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1.
Zhonghua Yi Xue Za Zhi ; 99(44): 3471-3476, 2019 Nov 26.
Artigo em Chinês | MEDLINE | ID: mdl-31826564

RESUMO

Objective: To analyze the correlation between intracranial air and electrode displacement after deep brain stimulation. Compared the accuracy of the electrodes on both sides while bilateral intracranial air. Methods: A total of 133 patients with bilateral DBS from February 2017 to February 2019 in neurosurgery department of the General Hospital of Northern Theater Command were included. A total of 266 electrodes were implanted, including 160 sides of subthalamic nucleus, 2 sides of ventromedial nucleus of thalamus and 104 sides of Globus pallidus interior. All patients underwent three-dimensional reconstruction of the head 2 hours after operation and 1 week after operation, which was fused with the preoperative surgical plan.The volume of the intracranial air is obtained by summing up the CT layer-by-layer measurements after surgery. The distance between the implanted electrode and the preoperative target on the X and Y axes in the target plane is measured.Values were expressed as means±SEM,and the t test was performed. Bivariate correlation analysis using linear correlation analysis.P<0.05 was considered statistically significant. Results: There was no statistically significant difference in the fusion error of the electrode between 2 hours and 1 week after surgery on the X-axis. But there was significant difference on the Y-axis. The difference between intracranial air volume and two fusion errors was not linearly correlated on X axis, but linearly positively correlated on Y axis. Conclusion: Intracranial air volume is an important factor affecting the accuracy of DBS surgery. The larger intracranial air volume, the larger the displacement of electrodes on Y axis.


Assuntos
Estimulação Encefálica Profunda , Núcleo Subtalâmico , Eletrodos Implantados , Globo Pálido , Humanos , Imagem por Ressonância Magnética , Doença de Parkinson/terapia
2.
Medicine (Baltimore) ; 98(52): e18406, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31876713

RESUMO

As an anesthetic reversal agent, there are concerns with cholinesterase inhibitors regarding worsening of Parkinson's disease (PD)-related symptoms. Sugammadex, a relatively new reversal agent, does not inhibit acetylcholinesterase and does not require co-administration of an antimuscarinic agent. The present study compared the recovery profiles of 2 agents initially administered for reversal of neuromuscular blockade in patients with advanced PD who underwent deep brain stimulator implantation.A total of 121 patients with PD who underwent deep brain stimulator implantation were retrospectively analyzed. Patients were divided into 1 of 2 groups according to the type of neuromuscular blockade reversal agent (pyridostigmine vs sugammadex) initially administered. Recovery profiles reflecting time to extubation, reversal failure at first attempt, and hemodynamic stability, including incidence of hypertension or tachycardia during the emergence period, were compared.Time to extubation in the sugammadex group was significantly shorter (P < .001). In the sugammadex group, reversal failure at first attempt did not occur in any patient, while it occurred in seven (9.7%) patients in the pyridostigmine group (P = .064), necessitating an additional dose of pyridostigmine (n = 3) or sugammadex (n = 4). The incidence of hemodynamic instability during anesthetic emergence was significantly lower in the sugammadex group than in the pyridostigmine group (P = .019).Sugammadex yielded a recovery profile superior to that of pyridostigmine during the anesthesia emergence period in advanced PD patients. Sugammadex is also likely to be associated with fewer adverse effects than traditional reversal agents, which in turn would also improve overall postoperative management in this patient population.


Assuntos
Inibidores da Colinesterase/uso terapêutico , Estimulação Encefálica Profunda , Eletrodos Implantados , Bloqueio Neuromuscular/métodos , Doença de Parkinson/terapia , Implantação de Prótese , Brometo de Piridostigmina/uso terapêutico , Sugammadex/uso terapêutico , Período de Recuperação da Anestesia , Estimulação Encefálica Profunda/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Neuromuscular/efeitos adversos , Implantação de Prótese/métodos , Estudos Retrospectivos
3.
No Shinkei Geka ; 47(10): 1037-1043, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31666419

RESUMO

BACKGROUND: Device-related infection frequently becomes a serious problem after deep brain stimulation(DBS)surgery and DBS device removal is usually the only effective treatment option. In this study, we examined risk factors for infection related to DBS devices at our institution. METHODS: We retrospectively investigated 80 DBS surgeries performed between March 2009 and September 2017 at our institution. We examined the relationship between DBS device-related infection and the following items:duration of electrode placement surgery, total number of tracks of microelectrode recordings(MER), period between surgeries, highest body temperature until implantable pulse generator(IPG)implantation, and patient background characteristics. RESULTS: Four(5.0%)patients developed device-related infection after DBS surgery. Three of them required device removal, whereas one improved following antibiotic treatment alone. We did not identify any specific trend or risk factor for infection. DISCUSSION: We perform DBS surgery in two stages. Patients were implanted with an IPG 2-3 days after electrode placement until August 2016, and at 6-8 days starting in September 2016. All cases of infection developed before September 2016, and no cases of infection have occurred since September 2016. We believe that lengthy surgical electrode placement affects the general status of patients and performing surgery before stabilization might confer a risk of infection. CONCLUSION: Device-related infection after DBS surgery does not seem to be associated with any risk factors. However, a shorter period between two-staged surgeries might affect infection rates.


Assuntos
Estimulação Encefálica Profunda , Antibacterianos , Eletrodos Implantados , Humanos , Estudos Retrospectivos , Fatores de Risco
4.
Adv Exp Med Biol ; 1101: 1-40, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31729670

RESUMO

The Utah electrode array (UEA) and its many derivatives have become a gold standard for high-channel count bi-directional neural interfaces, in particular in human subject applications. The chapter provides a brief overview of leading electrode concepts and the context in which the UEA has to be understood. It goes on to discuss the key advances and developments of the UEA platform in the past 15 years, as well as novel wireless and system integration technologies that will merge into future generations of fully integrated devices. Aspects covered include novel device architectures that allow scaling of channel count and density of electrode contacts, material improvements to substrate, electrode contacts, and encapsulation. Further subjects are adaptations of the UEA platform to support IR and optogenetic simulation as well as an improved understanding of failure modes and methods to test and accelerate degradation in vitro such as to better predict device failure and lifetime in vivo.


Assuntos
Microeletrodos , Eletrodos Implantados/tendências , Humanos , Microeletrodos/tendências , Sistema Nervoso , Utah
5.
Chirurgia (Bucur) ; 114(4): 451-460, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31511131

RESUMO

Background: Recently, there was described the possibility to increase the lower esophageal sphincter (LES) tone by means of implantable electrical stimulator. Although, this method has already been used in clinical practice, however, the optimal parameters of LES electrical stimulation are still unknown. Aims: The goals of this study were to get clinical data regarding the effects of different types of electrical stimulation on LES and to elaborate and test the prototype on laboratory animals. Material and Methods: In the Department of Surgery no 4, during 4 years (2015-2018), there has been achieved one clinical-experimental study of LES electrical stimulation. During the first stage, the electrical stimulation of the LES, using an external pulse generator, was assessed in 15 patients. These patients underwent an antireflux intervention, with an additional insertion of 2 temporary electrodes on the LES. During the second stage, there was created an experimental device which consisted of a re-insertable microstimulator using wireless energy transfer. During the third stage, it was tested in the experimental surgery center "Pius Branzeu", Timisoara, on laboratory animals (pigs). Results: Values of the LES resting pressure and integrated relaxation pressure (IRP) were significantly different during the prestimulation and poststimulation periods. Conclusions: There was successfully demonstrated the possibility to increase the LES tone. Modifications in the LES functionality and tone, during the electrical stimulation and in the period immediately after the stimulation, depend upon the pulse frequency and length. Also, the additional change of the Bluetooth transmitter antenna is necessary to offset the screening effect of the biological tissues.


Assuntos
Terapia por Estimulação Elétrica , Esfíncter Esofágico Inferior/cirurgia , Refluxo Gastroesofágico/terapia , Animais , Eletrodos Implantados , Humanos , Modelos Animais , Implantação de Prótese , Suínos , Resultado do Tratamento
6.
Turk J Ophthalmol ; 49(4): 213-219, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31486609

RESUMO

In outer retinal degenerative diseases such as retinitis pigmentosa, choroideremia, and geographic atrophy, 30% of the ganglion cell layer in the macula remains intact. With subretinal and epiretinal prostheses, these inner retinal cells are stimulated with controlled electrical current by either a microphotodiode placed in the subretinal area or a microelectrode array tacked to the epiretinal region. As the patient learns to interpret the resulting phosphene patterns created in the brain through special rehabilitation exercises, their orientation, mobility, and quality of life increase. Implants that stimulate the lateral geniculate nucleus or visual cortex are currently being studied for diseases in which the ganglion cells and optic nerve are completely destroyed.


Assuntos
Estimulação Elétrica/instrumentação , Eletrodos Implantados , Degeneração Retiniana/complicações , Retinite Pigmentosa/complicações , Transtornos da Visão/reabilitação , Próteses Visuais , Humanos , Microeletrodos , Qualidade de Vida , Transtornos da Visão/etiologia
8.
Epileptic Disord ; 21(4): 379-384, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31403465

RESUMO

We report the first patient to die from refractory convulsive status epilepticus (SE) after the removal of a stimulator. The removal occurred after a two-year period of successful control of super-refractory convulsive SE with deep brain stimulation of the bilateral anterior nucleus of the thalamus (ANT-DBS). The female patient, born in 1990, suffered from high fever and seizures, and was diagnosed with viral encephalitis in 2005. After four weeks of medical treatment, she recovered with no neurological disabilities, but suffered from monthly seizures. Ten years later, the patient presented with convulsive SE, while four months pregnant in February of 2015. Her SE remained super-refractory to drugs despite the termination of pregnancy. Therefore, ANT-DBS was performed in March of 2015. The patient became SE-free following activation of an ANT-DBS stimulator. However, the stimulation treatment was terminated according to the family's request when a tremor developed two years after the treatment had begun. Subsequently, four SE episodes occurred and the tremor did not improve. The stimulator and electrodes were removed in August of 2017. The patient died of an uncontrolled SE two months later. This case demonstrates the effectiveness of ANT-DBS for emergency super-refractory convulsive SE with both positive and negative outcomes.


Assuntos
Estimulação Encefálica Profunda , Epilepsia Resistente a Medicamentos/terapia , Convulsões/terapia , Estado Epiléptico/terapia , Núcleos Anteriores do Tálamo , Estimulação Encefálica Profunda/métodos , Eletrodos Implantados , Feminino , Humanos , Masculino , Resultado do Tratamento
9.
Nat Commun ; 10(1): 3572, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395890

RESUMO

How are memories transferred from short-term to long-term storage? Systems-level memory consolidation is thought to be dependent on the coordinated interplay of cortical slow waves, thalamo-cortical sleep spindles and hippocampal ripple oscillations. However, it is currently unclear how the selective interaction of these cardinal sleep oscillations is organized to support information reactivation and transfer. Here, using human intracranial recordings, we demonstrate that the prefrontal cortex plays a key role in organizing the ripple-mediated information transfer during non-rapid eye movement (NREM) sleep. We reveal a temporally precise form of coupling between prefrontal slow-wave and spindle oscillations, which actively dictates the hippocampal-neocortical dialogue and information transfer. Our results suggest a model of the human sleeping brain in which rapid bidirectional interactions, triggered by the prefrontal cortex, mediate hippocampal activation to optimally time subsequent information transfer to the neocortex during NREM sleep.


Assuntos
Hipocampo/fisiologia , Consolidação da Memória/fisiologia , Modelos Psicológicos , Córtex Pré-Frontal/fisiologia , Sono de Ondas Lentas/fisiologia , Adulto , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/terapia , Eletrodos Implantados , Eletroencefalografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Adulto Jovem
11.
J Clin Neurosci ; 69: 104-108, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31416732

RESUMO

This retrospective study aims to explore the clinical utility of microelectrode recording (MER) during subthalamic deep brain stimulation (DBS) surgery in patients with Parkinson's disease (PD). We analyzed the data from 103 PD patients, who consecutively received bilateral subthalamic nucleus (STN) DBS at an experienced academic medical center. We collected demographic, clinical, and DBS related data, including intraoperative microelectrode recording data, electrode positioning, and clinical effects provided by intraoperative microstimulation. The 2 brain sides were independently analyzed and are described as first and second side (to be operated on); the first side is contralateral to motor symptoms onset. Patients were mostly men (64.1%). In both sides of the brain, percentage of agreement with the electrode final position was higher with clinical results than with intraoperative microelectrode recordings (98% vs 57% on the first implantation side, and 97% vs 58% on the second implantation side, respectively). Regarding electrode final implantation depth, 86% of electrodes were implanted between 0 mm and +2 mm in relation to anatomical target, and 95% of electrodes were implanted from -2 mm to +2 mm. Our study suggests that MER might not be necessary to achieve good clinical outcomes in PD patients undergoing STN DBS. These results support and inform the design of future prospective controlled research studies.


Assuntos
Estimulação Encefálica Profunda/métodos , Monitorização Neurofisiológica Intraoperatória/métodos , Doença de Parkinson/terapia , Eletrodos Implantados , Feminino , Humanos , Masculino , Microeletrodos , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Núcleo Subtalâmico/fisiologia
12.
World Neurosurg ; 132: e487-e495, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31449992

RESUMO

OBJECTIVE: During deep brain stimulation (DBS) surgery, microelectrode recording (MER) leads to target refinement from the initial plan in 30% to 47% of hemispheres; however, it is unclear whether the DBS lead ultimately resides within the MER-optimized target in relation to initial radiographic target coordinates in these hemispheres. This study aimed to determine the frequency of discordance between radiographic and neurophysiologic nucleus and whether target optimization with MER leads to a significant change in DBS lead location away from initial target. METHODS: Consecutive cases of DBS surgery with MER using intraoperative computed tomography were included. Coordinates of initial anatomic target (AT), MER-optimized target (MER-O) and DBS lead were obtained. Hemispheres were categorized as "discordant" (D) if there was a suboptimal neurophysiologic signal despite accurate targeting of AT. Hemispheres where the first MER pass was satisfactory were deemed "concordant" (C). Coordinates and radial distances between 1) AT/MER-O; 2) MER-O/DBS; and 3) AT/DBS were calculated and compared. RESULTS: Of the 273 hemispheres analyzed, 143 (52%) were D, and 130 (48%) were C. In C hemispheres, DBS lead placement error (mean ± standard error of the mean) was 0.88 ± 0.07 mm. In D hemispheres, MER resulted in significant migration of DBS lead (mean AT-DBS error 2.11 ± 0.07 mm), and this distance was significantly greater than the distance between MER-O and DBS (2.11 vs. 1.09 mm, P < 0.05). Directional assessment revealed that the DBS lead migrated in the intended direction as determined by MER-O in D hemispheres, except when the intended direction was anterolateral. CONCLUSIONS: Discordance between radiographic and neurophysiologic target was seen in 52% of hemispheres, and MER resulted in appropriate deviation of the DBS lead toward the appropriate target. The actual value of the deviation, when compared with DBS lead placement error in C hemispheres, was, on average, small.


Assuntos
Estimulação Encefálica Profunda/métodos , Monitorização Neurofisiológica Intraoperatória/métodos , Transtornos dos Movimentos/terapia , Neuronavegação/métodos , Idoso , Eletrodos Implantados , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Microeletrodos , Pessoa de Meia-Idade , Neuroimagem/métodos , Tomografia Computadorizada por Raios X
14.
Nat Commun ; 10(1): 3096, 2019 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-31363096

RESUMO

Natural communication often occurs in dialogue, differentially engaging auditory and sensorimotor brain regions during listening and speaking. However, previous attempts to decode speech directly from the human brain typically consider listening or speaking tasks in isolation. Here, human participants listened to questions and responded aloud with answers while we used high-density electrocorticography (ECoG) recordings to detect when they heard or said an utterance and to then decode the utterance's identity. Because certain answers were only plausible responses to certain questions, we could dynamically update the prior probabilities of each answer using the decoded question likelihoods as context. We decode produced and perceived utterances with accuracy rates as high as 61% and 76%, respectively (chance is 7% and 20%). Contextual integration of decoded question likelihoods significantly improves answer decoding. These results demonstrate real-time decoding of speech in an interactive, conversational setting, which has important implications for patients who are unable to communicate.


Assuntos
Mapeamento Encefálico/métodos , Córtex Cerebral/fisiologia , Fala/fisiologia , Interfaces Cérebro-Computador , Eletrocorticografia/instrumentação , Eletrocorticografia/métodos , Eletrodos Implantados , Epilepsia/diagnóstico , Epilepsia/fisiopatologia , Feminino , Humanos , Fatores de Tempo
15.
IEEE Pulse ; 10(4): 6-11, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31380738

RESUMO

The medical benefits of mild electrical stimulation of the cranium may seem like marketing hype, but decades of clinical research studies have verified that it does alleviate symptoms in a wide range of conditions. This method delivers very-low-frequency current to electrodes placed on the head, and that tiny current spreads across the brain to influence neurons and affect brain- network connectivity. Today, psychiatrists and neurologists commonly employ this technique as part of the therapy for people with anxiety, depression, posttraumatic stress disorder, epilepsy, Parkinson's disease, and a host of other conditions. Researchers are also reporting that stimulation can improvemental performance.


Assuntos
Transtornos de Ansiedade , Encéfalo/fisiopatologia , Estimulação Encefálica Profunda , Depressão , Eletrodos Implantados , Epilepsia , Doença de Parkinson , Transtornos de Estresse Pós-Traumáticos , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/terapia , Depressão/fisiopatologia , Depressão/terapia , Epilepsia/fisiopatologia , Epilepsia/terapia , Humanos , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/terapia
16.
Orv Hetil ; 160(31): 1216-1222, 2019 Aug.
Artigo em Húngaro | MEDLINE | ID: mdl-31352808

RESUMO

Introduction: The cochlear implants vary in electrodes in terms of length, width and proximity to the modiolus. The precurved electrode arrays could be placed closer to the modiolus and the ganglion cells compared to straight electrodes. The two types of electrode arrays provide different electrophysiological characteristics; however, proximity to the modiolus may lead to better hearing performance. Aim: To investigate our preliminary electrophysiological results that suggest that the Slim Modiolar (SM) electrode array has the potential to elicit similar neural responses as the thicker perimodiolar (Contour Advance, CA) electrode from the same generation of implants. Method: Subjects that were implanted either with CA or SM electrodes were enrolled, 54 consecutive subjects in each group. All electrodes were introduced into the cochlea via the round window. The diameter of the largest turn of the electrode arrays within the cochlea was measured through postoperative radiography. The energy consumption parameters were estimated 2 months after implantation. Results: The mean of the largest turns of the arrays within the cochlea was 4.2 ± 0.5 mm in the SM group and 4.9 ± 1.1 mm in the CA group. 'Auto power' was 44.81 ± 5.05% and 50.85 ± 8.35% with SM and CA, respectively. Estimated energy consumption was lower with SM. The differences were statistically significant. Conclusion: Our measurements for a large cohort in each group suggest that the SM electrode array takes a significantly closer position to the modiolus than the CA. This finding supports our earlier electrophysiological result and indicates better performance abilities. Orv Hetil. 2019; 160(31): 1216-1222.


Assuntos
Cóclea/diagnóstico por imagem , Implante Coclear/instrumentação , Implante Coclear/métodos , Implantes Cocleares , Nível de Discriminação Sonora/fisiologia , Radiografia/métodos , Cóclea/cirurgia , Eletrodos Implantados , Humanos
17.
Plast Reconstr Surg ; 144(2): 218e-229e, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348345

RESUMO

BACKGROUND: Traditional approaches to amputation are not capable of reproducing the dynamic muscle relationships that are essential for proprioceptive sensation and joint control. In this study, the authors present two caprine models of the agonist-antagonist myoneural interface (AMI), a surgical approach designed to improve bidirectional neural control of a bionic limb. The key advancement of the AMI is the surgical coaptation of natively innervated agonist-antagonist muscle pairs within the residual limb. METHODS: One AMI was surgically created in the hindlimb of each of two African Pygmy goats at the time of primary transtibial amputation. Each animal was also implanted with muscle electrodes and sonomicrometer crystals to enable measurement of muscle activation and muscle state, respectively. Coupled agonist-antagonist excursion in the agonist-antagonist myoneural interface muscles was measured longitudinally for each animal. Fibrosis in the residual limb was evaluated grossly in each animal as part of a planned terminal procedure. RESULTS: Electromyographic and muscle state measurements showed coupled agonist-antagonist motion within the AMI in the presence of both neural activation and artificial muscle stimulation. Gross observation of the residual limb during a planned terminal procedure revealed a thin fibrotic encapsulation of the AMI constructs, which was not sufficient to preclude coupled muscle excursion. CONCLUSIONS: These findings highlight the AMI's potential to provide coupled motion of distal agonist-antagonist muscle pairs preserved during below- or above-knee amputation at nearly human scale. Guided by these findings, it is the authors' expectation that further development of the AMI architecture will improve neural control of advanced limb prostheses through incorporation of physiologically relevant muscle-tendon proprioception.


Assuntos
Amputação/métodos , Eletromiografia/métodos , Propriocepção , Desenho de Prótese , Implantação de Prótese/métodos , Animais , Membros Artificiais , Modelos Animais de Doenças , Eletrodos Implantados , Feminino , Fêmur/cirurgia , Cabras , Masculino , Músculo Esquelético/inervação , Tíbia/cirurgia
18.
Neuromodulation ; 22(6): 745-750, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31318471

RESUMO

OBJECTIVE: The objective was to assess the efficacy and the safety of sacral nerve modulation (SNM) in men with fecal incontinence (FI) compared with those of SNM in women. METHOD: Prospectively collected data from patients from seven tertiary colorectal units who underwent an implant procedure between January 2010 and December 2015 were reviewed retrospectively. Outcomes and surgical revision and definitive explantation rates were compared between men and women. RESULTS: A total of 469 patients (60 men [12.8%]; mean age = 61.4 ± 12.0 years) were included in the study, 352 (78.1%) (31 men [8.8%]) of whom received a permanent implant. The ratio of implanted/tested men was significantly lower than the ratio of implanted/tested women (p = 0.0004). After a mean follow-up of 3.4 ± 1.9 years, the cumulative successful treatment rates tended to be less favorable in men than in women (p = 0.0514): 88.6% (75.6-95.1), 75.9% (60.9-86.4), 63.9% (48.0-77.3), and 43.9% (26.7-62.7) at one, two, three, and five years, respectively, in men; 92.0% (89.1-94.2), 84.2% (80.3-87.4), 76.8% (72.3-80.7), and 63.6% (57.5-69.3) at one, two, three, and five years, respectively, in women. The revision rate for infection and the definitive explantation rate for infection were higher in men than in women (p = 0.0001 and p = 0.0024, respectively). CONCLUSION: Both short- and long-term success rates of SNM for FI were lower in men than in women. The revision and definitive explantation for long-term infection rates were significantly higher in men.


Assuntos
Terapia por Estimulação Elétrica/métodos , Eletrodos Implantados , Incontinência Fecal/diagnóstico por imagem , Incontinência Fecal/terapia , Plexo Lombossacral/diagnóstico por imagem , Caracteres Sexuais , Idoso , Terapia por Estimulação Elétrica/instrumentação , Incontinência Fecal/fisiopatologia , Feminino , Seguimentos , Humanos , Plexo Lombossacral/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
19.
BMC Surg ; 19(1): 92, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307448

RESUMO

BACKGROUND: The accuracy of deep brain stimulation (DBS) depends on precise electrode positioning, which has been pursued for ideal treatment outcomes. As a critical component of DBS, the fixation performance of lead anchoring devices has been widely studied. Possible reasons for lead shift were analyzed in the current study and we further provided effective solutions to reduce potential manual errors. METHODS: Seventy-nine patients who received DBS implantations at the Ruijin Hospital from April to November 2017 were retrospectively reviewed. Intraoperative lead shifts were measured by C-arm fluoroscopy. Lead adjustment counts were recorded and compared among three lead fixation devices: Stimloc™ (Medtronic, Minneapolis, MN, USA), TouchLoc (SceneRay, Suzhou, China), and the traditional lead anchoring device. RESULTS: Mean (± SD) distances of lead shifts were 0.29 ± 2.42 mm in Stimloc devices, 0.43 ± 0.55 mm in TouchLoc devices, and 1.52 ± 1.05 mm in traditional devices (p < 0.0001). Average numbers of adjustments in this series were 0.3 ± 0.5 in Stimloc devices, 0.3 ± 1.3 in TouchLoc devices, and 1.1 ± 1.0 in traditional devices (p = 0.0001). Pairwise comparisons among the three devices (TouchLoc vs. Stimloc: p = 0.273; TouchLoc vs. Traditional: p = 0.0001; Stimloc vs. traditional: p < 0.0001) suggested significant differences, which were mainly attributed to the traditional devices. CONCLUSIONS: Three lead anchoring devices have been compared for their performance in the accuracy of lead fixation, in which the newly designed lead fixation devices have presented its advantages to the traditional one. In addition to the application of the Stimloc and TouchLoc devices, verification by C-arm fluoroscopy should be performed to provide an intuitive view of the depth deviation of electrode position during DBS electrode implantation.


Assuntos
Estimulação Encefálica Profunda/instrumentação , Eletrodos Implantados , Transtornos dos Movimentos/terapia , Adolescente , Adulto , Idoso , China , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
Handb Clin Neurol ; 161: 45-71, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31307620

RESUMO

Identification and localization of the "epileptogenic process" in the brain of patients with drug-resistant epilepsy for surgical cure is the goal of presurgical investigations. Intracranial recordings are required when conflicting data between seizure clinical semiology and EEG prevent precise localization within one hemisphere or lateralization, when a visible lesion on MRI seems unrelated to the electroclinical data, or in MRI-negative cases. Two methods are currently used. The objective of the subdural grid electrocorticography with or without depth electrodes (SDG/DE) is the best possible identification of the area of onset of spontaneous seizures and localization of the eloquent cortex. The objective of stereoelectroencephalography (SEEG) is to define the epileptogenic zone (configured as a network) and its relation to an unmasked lesion. Two-dimensional (SDG) and three-dimensional (SEEG) brain sampling dictate different strategies for noninvasive presurgical phase I goals as well as for data analysis. SEEG must resolve several potential localization hypotheses in a manner that cannot be achieved with SDG. SDG operates through brain surface coverage, unlike SEEG, which samples networks. SDG estimates the extent of cortical resection through a lobar or sublobar localization of ictal onset and constraints from functional mapping. SEEG defines a tailored resection according to the results of anatomo-electro-clinical correlations in stereotaxic space that will guide the ablation of the epileptogenic zone. SEEG is currently expanding faster than SDG. The prerequisites (especially in the preimplantation hypothetical strategy) and technical tools (especially stimulation and functional mapping) in the two methods are very different. This chapter presents a comparative review of the rationale, indications, electrode implantation strategies, interpretation, and surgical decision making of these two approaches of presurgical evaluation for epilepsy surgery.


Assuntos
Mapeamento Encefálico/métodos , Epilepsia Resistente a Medicamentos , Eletrocorticografia/métodos , Eletroencefalografia/métodos , Cuidados Pré-Operatórios/métodos , Epilepsia Resistente a Medicamentos/fisiopatologia , Epilepsia Resistente a Medicamentos/cirurgia , Eletrodos Implantados , Humanos
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