Non-Invasive Brain Stimulation for Children with Autism Spectrum Disorders: A Short-Term Outcome Study.

Non-Invasive Brain Stimulation (NIBS) is a relatively new therapeutic approach that has shown beneficial effects in Autism Spectrum Disorder (ASD). One question to be answered is how enduring its neuromodulatory effect could be. Twenty-four patients with ASD (mean age: 12.2 years) received 20 sessions of NIBS over the left dorsolateral prefrontal cortex (L-DLPFC). They were randomized into two groups with two (G1) or three (G2) clinical evaluations before NIBS. Both groups had a complete follow-up at six months after the intervention, with the aim of determining the short-term outcome using the total score on the Autism Behavior Checklist, Autism Treatment Evaluation Checklist, and the Autism Diagnostic Interview. Transcranial Direct Current Stimulation (tDCS) was used in ASD patients aged <11 years, and repetitive Transcranial Magnetic Stimulation (rTMS) for 11-13-year-olds. Observation points were at one, three, and six months after completing all the sessions of NIBS. A significant reduction in the total score on the three clinical scales was observed and maintained during the first six months after treatment, with a slight and non-significant tendency to increase the scores in the last evaluation. Twenty sessions of NIBS over the L-DLPFC improves autistic symptoms in ASD children, with a lasting effect of six months.

Effectiveness of music therapy as an aid to neurorestoration of children with severe neurological disorders.

This study was a two-armed parallel group design aimed at testing real world effectiveness of a music therapy (MT) intervention for children with severe neurological disorders. The control group received only the standard neurorestoration program and the experimental group received an additional MT "Auditory Attention plus Communication protocol" just before the usual occupational and speech therapy. Multivariate Item Response Theory (MIRT) identified a neuropsychological status-latent variable manifested in all children and which exhibited highly significant changes only in the experimental group. Changes in brain plasticity also occurred in the experimental group, as evidenced using a Mismatch Event Related paradigm which revealed significant post intervention positive responses in the latency range between 308 and 400 ms in frontal regions. LORETA EEG source analysis identified prefrontal and midcingulate regions as differentially activated by the MT in the experimental group. Taken together, our results showing improved attention and communication as well as changes in brain plasticity in children with severe neurological impairments, confirm the importance of MT for the rehabilitation of patients across a wide range of dysfunctions.

Registro cerebral profundo y tiempo quirúrgico en la neurocirugía estereotáctica funcional para trastornos del movimiento / Deep brain recording and length of surgery in stereotactic and functional neurosurgery for movement disorders

OBJETIVO: Estudiar la duración de los registros cerebrales multiunitarios (RCM) en 20 años de neurocirugías en trastornos del movimiento, así como las veces en que fue necesario explorar todos los trayectos de los electrodos en las posiciones registradas simultáneamente (PRS) por grupos que usan registros cerebrales unitarios (RCU). MATERIAL Y MÉTODO: Análisis estadístico descriptivo retrospectivo de la duración de los RCM en 4.296 trayectos en 952 cirugías. Los criterios de exclusión fueron: trayectos con menos de 5 señales grabadas, o con señales con duración diferente de los 2 s habituales, o cuando existieron situaciones no usuales, ni relacionadas con los RCM, así como las primeras 20 cirugías de cada blanco quirúrgico, resultando así un total de 3.448 trayectos en 805 cirugías. Del total de 952 cirugías, se analiza además en cuántas de ellas fueron explorados todos los trayectos en las PRS de RCU. RESULTADOS: La media y su intervalo de confianza (p = 0,05) del tiempo por trayecto de RCM es 5,49 ± 0,16 min en cirugía en núcleo subtalámico; 8,82 ± 0,24 min en globo pálido medial o interno; y 18,51 ± 1,31 min en núcleo ventral intermedio del tálamo. Para la suma total de trayectos por cirugía, en el 75% de los casos el tiempo total es de menos de 39 min en núcleo subtalámico, casi 42 min en globo pálido medial o interno y menos de 1h y 17 min en núcleo ventral intermedio del tálamo. En solo el 4,2% de las cirugías fueron explorados todos los trayectos en las PRS de RCU. CONCLUSIONES: El impacto de los RCM en el tiempo quirúrgico es aceptable para esta guía en la localización objetiva de los blancos quirúrgicos, sin tener que usar varios electrodos simultáneos, no todos imprescindibles en la mayoría de los casos, con menor riesgo así para el paciente

OBJECTIVE: Our objectives were to study the length of multi-unit recordings (MURs) of brain activity in 20 years of movement disorder neurosurgeries and to determine the number of times in which it was necessary for the teams using single-unit recording (SUR) to explore all the electrode tracks in the simultaneously recorded sites (SRS). MATERIAL AND METHOD: This was a retrospective descriptive statistical analysis of MUR lengthon 4,296 tracks in 952 surgeries. The exclusion criteria were: tracks with fewer than 5 recorded signals, tracks that had a signal length different from the habitual 2 s, or there being unusual situations not related to the MUR, as well as the first 20 surgeries of each surgical target. This yielded a total of 3,448 tracks in 805 surgeries. We also determined the number of the total 952 surgeries in which all the tracks in the SURs of the SRS were explored. RESULTS: The mean and its confidence interval (P = .05) of time per MUR track were5.49 ± 0.16 min in subthalamic nucleus surgery, 8.82 ± 0.24 min in the medial or internalglobus pallidus) and 18.51 ± 1.31min in the ventral intermediate nucleus of the thalamus. For the total sum of tracks per surgery, in 75% of cases the total time was less than 39 min insubthalamic nucleus, almost 42 min in the medial or internal globus pallidus and less than1 h and 17min in ventral intermediate nucleus of the thalamus. All the tracks in the SURSRS were explored in only 4.2% of the surgeries. CONCLUSIONS: The impact of MUR on surgical time is acceptable for this guide in objective

Dystonia and tremor secondary to thalamic infarction successfully treated with thalamotomy of the ventralis intermedius nucleus.

BACKGROUND: Focal thalamic lesions have been associated with a variety of involuntary movements such as tremor, dystonia, and chorea-ballism. METHODS: We describe a patient with severe hyperkinesias of the right arm secondary to a thalamic infarction in the left postero-ventral region of the thalamus. RESULTS: The dystonia and tremor of the right upper limb were subsequently controlled with another surgical lesion of the ventralis intermedius nucleus of the thalamus. CONCLUSION: This observation suggests that ablative surgery might be applied to treat a movement disorder induced by the lesion of the same nucleus, which in addition lead to interesting pathophysiological conjectures.

[Deep brain recording and length of surgery in stereotactic and functional neurosurgery for movement disorders]. / Registro cerebral profundo y tiempo quirúrgico en la neurocirugía estereotáctica funcional para trastornos del movimiento.

OBJECTIVE: Our objectives were to study the length of multi-unit recordings (MURs) of brain activity in 20 years of movement disorder neurosurgeries and to determine the number of times in which it was necessary for the teams using single-unit recording (SUR) to explore all the electrode tracks in the simultaneously recorded sites (SRS). MATERIAL AND METHOD: This was a retrospective descriptive statistical analysis of MUR length on 4,296 tracks in 952 surgeries. The exclusion criteria were: tracks with fewer than 5 recorded signals, tracks that had a signal length different from the habitual 2s, or there being unusual situations not related to the MUR, as well as the first 20 surgeries of each surgical target. This yielded a total of 3,448 tracks in 805 surgeries. We also determined the number of the total 952 surgeries in which all the tracks in the SURs of the SRS were explored. RESULTS: The mean and its confidence interval (P=.05) of time per MUR track were 5.49±0.16min in subthalamic nucleus surgery, 8.82±0.24min in the medial or internal globus pallidus) and 18.51±1.31min in the ventral intermediate nucleus of the thalamus. For the total sum of tracks per surgery, in 75% of cases the total time was less than 39min in subthalamic nucleus, almost 42min in the medial or internal globus pallidus and less than 1h and 17min in ventral intermediate nucleus of the thalamus. All the tracks in the SUR SRS were explored in only 4.2% of the surgeries. CONCLUSIONS: The impact of MUR on surgical time is acceptable for this guide in objective localization for surgical targets, without having to use several simultaneous electrodes (not all indispensable in most of the cases). Consequently, there is less risk for the patient.

Anatomic and neurophysiological methods for the targeting and lesioning of the subthalamic nucleus: Cuban experience and review.

OBJECTIVE: To develop a method to place a lesion precisely in the subthalamic nucleus (STN) and evaluate its effectiveness. METHODS: A retrospective study of targeting data collected during stereotactic planning to lesion the STN in 31 patients with Parkinson's disease and of results in more than 50 procedures was performed. The targeting method was based on computed tomographic imaging together with semimicroelectrode recording digital processing and electrical stimulation. Two statistical methods were used to correlate initial with final target coordinates and assess the efficacy of the targeting procedure. RESULTS: The anatomic target based on computed tomographic imaging data showed electrical activity in the subthalamus in the first pass in 82% of the procedures. In the remaining 18%, the STN was an average of 1.93 mm away from the nearest trajectory that recorded the STN (range, 1.41-2.24 mm). The average number of trajectories per procedure was 7.2; the location of the first trajectory relative to the center of the nucleus determined by electrical and physiological means (P < 0.01, analysis of variance, Student's t test) was as follows: in the lateral direction, 1.25 +/- 1.15 mm; in the anteroposterior direction, 1.53 +/- 1.31 mm; and in the vertical direction, 0.67 +/- 0.51 mm. The average number of tracts necessary to lesion the STN was two. CONCLUSION: The combination of computed tomographic imaging, semimicroelectrode recording, and microstimulation provides an effective method to identify the STN lesion in parkinsonian patients. The method used for anatomic localization and electrophysiological mapping of the subthalamus was found to be effective in reaching the sensorimotor region of the nucleus. We carried out an accurate determination of the subthalamus location and its volume in the lesioning.

Caracterización de las alteraciones gráficas en pacientes con enfermedades neurodegenerativas / Characterization of graphic alterations on patients with neurodegenerative diseases

Introducción. Los trastornos degenerativos extrapiramidales comparten síntomas comunes como las alteraciones de la escritura y de las habilidades manuales. Material y método. Con la finalidad de comprobar la utilidad de la aplicación de la Escala Cuantitativa para la Escritura (Oligraf) creada en el Centro Internacional de Restauración Neurológica, y valorar su sensibilidad en diversas alteraciones, se aplicó la escala en 33 pacientes (6 con atrofia multisistémica, 3 con parálisis supranuclear progresiva y 24 con enfermedad de Parkinson idiopática) antes y después de intervención terapéutica. Resultados. Se encontraron alteraciones de la escritura en todos, pero predominó la macrografía, cabalgamiento y aglutinamiento en la atrofia multisistémica y la micrografía en la parálisis supranuclear progresiva y en la enfermedad de Parkinson idiopática. Los cambios tras el tratamiento fueron evaluados por la misma escala. Discusión. La presencia de macrografía diferencia la atrofia multisistémica de los otros trastornos. La Escala Cuantitativa para la Escritura (Oligraf) resultó sensible para identificar las alteraciones de la escritura y su mejoría en casi el 70

de los pacientes después del tratamiento(AU)

Personal-compputer-based system for three-dimensional anatomic-physiological correlations during stereotactic and functional neurosurgeryç

This paper describes the automatic three-dimensional (3D) graphic possibilities that are supplied by the Neurosurgical Deep Recording System (NDRS) to facilitate anatomic-physiological targeting during stereotactic and functional neurosurgery using depth recording. This software has been developed to substitute the complex electronic equipment ordinarily used for deep brain electrical recording, display and processing by a personal computer. It may also help to improve on-line graphic analysis, automatic management of the recorded information and flexibility to implement different forms of signal analysis. It can automatically show a 2D or 3D representation of the electrode track, with the electrophysiological findings superimposed as well as the corresponding sagittal, coronal and axial views of a brain atlas using automatic scaling. The NDRS has already successfully been applied during more than 300 neurosurgeries in Spain and Cuba, enabling improved targeting accuracy and safety(AU)