.8 usable percepts per grid. Allowing 'perceptually unique' percepts at the same anatomical location, the mean was 5.5 usable percepts per grid.Significance.Compared to the small area of coverage and redundancy of a microelectrode system, or the poor resolution of a standard ECoG grid, a mECoG is likely the best modality for a somatosensory BCI system with good coverage of the hand and minimal redundancy.

Managing Outliers in Adolescent Food Frequency Questionnaire Data.

OBJECTIVE: The goal of this study was to explore the impact of 5 decision rules for removing outliers from adolescent food frequency questionnaire (FFQ) data. DESIGN: This secondary analysis used baseline and 3-month data from a weight loss intervention clinical trial. PARTICIPANTS: African American adolescents (n = 181) were recruited from outpatient clinics and community health fairs. VARIABLES MEASURED: Data collected included self-reported FFQ and mediators of weight (food addiction, depressive symptoms, and relative reinforcing value of food), caregiver-reported executive functioning, and objectively measured weight status (percentage overweight). ANALYSIS: Descriptive statistics examined patterns in study variables at baseline and follow-up. Correlational analyses explored the relationships between FFQ data and key study variables at baseline and follow-up. RESULTS: Compared with not removing outliers, using decision rules reduced the number of cases and restricted the range of data. The magnitude of baseline FFQ-mediator relationships was attenuated under all decision rules but varied (increasing, decreasing, and reversing direction) at follow-up. Decision rule use increased the magnitude of change in FFQ estimated energy intake and significantly strengthened its relationship with weight change under 2 fixed range decision rules. CONCLUSIONS AND IMPLICATIONS: Results suggest careful evaluation of outliers and testing and reporting the effects of different outlier decision rules through sensitivity analyses.

Gamma-band modulation in the human amygdala during reaching movements.

OBJECTIVE: Motor brain-computer interface (BCI) represents a new frontier in neurological surgery that could provide significant benefits for patients living with motor deficits. Both the primary motor cortex and posterior parietal cortex have successfully been used as a neural source for human motor BCI, leading to interest in exploring other brain areas involved in motor control. The amygdala is one area that has been shown to have functional connectivity to the motor system; however, its role in movement execution is not well studied. Gamma oscillations (30-200 Hz) are known to be prokinetic in the human cortex, but their role is poorly understood in subcortical structures. Here, the authors use direct electrophysiological recordings and the classic "center-out" direct-reach experiment to study amygdaloid gamma-band modulation in 8 patients with medically refractory epilepsy. METHODS: The study population consisted of 8 epilepsy patients (2 men; age range 21-62 years) who underwent implantation of micro-macro depth electrodes for seizure localization and EEG monitoring. Data from the macro contacts sampled at 2000 Hz were used for analysis. The classic center-out direct-reach experiment was used, which consists of an intertrial interval phase, a fixation phase, and a response phase. The authors assessed the statistical significance of neural modulation by inspecting for nonoverlapping areas in the 95% confidence intervals of spectral power for the response and fixation phases. RESULTS: In 5 of the 8 patients, power spectral analysis showed a statistically significant increase in power within regions of the gamma band during the response phase compared with the fixation phase. In these 5 patients, the 95% bootstrapped confidence intervals of trial-averaged power in contiguous frequencies of the gamma band during the response phase were above, and did not overlap with, the confidence intervals of trial-averaged power during the fixation phase. CONCLUSIONS: To the authors' knowledge, this is the first time that direct neural recordings have been used to show gamma-band modulation in the human amygdala during the execution of voluntary movement. This work indicates that gamma-band modulation in the amygdala could be a contributing source of neural signals for use in a motor BCI system.

Beta-band power modulation in the human hippocampus during a reaching task.

OBJECTIVE: Characterize the role of the beta-band (13-30 Hz) in the human hippocampus during the execution of voluntary movement. APPROACH: We recorded electrophysiological activity in human hippocampus during a reach task using stereotactic electroencephalography (SEEG). SEEG has previously been utilized to study the theta band (3-8 Hz) in conflict processing and spatial navigation, but most studies of hippocampal activity during movement have used noninvasive measures such as fMRI. We analyzed modulation in the beta band (13-30 Hz), which is known to play a prominent role throughout the motor system including the cerebral cortex and basal ganglia. We conducted the classic 'center-out' direct-reach experiment with nine patients undergoing surgical treatment for medically refractory epilepsy. MAIN RESULTS: In seven of the nine patients, power spectral analysis showed a statistically significant decrease in power within the beta band (13-30 Hz) during the response phase, compared to the fixation phase, of the center-out direct-reach task using the Wilcoxon signed-rank hypothesis test (p < 0.05). SIGNIFICANCE: This finding is consistent with previous literature suggesting that the hippocampus may be involved in the execution of movement, and it is the first time that changes in beta-band power have been demonstrated in the hippocampus using human electrophysiology. Our findings suggest that beta-band modulation in the human hippocampus may play a role in the execution of voluntary movement.

A Phantom Study of the Spatial Precision and Accuracy of Stereotactic Localization Using Computed Tomography Imaging with the Leksell Stereotactic System.

BACKGROUND: Stereotactic localization of neurosurgical targets traditionally relies on computed tomography (CT), which is considered the optimal imaging modality for geometric accuracy. However, in-depth investigations that characterize the precision and accuracy of CT images are lacking. We used a CT phantom to examine interscanner precision and interprotocol accuracy in coordinate localization. METHODS: A polymethylacrylate phantom was scanned with Toshiba Aquilion 64 and GE Healthcare LightSpeed 16 CT scanners, using both helical and incremental single-slice (SS) image acquisition protocols. The X, Y, and Z coordinates of 94 points across 6 surfaces of the phantom were physically measured. The CT scan-derived coordinates were compared with the phantom coordinates and with each other to determine accuracy and precision, respectively. RESULTS: Using the SS imaging protocol, the mean (SD) interscanner disparity in localization was 0.93 (0.39) mm, given by the average Euclidean distance between the coordinates of the 2 scanners. This discrepancy significantly varied by axis and surface, with the greatest discrepancy in the Z-axis of 0.30 mm (95% confidence interval, 0.25-0.35; P = 0.05) and on the superior surface of 1.30 mm (95% confidence interval, 1.15-1.45; P = 0.05). SS acquisition was significantly more accurate than the helical protocol. CONCLUSIONS: We found evidence of clinically relevant inconsistency between 2 CT scanners used for stereotactic localization. SS image acquisition was superior to helical scanning with respect to localization accuracy. Interscanner consistency cannot be assumed. Institutions would benefit from identifying the errors inherent in their CT scanners.

Utility and lower limits of frequency detection in surface electrode stimulation for somatosensory brain-computer interface in humans.

OBJECTIVE: Stimulation of the primary somatosensory cortex (S1) has been successful in evoking artificial somatosensation in both humans and animals, but much is unknown about the optimal stimulation parameters needed to generate robust percepts of somatosensation. In this study, the authors investigated frequency as an adjustable stimulation parameter for artificial somatosensation in a closed-loop brain-computer interface (BCI) system. METHODS: Three epilepsy patients with subdural mini-electrocorticography grids over the hand area of S1 were asked to compare the percepts elicited with different stimulation frequencies. Amplitude, pulse width, and duration were held constant across all trials. In each trial, subjects experienced 2 stimuli and reported which they thought was given at a higher stimulation frequency. Two paradigms were used: first, 50 versus 100 Hz to establish the utility of comparing frequencies, and then 2, 5, 10, 20, 50, or 100 Hz were pseudorandomly compared. RESULTS: As the magnitude of the stimulation frequency was increased, subjects described percepts that were "more intense" or "faster." Cumulatively, the participants achieved 98.0% accuracy when comparing stimulation at 50 and 100 Hz. In the second paradigm, the corresponding overall accuracy was 73.3%. If both tested frequencies were less than or equal to 10 Hz, accuracy was 41.7% and increased to 79.4% when one frequency was greater than 10 Hz (p = 0.01). When both stimulation frequencies were 20 Hz or less, accuracy was 40.7% compared with 91.7% when one frequency was greater than 20 Hz (p < 0.001). Accuracy was 85% in trials in which 50 Hz was the higher stimulation frequency. Therefore, the lower limit of detection occurred at 20 Hz, and accuracy decreased significantly when lower frequencies were tested. In trials testing 10 Hz versus 20 Hz, accuracy was 16.7% compared with 85.7% in trials testing 20 Hz versus 50 Hz (p < 0.05). Accuracy was greater than chance at frequency differences greater than or equal to 30 Hz. CONCLUSIONS: Frequencies greater than 20 Hz may be used as an adjustable parameter to elicit distinguishable percepts. These findings may be useful in informing the settings and the degrees of freedom achievable in future BCI systems.

Comparison of Intraoperative 3-Dimensional Fluoroscopy With Standard Computed Tomography for Stereotactic Frame Registration.

BACKGROUND: Three-dimensional fluoroscopy via the O-arm (Medtronic, Dublin, Ireland) has been validated for intraoperative confirmation of successful lead placement in stereotactic electrode implantation. However, its role in registration and targeting has not yet been studied. After frame placement, many stereotactic neurosurgeons obtain a computed tomography (CT) scan and merge it with a preoperative magnetic resonance imaging (MRI) scan to generate planning coordinates; potential disadvantages of this practice include increased procedure time and limited scanner availability. OBJECTIVE: To evaluate whether the second-generation O-arm (O2) can be used in lieu of a traditional CT scan to obtain accurate frame-registration scans. METHODS: In 7 patients, a postframe placement CT scan was merged with preoperative MRI and used to generate lead implantation coordinates. After implantation, the fiducial box was again placed on the patient to obtain an O2 confirmation scan. Vector, scalar, and Euclidean differences between analogous X, Y, and Z coordinates from fused O2/MRI and CT/MRI scans were calculated for 33 electrode target coordinates across 7 patients. RESULTS: Marginal means of difference for vector (X = -0.079 ± 0.099 mm; Y = -0.076 ± 0.134 mm; Z = -0.267 ± 0.318 mm), scalar (X = -0.146 ± 0.160 mm; Y = -0.306 ± 0.106 mm; Z = 0.339 ± 0.407 mm), and Euclidean differences (0.886 ± 0.190 mm) remained within the predefined equivalence margin differences of -2 mm and 2 mm. CONCLUSION: This study demonstrates that O2 may emerge as a viable alternative to the traditional CT scanner for generating planning coordinates. Adopting the O2 as a perioperative tool may offer reduced transport risks, decreased anesthesia time, and greater surgical efficiency.

Functional Frequency Discrimination From Cortical Somatosensory Stimulation in Humans.

Recently, efforts to produce artificial sensation through cortical stimulation of primary somatosensory cortex (PSC) in humans have proven safe and reliable. Changes in stimulation parameters like frequency and amplitude have been shown to elicit different percepts, but without clearly defined psychometric profiles. This study investigates the functionally useful limits of frequency changes on the percepts felt by three epilepsy patients with subdural electrocorticography (ECoG) grids. Subjects performing a hidden target task were stimulated with parameters of constant amplitude, pulse-width, and pulse-duration, and a randomly selected set of two frequencies (20, 30, 40, 50, 60, and 100 Hz). They were asked to decide which target had the "higher" frequency. Objectively, an increase in frequency differences was associated with an increase in perceived intensity. Reliable detection of stimulation occurred at and above 40 Hz with a lower limit of detection around 20 Hz and a just-noticeable difference estimated at less than 10 Hz. These findings suggest that frequency can be used as a reliable, adjustable parameter and may be useful in establishing settings and thresholds of functionality in future BCI systems.

Clinical neuroprosthetics: Today and tomorrow.

Implantable neurostimulation devices provide a direct therapeutic link to the nervous system and can be considered brain-computer interfaces (BCI). Under this definition, BCI are not simply science fiction, they are part of existing neurosurgical practice. Clinical BCI are standard of care for historically difficult to treat neurological disorders. These systems target the central and peripheral nervous system and include Vagus Nerve Stimulation, Responsive Neurostimulation, and Deep Brain Stimulation. Recent advances in clinical BCI have focused on creating "closed-loop" systems. These systems rely on biomarker feedback and promise individualized therapy with optimal stimulation delivery and minimal side effects. Success of clinical BCI has paralleled research efforts to create BCI that restore upper extremity motor and sensory function to patients. Efforts to develop closed loop motor/sensory BCI is linked to the successes of today's clinical BCI.

Internalized weight bias and psychological wellbeing: An exploratory investigation of a preliminary model.

Although a growing body of literature demonstrates negative effects of internalized weight bias (IWB), the relationships between IWB and relevant social, psychological, and behavioral variables have not yet been evaluated systematically. The purpose of the present study was to create and assess a model of hypothesized risks and outcomes of IWB. In an online survey, 650 adult males and females completed self-report measures of IWB, self-esteem, weight-related stigma experiences, body-related shame, body satisfaction, societal influence on body image, appearance comparisons, binge eating, distress, and weight-related quality of life. The originally hypothesized model did not provide an adequate fit to the data. Iterative modifications were undertaken, and the resulting model, in which social factors were associated with IWB and body image-related constructs which were in turn associated with psychological and behavioral outcomes, provided excellent fit to the data (CFI > .99, SRMR = .02, and RMSEA = .03). Most model paths were similar for underweight or normal weight participants versus participants with overweight or obesity. This study represents an initial effort at constructing a comprehensive model of IWB that can be further refined in future research and used to help guide the development of related interventions.

Directional tuning during reach planning in the supramarginal gyrus using local field potentials.

Previous work in directional tuning for brain machine interfaces has primarily relied on algorithm sorted neuronal action potentials in primary motor cortex. However, local field potential has been utilized to show directional tuning in macaque studies, and inferior parietal cortex has shown increased neuronal activity in reaching tasks that relied on MRI imaging. In this study we utilized local field potential recordings from a human subject performing a delayed reach task and show that high frequency band (76-100 Hz) spectral power is directionally tuned to different reaching target locations during an active reach. We also show that during the delay phase of the task, directional tuning is present in areas of the inferior parietal cortex, in particular, the supramarginal gyrus.

Biases in processing of mood-congruent facial expressions in depression.

Cognitive models of depression suggest that depressed individuals exhibit a tendency to attribute negative meaning to neutral stimuli, and enhanced processing of mood-congruent stimuli. However, evidence thus far has been inconsistent. In this study, we sought to identify both differential interpretation of neutral information as well as emotion processing biases associated with depression. Fifty adult participants completed standardized mood-related questionnaires, a novel immediate mood scale questionnaire (IMS-12), and a novel task, Emotion Matcher, in which they were required to indicate whether pairs of emotional faces show the same expression or not. We found that overall success rate and reaction time on the Emotion Matcher task did not differ as a function of severity of depression. However, more depressed participants had significantly worse performance when presented with sad-neutral face pairs, as well as increased reaction times to happy-happy pairs. In addition, accuracy of the sad-neutral pairs was found to be significantly associated with depression severity in a regression model. Our study provides partial support for the mood-congruent hypothesis, revealing only a potential bias in interpretation of sad and neutral expressions, but not a general deficit in processing of facial expressions. The potential of such bias in serving as a predictor for depression should be further examined in future studies.

Brain-Computer Interfaces in Quadriplegic Patients.

Brain-computer interfaces (BCI) are implantable devices that interface directly with the nervous system. BCI for quadriplegic patients restore function by reading motor intent from the brain and use the signal to control physical, virtual, and native prosthetic effectors. Future closed-loop motor BCI will incorporate sensory feedback to provide patients with an effective and intuitive experience. Development of widely available BCI for patients with neurologic injury will depend on the successes of today's clinical BCI. BCI are an exciting next step in the frontier of neuromodulation.

Electrocorticographic changes in field potentials following natural somatosensory percepts in humans.

OBJECTIVE: Restoration of somatosensory deficits in humans requires a clear understanding of the neural representations of percepts. To characterize the cortical response to naturalistic somatosensation, we examined field potentials in the primary somatosensory cortex of humans. METHODS: Four patients with intractable epilepsy were implanted with subdural electrocorticography (ECoG) electrodes over the hand area of S1. Three types of stimuli were applied, soft-repetitive touch, light touch, and deep touch. Power in the alpha (8-15 Hz), beta (15-30 Hz), low-gamma (30-50 Hz), and high-gamma (50-125 Hz) frequency bands were evaluated for significance. RESULTS: Seventy-seven percent of electrodes over the hand area of somatosensory cortex exhibited changes in these bands. High-gamma band power increased for all stimuli, with concurrent alpha and beta band power decreases. Earlier activity was seen in these bands in deep touch and light touch compared to soft touch. CONCLUSIONS: These findings are consistent with prior literature and suggest a widespread response to focal touch, and a different encoding of deeper pressure touch than soft touch.

Dual responsive neurostimulation implants for epilepsy.

Closed-loop brain-responsive neurostimulation via the RNS System is a treatment option for adults with medically refractory focal epilepsy. Using a novel technique, 2 RNS Systems (2 neurostimulators and 4 leads) were successfully implanted in a single patient with bilateral parietal epileptogenic zones. In patients with multiple epileptogenic zones, this technique allows for additional treatment options. Implantation can be done successfully, without telemetry interference, using proper surgical planning and neurostimulator positioning.Trajectories for the depth leads were planned using neuronavigation with CT and MR imaging. Stereotactic frames were used for coordinate targeting. Each neurostimulator was positioned with maximal spacing to avoid telemetry interference while minimizing patient discomfort. A separate J-shaped incision was used for each neurostimulator to allow for compartmentalization in case of infection. In order to minimize surgical time and risk of infection, the neurostimulators were implanted in 2 separate surgeries, approximately 3 weeks apart.The neurostimulators and leads were successfully implanted without adverse surgical outcomes. The patient recovered uneventfully, and the early therapy settings over several months resulted in preliminary decreases in aura and seizure frequency. Stimulation by one of the neurostimulators did not result in stimulation artifacts detected by the contralateral neurostimulator.