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1.
Otol Neurotol ; 43(10): e1107-e1114, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36351225

RESUMO

OBJECTIVE: Monitor four-point impedance in cochlear implant recipients over time and determine if implant type, surgical approach, and electrode positioning affected impedance measurements. STUDY DESIGN: Prospective observational. SETTING: Hospital. PATIENTS: Adult cochlear implant recipients implanted with a perimodiolar or lateral wall cochlear implant. MAIN OUTCOME MEASURES: Mean values for four-point impedances were calculated for all electrode contacts at perioperative and 3 months after surgery. Linear mixed models were applied to the impedance data to compare between implant types and time points. The angular insertion depth and electrode position relative to the medial and lateral wall, commonly termed the Intracochlear Position Index (ICPI), were collected and compared with impedance measurements. RESULTS: Perioperatively, the four-point impedance was similar between implant types, with perimodiolar implants having marginally higher impedance values in the basal region. At 3 months after surgery, impedances significantly increased in the basal half of the electrode array for both implants, with higher impedance values for CI532 implants. There were no significant differences in insertion angle depth between implant types. The ICPI values for the seven most basal electrodes were similar for both implants; however, CI532 arrays were significantly more medially placed along the remaining apical portion of the array, which is expected. ICPI values did not correlate with impedance measurements for either implant. CONCLUSIONS: Four-point impedance increases at 3 months after surgery may reflect fibrous tissue formation after cochlear implantation. The higher impedance values in perimodiolar implants may reflect a more extensive fibrosis formation as a result of surgical approaches used, requiring drilling of the cochlea bone.


Assuntos
Implante Coclear , Implantes Cocleares , Adulto , Humanos , Impedância Elétrica , Cóclea/cirurgia , Eletrodos Implantados
2.
Sci Rep ; 12(1): 19234, 2022 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-36357503

RESUMO

In cochlear implant surgery, insertion of perimodiolar electrode arrays into the scala tympani can be complicated by trauma or even accidental translocation of the electrode array within the cochlea. In patients with partial hearing loss, cochlear trauma can not only negatively affect implant performance, but also reduce residual hearing function. These events have been related to suboptimal positioning of the cochlear implant electrode array with respect to critical cochlear walls of the scala tympani (modiolar wall, osseous spiral lamina and basilar membrane). Currently, the position of the electrode array in relation to these walls cannot be assessed during the insertion and the surgeon depends on tactile feedback, which is unreliable and often comes too late. This study presents an image-guided cochlear implant device with an integrated, fiber-optic imaging probe that provides real-time feedback using optical coherence tomography during insertion into the human cochlea. This novel device enables the surgeon to accurately detect and identify the cochlear walls ahead and to adjust the insertion trajectory, avoiding collision and trauma. The functionality of this prototype has been demonstrated in a series of insertion experiments, conducted by experienced cochlear implant surgeons on fresh-frozen human cadaveric cochleae.


Assuntos
Implante Coclear , Implantes Cocleares , Humanos , Implante Coclear/métodos , Cóclea/diagnóstico por imagem , Cóclea/cirurgia , Cóclea/lesões , Membrana Basilar , Rampa do Tímpano/diagnóstico por imagem , Rampa do Tímpano/cirurgia , Eletrodos Implantados
3.
Elife ; 112022 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-36355598

RESUMO

A wide range of techniques in neuroscience involve placing individual probes at precise locations in the brain. However, large-scale measurement and manipulation of the brain using such methods have been severely limited by the inability to miniaturize systems for probe positioning. Here, we present a fundamentally new, remote-controlled micropositioning approach composed of novel phase-change material-filled resistive heater micro-grippers arranged in an inchworm motor configuration. The microscopic dimensions, stability, gentle gripping action, individual electronic control, and high packing density of the grippers allow micrometer-precision independent positioning of many arbitrarily shaped probes using a single piezo actuator. This multi-probe single-actuator design significantly reduces the size and weight and allows for potential automation of microdrives. We demonstrate accurate placement of multiple electrodes into the rat hippocampus in vivo in acute and chronic preparations. Our robotic microdrive technology should therefore enable the scaling up of many types of multi-probe applications in neuroscience and other fields.


Assuntos
Neurônios , Procedimentos Cirúrgicos Robóticos , Animais , Ratos , Eletrofisiologia/métodos , Eletrodos Implantados , Encéfalo
4.
Biomaterials ; 291: 121874, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36334353

RESUMO

Bioelectronic medicine is a promising venue for treatment of disabilities using implantable neural interfaces. Peripheral neurostimulation of residual nerves recently enabled multiple functional benefits in amputees. Despite the preliminary promising impact on patients' life, the over-time stability of implants and the related nerve reactions are unclear. To unveil the mechanisms and inform the design of better nerve-electrode interfaces, we engaged a multifaceted approach, merging functional responses from patients, their histological data, and corresponding computational modelling. Neurostimulation evoked different selective sensation locations and qualities over-time, with respective perceptual thresholds, that showed different degree of time stabilities dependent from the stimulating active sites. The histological analysis after explant showed mild tissue reactions, while electromechanically active sites and substrates remained conserved. Computational models, based on patients' histology, revealed the direct influence of the simulated tissue reaction to change of thresholds and type of perceived sensations. Novel insights of electrode biocompatibility was observed compared to animals and the increase of thresholds could be predicted computationally. This multifaced framework suggest that future intraneural implants should have easier implantation and higher biocompatibility counteracting the sensations changes through AI-based stimulations and electrode coatings.


Assuntos
Amputados , Animais , Humanos , Desenho de Prótese , Eletrodos , Simulação por Computador , Eletrodos Implantados
5.
Biosensors (Basel) ; 12(11)2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36421162

RESUMO

Chronic implantation of an epidural Electrocorticography (ECoG) electrode produces thickening of the dura mater and proliferation of the fibrosis around the interface sites, which is a significant concern for chronic neural ECoG recording applications used to monitor various neurodegenerative diseases. This study describes a new approach to developing a slippery liquid-infused porous surface (SLIPS) on the flexible ECoG electrode for a chronic neural interface with the advantage of increased cell adhesion. In the demonstration, the electrode was fabricated on the polyimide (PI) substrate, and platinum (Pt)-gray was used for creating the porous nanocone structure for infusing the silicone oil. The combination of nanocone and the infused slippery oil layer created the SLIPS coating, which has a low impedance (4.68 kΩ) level favourable for neural recording applications. The electrochemical impedance spectroscopy and equivalent circuit modelling also showed the effect of the coating on the recording site. The cytotoxicity study demonstrated that the coating does not have any cytotoxic potentiality; hence, it is biocompatible for human implantation. The in vivo (acute recording) neural recording on the rat model also confirmed that the noise level could be reduced significantly (nearly 50%) and is helpful for chronic ECoG recording for more extended neural signal recording applications.


Assuntos
Eletrocorticografia , Polímeros , Animais , Ratos , Humanos , Eletrodos Implantados , Polímeros/química , Sistema Nervoso , Platina
6.
Arq. bras. cardiol ; 119(4 supl.1): 266-266, Oct, 2022.
Artigo em Inglês | Sec. Est. Saúde SP, CONASS, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1397604

RESUMO

INTRODUCTION: The Atrioventricular Septal Defect (AVSD) corresponds to 3% of congenital heart diseases, being associated with genetic syndromes and other congenital malformations. One of the anatomical alterations present in AVSD is the posterior displacement of the atrioventricular node, located between the coronary sinus and the annulus of the atrioventricular valve, increasing the risk of injury to the same during mitral cleft repair, generating atrioventricular block (AVB), Such a complication may evolve with the need for definitive implantation of a pacemaker. ABSTRACT: A 27-year-old female patient with complex heart disease (left atrial isomerism, partial AVSD, muscular interventricular communication, single atrium, pulmonary hypertension), underwent atrial septation surgery, mitral cleft repair and ventriculoseptoplasty in the first year of life, evolving in the postoperative period with total AVB, requiring implantation of a permanent pacemaker 1 month after the surgical procedure. In follow-up, she demonstrated heart rate reversibility, being submitted to extraction of the pacemaker generator and plasty of the abdominal pocket at age 22, remaining with the endocardial electrode. The patient evolved with symptoms of right heart failure (dyspnea, with worsening of the functional class). During the current diagnostic investigation, a significant pulmonary gradient was evidenced by the transthoracic echocardiogram, but without valvular lesion. An angiotomography of the heart and basal vessels was performed, which showed extrinsic compression of the right pulmonary artery by the pacemaker wire, which generated the pulmonary stenosis evidenced by the echocardiogram. CONCLUSION: Extrinsic compression by endocardial pacemaker lead is a rare phenomenon that can be difficult to recognize. In the case reported, due to the left atrial isomerism and the need to implant a permanent pacemaker during childhood in the abdominal cavity, the electrode was implanted through the azygos venous system. With the development and growth of the patient, the fixed electrode implanted in the right ventricle pulled the azygos vein under the right pulmonary artery, generating extrinsic compression and pulmonary stenosis evidenced both by imaging methods and by the patient's clinical condition. It is clear the importance of late follow-up of patients who still have implanted electrodes, even without the use of a pacemaker, in complex anatomical situations.


Assuntos
Marca-Passo Artificial , Artéria Pulmonar , Eletrodos Implantados , Bloqueio Atrioventricular , Cardiopatias Congênitas , Insuficiência Cardíaca , Hipertensão Pulmonar
7.
Otol Neurotol ; 43(10): 1155-1161, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36201552

RESUMO

HYPOTHESIS: Robotics-assisted cochlear implant (CI) insertions will result in reduced intracochlear trauma when compared with manual, across multiple users. BACKGROUND: Whether intracochlear trauma and translocations are two factors that may contribute to significant variability in CI outcomes remains to be seen. To address this issue, we have developed a robotics-assisted insertion system designed to aid the surgeon in inserting electrode arrays with consistent speeds and reduced variability. This study evaluated the effect of robotics-assisted insertions on the intracochlear trauma as compared with manual insertions in cadaveric cochleae in a simulated operative environment. METHODS: Twelve neurotologists performed bilateral electrode insertions into cochleae of full cadaveric heads using both the robotics-assisted system and manual hand insertion. Lateral wall electrodes from three different manufacturers (n = 24) were used and randomized between surgeons. Insertion angle of the electrode and trauma scoring were evaluated using high-resolution three-dimensional x-ray microscopy and compared between robotics-assisted and manual insertions. RESULTS: Three-dimensional x-ray microscopy provided excellent resolution to characterize the in situ trauma and insertion angle. Robotics-assisted insertions significantly decreased insertional intracochlear trauma as measured by reduced trauma scores compared with manual insertions (average: 1.3 versus 2.2, device versus manual, respectively; p < 0.05). There was no significant difference between insertion angles observed for manual and robotics-assisted techniques (311 ± 131° versus 307 ± 96°, device versus manual, respectively). CONCLUSIONS: Robotics-assisted insertion systems enable standardized electrode insertions across individual surgeons and experience levels. Clinical trials are necessary to investigate whether insertion techniques that reduce insertional variability and the likelihood of intracochlear trauma also improve CI auditory outcomes.


Assuntos
Implante Coclear , Implantes Cocleares , Humanos , Implante Coclear/métodos , Cóclea/cirurgia , Eletrodos Implantados , Cadáver
8.
J Neurosci Methods ; 382: 109719, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36195238

RESUMO

BACKGROUND: Large-scale microelectrode recordings offer a unique opportunity to study neurophysiological processes at the network level with single cell resolution. However, in the small brains of many experimental animals, it is often technically challenging to verify the correct targeting of the intended structures, which inherently limits the reproducibility of acquired data. NEW METHOD: To mitigate this problem, we have developed a method to programmatically segment the trajectory of electrodes arranged in larger arrays from acquired CT-images and thereby determine the position of individual recording tips with high spatial resolution, while also allowing for coregistration with an anatomical atlas, without pre-processing of the animal samples or post-imaging histological analyses. RESULTS: Testing the technical limitations of the developed method, we found that the choice of scanning angle influences the achievable spatial resolution due to shadowing effects caused by the electrodes. However, under optimal acquisition conditions, individual electrode tip locations within arrays with 250 µm inter-electrode spacing were possible to reliably determine. COMPARISON TO EXISTING METHODS: Comparison to a histological verification method suggested that, under conditions where individual wires are possible to track in slices, a 90% correspondence could be achieved in terms of the number of electrodes groups that could be reliably assigned to the same anatomical structure. CONCLUSIONS: The herein reported semi-automated procedure to verify anatomical targeting of brain structures in the rodent brain could help increasing the quality and reproducibility of acquired neurophysiological data by reducing the risk of assigning recorded brain activity to incorrectly identified anatomical locations. DATA AVAILABILITY: The tools developed in this study are freely available as a software package at: https://github.com/NRC-Lund/ct-tools.


Assuntos
Estimulação Encefálica Profunda , Animais , Microeletrodos , Estimulação Encefálica Profunda/métodos , Reprodutibilidade dos Testes , Encéfalo/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Eletrodos Implantados
10.
Oper Neurosurg (Hagerstown) ; 23(6): e348-e352, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36227247

RESUMO

BACKGROUND: Spinal cord stimulation (SCS) is a safe neuromodulatory treatment used to treat failed back surgery syndrome, chronic neuropathic pain, and complex regional pain syndrome. Despite its efficacy, some patients fail to achieve pain relief and elect to undergo removal of SCS paddle leads. The safety and best practices of these procedures have not been defined. OBJECTIVE: In this article, we describe our technique and complication rate in a series of SCS paddle removals. METHODS: All patients who underwent SCS paddle removal at the Albany Medical Center between 2011 and 2020 were identified. Medical charts were reviewed for demographic data, operative technique, and incidence of complications within 30 days of the procedure. RESULTS: Thirty-two (91%) patients underwent a thoracic paddle removal, whereas 3 (9%) underwent a cervical paddle removal. All cases underwent preoperative imaging with computed tomography or MRI, and all cases were performed with neuromonitoring and fluoroscopy. The technique required for paddle removal depended on the extent of local scar formation and ranged from soft tissue dissection to additional laminectomy at an adjacent level. Cases took on average 2 ± 0.09 hours with 23.21 ± 4.29 cc blood loss. Two patients had superficial infections, which were cleared with 1 week of oral antibiotics. There were no other adverse events. CONCLUSION: Thirty-five patients successfully underwent paddle removal with the minor complications reported. In this article, we show that by using neuromonitoring, fluoroscopy, and the techniques described, SCS paddle removal can be performed with minimal risk.


Assuntos
Síndromes da Dor Regional Complexa , Síndrome Pós-Laminectomia , Neuralgia , Estimulação da Medula Espinal , Humanos , Estimulação da Medula Espinal/métodos , Eletrodos Implantados/efeitos adversos , Síndrome Pós-Laminectomia/terapia , Síndrome Pós-Laminectomia/etiologia , Síndromes da Dor Regional Complexa/terapia , Neuralgia/terapia
11.
Neurosurg Focus ; 53(4): E5, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36183179

RESUMO

OBJECTIVE: Patients with tuberous sclerosis complex (TSC) epilepsy present with unique clinical challenges such as early seizure onset and high rates of intractability and multifocality. Although there are numerous studies about the safety and efficacy of stereoelectroencephalography (SEEG), this topic has not been studied in TSC patients who have distinct epilepsy profiles. The authors investigated subdural grid (SDG) and SEEG monitoring to determine whether these procedures lead to similar seizure and safety outcomes and to identify features unique to this pediatric population. METHODS: TSC patients who underwent SDG or SEEG placement and a second epilepsy surgery during the period from 2007 to 2021 were included in this single-center retrospective cohort analysis. Various patient, hospitalization, and epilepsy characteristics were collected. RESULTS: A total of 50 TSC patients were included in this study: 30 were included in the SDG cohort and 20 in the SEEG cohort. Baseline weekly seizure count did not significantly differ between the 2 groups (p = 0.412). The SEEG group had a greater mean baseline number of antiepileptic drugs (AEDs) (3.0 vs 2.0, p = 0.003), higher rate of previous surgical interventions (25% vs 0%, p = 0.007), and larger proportion of patients who underwent bilateral monitoring (50% vs 13.3%, p = 0.005). Despite this, there was no significant difference in seizure freedom between the SDG and SEEG cohorts. The mean reduction in seizure count was 84.9% and 47.8% of patients were seizure free at last follow-up (mean 79.4 months). SEEG trended toward being a safer procedure than SDG monitoring, with a shorter mean ICU stay (0.7 days vs 3.9 days, p < 0.001), lower blood transfusion rate (0% vs 13.3%, p = 0.140), and lower surgical complication rate (0% vs 10%, p = 0.265). CONCLUSIONS: In the comparison of the SDG and SEEG cohorts, the SEEG group included patients who appeared to receive more aggressive management and have a higher rate of multifocality, more prior surgical interventions, more AEDs at baseline, and a higher rate of bilateral invasive monitoring. Despite this, the SEEG cohort had similar seizure outcomes and a trend toward increased safety. Based on these findings, SEEG appears to allow for monitoring of a wider breadth of TSC patients given its minimally invasive nature and its relative simplicity for monitoring numerous regions of the brain.


Assuntos
Epilepsia Resistente a Medicamentos , Epilepsia , Esclerose Tuberosa , Anticonvulsivantes/uso terapêutico , Carotenoides , Criança , Epilepsia Resistente a Medicamentos/cirurgia , Eletrodos Implantados , Eletroencefalografia/métodos , Epilepsia/cirurgia , Humanos , Estudos Retrospectivos , Convulsões/cirurgia , Técnicas Estereotáxicas , Resultado do Tratamento , Esclerose Tuberosa/complicações , Esclerose Tuberosa/cirurgia , Vitamina A/análogos & derivados
12.
Neurosurg Focus ; 53(4): E10, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36183183

RESUMO

OBJECTIVE: Responsive neurostimulation (RNS) is a promising treatment for pediatric patients with drug-resistant epilepsy for whom resective surgery is not an option. The relative indications and risk for pediatric patients undergoing RNS therapy require further investigation. Here, the authors report their experience with RNS implantation and therapy in pediatric patients. METHODS: The authors performed a retrospective chart review to identify patients implanted with RNS depth or strip electrodes for the treatment of drug-resistant epilepsy at their institution between 2020 and 2022. Patient demographics, surgical variables, and patient seizure outcomes (Engel class and International League Against Epilepsy [ILAE] reporting) were evaluated. RESULTS: The authors identified 20 pediatric patients ranging in age from 8 to 21 years (mean 15 [SD 4] years), who underwent RNS implantation, including depth electrodes (n = 15), strip electrodes (n = 2), or both (n = 3). Patient seizure semiology, onset, and implantation strategy were heterogeneous, including bilateral centromedian nucleus (n = 5), mesial temporal lobe (n = 4), motor cortex or supplementary motor area (n = 7), or within an extratemporal epileptogenic zone (n = 4). There were no acute complications of RNS implantation (hemorrhage or stroke) or device malfunctions. One patient required rehospitalization for postoperative infection. At the longest follow-up (mean 10 [SD 7] months), 13% patients had Engel class IIB, 38% had Engel class IIIA, 6% had Engel class IIIB, 19% had Engel class IVA, 19% had Engel class IVB, and 6% had Engel class IVC outcomes. Using ILAE metrics, 6% were ILAE class 3, 25% were ILAE class 4, and 69% were ILAE class 5. CONCLUSIONS: This case series supports current literature suggesting that RNS is a safe and potentially effective surgical intervention for pediatric patients with drug-resistant epilepsy. The authors report comparable rates of serious adverse events to current RNS literature in pediatric and adult populations. Seizure outcomes may continue to improve with follow-up as stimulation strategy is refined and the chronic neuromodulatory effect evolves, as previously described in patients with RNS. Further large-scale, multicenter case series of RNS in pediatric patients with drug-resistant epilepsy are required to determine long-term pediatric safety and effectiveness.


Assuntos
Epilepsia Resistente a Medicamentos , Epilepsia , Adolescente , Adulto , Criança , Epilepsia Resistente a Medicamentos/etiologia , Epilepsia Resistente a Medicamentos/cirurgia , Eletrodos Implantados/efeitos adversos , Epilepsia/terapia , Humanos , Estudos Multicêntricos como Assunto , Estudos Retrospectivos , Convulsões/etiologia , Resultado do Tratamento , Adulto Jovem
13.
Neurosurg Focus ; 53(4): E4, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36183187

RESUMO

OBJECTIVE: The objective of this study was to compare the relative safety and effectiveness of invasive monitoring with subdural electrodes (SDEs) and stereoelectroencephalography (sEEG) in pediatric patients with drug-resistant epilepsy. METHODS: A retrospective cohort study was performed in 176 patients who underwent invasive monitoring evaluations at UPMC Children's Hospital of Pittsburgh between January 2000 and September 2021. To examine differences between SDE and sEEG groups, independent-samples t-tests for continuous variables and Pearson chi-square tests for categorical variables were performed. A p value < 0.1 was considered statistically significant. RESULTS: There were 134 patients (76%) in the SDE group and 42 (24%) in the sEEG group. There was a difference in the proportion with complications (17.9% in the SDE group vs 7.1% in the sEEG group, p = 0.09) and resection (75.4% SDE vs 21.4% sEEG, p < 0.01) between SDE and sEEG patients. However, there was no observable difference in the rates of postresection seizure freedom at 1-year clinical follow-up (60.2% SDE vs 75.0% sEEG, p = 0.55). CONCLUSIONS: These findings reveal a difference in rates of surgical complications and resection between SDEs and sEEG. Larger prospective, multi-institutional pediatric comparative effectiveness studies may further explore these associations.


Assuntos
Epilepsia Resistente a Medicamentos , Eletroencefalografia , Criança , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/cirurgia , Eletrodos Implantados , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Técnicas Estereotáxicas , Resultado do Tratamento
14.
Neurosurg Focus ; 53(4): E3, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36183186

RESUMO

OBJECTIVE: Stereoelectroencephalography (SEEG) is a widely used technique for localizing seizure onset zones prior to resection. However, its use has traditionally been avoided in children under 2 years of age because of concerns regarding pin fixation in the immature skull, intraoperative and postoperative electrode bolt security, and stereotactic registration accuracy. In this retrospective study, the authors describe their experience using SEEG in patients younger than 2 years of age, with a focus on the procedure's safety, feasibility, and accuracy as well as surgical outcomes. METHODS: A retrospective review of children under 2 years of age who had undergone SEEG while at Children's Hospital of Philadelphia between November 2017 and July 2021 was performed. Data on clinical characteristics, surgical procedure, imaging results, electrode accuracy measurements, and postoperative outcomes were examined. RESULTS: Five patients younger than 2 years of age underwent SEEG during the study period (median age 20 months, range 17-23 months). The mean age at seizure onset was 9 months. Developmental delay was present in all patients, and epilepsy-associated genetic diagnoses included tuberous sclerosis (n = 1), KAT6B (n = 1), and NPRL3 (n = 1). Cortical lesions included tubers from tuberous sclerosis (n = 1), mesial temporal sclerosis (n = 1), and cortical dysplasia (n = 3). The mean number of placed electrodes was 11 (range 6-20 electrodes). Bilateral electrodes were placed in 1 patient. Seizure onset zones were identified in all cases. There were no SEEG-related complications, including skull fracture, electrode misplacement, hemorrhage, infection, cerebrospinal fluid leakage, electrode pullout, neurological deficit, or death. The mean target point error for all electrodes was 1.0 mm. All patients proceeded to resective surgery, with a mean follow-up of 21 months (range 8-53 months). All patients attained a favorable epilepsy outcome, including Engel class IA (n = 2), IC (n = 1), ID (n = 1), and IIA (n = 1). CONCLUSIONS: SEEG can be safely, accurately, and effectively utilized in children under age 2 with good postoperative outcomes using standard SEEG equipment. With minimal modification, this procedure is feasible in those with immature skulls and guides the epilepsy team's decision-making for early and optimal treatment of refractory epilepsy through effective localization of seizure onset zones.


Assuntos
Epilepsia Resistente a Medicamentos , Epilepsia , Esclerose Tuberosa , Criança , Pré-Escolar , Epilepsia Resistente a Medicamentos/cirurgia , Eletrodos Implantados , Eletroencefalografia/métodos , Epilepsia/diagnóstico por imagem , Epilepsia/cirurgia , Proteínas Ativadoras de GTPase , Histona Acetiltransferases , Humanos , Lactente , Estudos Retrospectivos , Convulsões/cirurgia , Técnicas Estereotáxicas , Esclerose Tuberosa/cirurgia
15.
J Neural Eng ; 19(5)2022 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-36198278

RESUMO

Objective. Despite the tremendous promise of invasive brain-computer interfaces (iBCIs), the associated study costs, risks, and ethical considerations limit the opportunity to develop and test the algorithms that decode neural activity into a user's intentions. Our goal was to address this challenge by designing an iBCI model capable of testing many human subjects in closed-loop.Approach. We developed an iBCI model that uses artificial neural networks (ANNs) to translate human finger movements into realistic motor cortex firing patterns, which can then be decoded in real time. We call the model the joint angle BCI, or jaBCI. jaBCI allows readily recruited, healthy subjects to perform closed-loop iBCI tasks using any neural decoder, preserving subjects' control-relevant short-latency error correction and learning dynamics.Main results. We validated jaBCI offline through emulated neuron firing statistics, confirming that emulated neural signals have firing rates, low-dimensional PCA geometry, and rotational jPCA dynamics that are quite similar to the actual neurons (recorded in monkey M1) on which we trained the ANN. We also tested jaBCI in closed-loop experiments, our single study examining roughly as many subjects as have been tested world-wide with iBCIs (n= 25). Performance was consistent with that of the paralyzed, human iBCI users with implanted intracortical electrodes. jaBCI allowed us to imitate the experimental protocols (e.g. the same velocity Kalman filter decoder and center-out task) and compute the same seven behavioral measures used in three critical studies.Significance. These encouraging results suggest the jaBCI's real-time firing rate emulation is a useful means to provide statistically robust sample sizes for rapid prototyping and optimization of decoding algorithms, the study of bi-directional learning in iBCIs, and improving iBCI control.


Assuntos
Interfaces Cérebro-Computador , Córtex Motor , Algoritmos , Eletrodos Implantados , Humanos , Córtex Motor/fisiologia , Movimento
16.
JAMA ; 328(15): 1506-1514, 2022 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-36255427

RESUMO

Importance: The use of spinal cord stimulation for chronic pain after lumbar spine surgery is increasing, yet rigorous evidence of its efficacy is lacking. Objective: To investigate the efficacy of spinal cord burst stimulation, which involves the placement of an implantable pulse generator connected to electrodes with leads that travel into the epidural space posterior to the spinal cord dorsal columns, in patients with chronic radiculopathy after surgery for degenerative lumbar spine disorders. Design, Setting, and Participants: This placebo-controlled, crossover, randomized clinical trial in 50 patients was conducted at St Olavs University Hospital in Norway, with study enrollment from September 5, 2018, through April 28, 2021. The date of final follow-up was May 20, 2022. Interventions: Patients underwent two 3-month periods with spinal cord burst stimulation and two 3-month periods with placebo stimulation in a randomized order. Burst stimulation consisted of closely spaced, high-frequency electrical stimuli delivered to the spinal cord. The stimulus consisted of a 40-Hz burst mode of constant-current stimuli with 4 spikes per burst and an amplitude corresponding to 50% to 70% of the paresthesia perception threshold. Main Outcomes and Measures: The primary outcome was difference in change from baseline in the self-reported Oswestry Disability Index (ODI; range, 0 points [no disability] to 100 points [maximum disability]; the minimal clinically important difference was 10 points) score between periods with burst stimulation and placebo stimulation. The secondary outcomes were leg and back pain, quality of life, physical activity levels, and adverse events. Results: Among 50 patients who were randomized (mean age, 52.2 [SD, 9.9] years; 27 [54%] were women), 47 (94%) had at least 1 follow-up ODI score and 42 (84%) completed all stimulation randomization periods and ODI measurements. The mean ODI score at baseline was 44.7 points and the mean changes in ODI score were -10.6 points for the burst stimulation periods and -9.3 points for the placebo stimulation periods, resulting in a mean between-group difference of -1.3 points (95% CI, -3.9 to 1.3 points; P = .32). None of the prespecified secondary outcomes showed a significant difference. Nine patients (18%) experienced adverse events, including 4 (8%) who required surgical revision of the implanted system. Conclusions and Relevance: Among patients with chronic radicular pain after lumbar spine surgery, spinal cord burst stimulation, compared with placebo stimulation, after placement of a spinal cord stimulator resulted in no significant difference in the change from baseline in self-reported back pain-related disability. Trial Registration: ClinicalTrials.gov Identifier: NCT03546738.


Assuntos
Dor nas Costas , Dor Crônica , Terapia por Estimulação Elétrica , Síndrome Pós-Laminectomia , Vértebras Lombares , Doenças da Coluna Vertebral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor nas Costas/etiologia , Dor nas Costas/terapia , Dor Crônica/etiologia , Dor Crônica/terapia , Vértebras Lombares/cirurgia , Medição da Dor , Qualidade de Vida , Medula Espinal , Resultado do Tratamento , Radiculopatia/etiologia , Radiculopatia/terapia , Síndrome Pós-Laminectomia/etiologia , Síndrome Pós-Laminectomia/terapia , Doenças da Coluna Vertebral/cirurgia , Terapia por Estimulação Elétrica/efeitos adversos , Terapia por Estimulação Elétrica/métodos , Eletrodos Implantados , Espaço Epidural , Estudos Cross-Over , Adulto
17.
JASA Express Lett ; 2(4): 044401, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-36154233

RESUMO

Cochlear implant (CI) users often produce different vocal pitches when using their left versus right CI. One possible explanation for this is that insertion depth differs across the two CIs. The goal of this study was to investigate the role of electrode insertion depth in the production of vocal pitch. Eleven individuals with bilateral CIs used maps simulating differences in insertion depth. Participants produced a sustained vowel and sang Happy Birthday. Approximately half the participants significantly shifted the pitch of their voice in response to different simulated insertion depths. The results suggest insertion depth differences can alter produced vocal pitch.


Assuntos
Implante Coclear , Implantes Cocleares , Terapia Comportamental , Implante Coclear/métodos , Eletrodos Implantados , Felicidade , Humanos
18.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 4830-4833, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-36086618

RESUMO

The iHandU system is a wearable device that quantitatively evaluates changes in wrist rigidity during Deep Brain Stimulation (DBS) surgery, allowing clinicians to find optimal stimulation settings that reduce patient symptoms. Robotic accuracy is also especially relevant in DBS surgery, as accurate electrode placement is required to increase effectiveness and reduce side effects. The main goal of this work is to integrate the advantages of each system in a closed-loop system between an industrial robot and the iHandU system. For this purpose, a comparative analysis of a Leksell stereotactic frame and neuro-robotic system accuracies was performed using a lab-made phantom. The neuro-robotic system reached 90% of trajectories, while the stereotactic frame reached all trajectories. There are significant differences in accuracy errors between these trajectories (p < 0.0001), which can be explained by the high correlation between the neuro-robotic system errors and the distance from the trajectory to the origin of the Leksell coordinate system (ρ = 0.72). Overall accuracy is comparable to existing neuro-robotic systems, achieving a deviation of (1.0 ± 0.5) mm at the target point. The accuracy of DBS electrode positioning and stimulation parameters choice leads to better long-term clinical outcomes in Parkinson's disease patients. Our neuro-robotic system combines real-time feedback assessment of the patient's symptomatic response and automatic positioning of the DBS electrode in a specific brain area.


Assuntos
Estimulação Encefálica Profunda , Procedimentos Cirúrgicos Robóticos , Robótica , Eletrodos Implantados , Humanos , Técnicas Estereotáxicas , Punho
19.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 3105-3110, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-36086622

RESUMO

Virtual reality (VR) offers a robust platform for human behavioral neuroscience, granting unprecedented experimental control over every aspect of an immersive and interactive visual environment. VR experiments have already integrated non-invasive neural recording modalities such as EEG and functional MRI to explore the neural correlates of human behavior and cognition. Integration with implanted electrodes would enable significant increase in spatial and temporal resolution of recorded neural signals and the option of direct brain stimulation for neurofeedback. In this paper, we discuss the first such implementation of a VR platform with implanted electrocorticography (ECoG) and stereo-electroencephalography ( sEEG) electrodes in human, in-patient subjects. Noise analyses were performed to evaluate the effect of the VR headset on neural data collected in two VR-naive subjects, one child and one adult, including both ECOG and sEEG electrodes. Results demonstrate an increase in line noise power (57-63Hz) while wearing the VR headset that is mitigated effectively by common average referencing (CAR), and no significant change in the noise floor bandpower (125-240Hz). To our knowledge, this study represents first demonstrations of VR immersion during invasive neural recording with in-patient human subjects. Clinical Relevance- Immersive virtual reality tasks were well-tolerated and the quality of clinical neural signals preserved during VR immersion with two in-patient invasive neural recording subjects.


Assuntos
Eletrocorticografia , Realidade Virtual , Adulto , Criança , Eletrodos Implantados , Eletroencefalografia , Humanos , Imageamento por Ressonância Magnética
20.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 1863-1866, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-36086639

RESUMO

Deep brain stimulation (DBS) is an established yet growing treatment for a range of neurological and psychiatric disorders. Over the last decade, numerous studies have underscored the effect of electrode placement on the clinical outcome of DBS. As a result, imaging is now extensively used for DBS electrode localization, even though the accuracy of different modalities in determining the true coordinates of DBS electrodes is less explored. Postoperative magnetic resonance imaging (MRI) is a gold standard method for DBS electrode localization, however, the geometrical distortion induced by the lead's artifact could limit the accuracy. In this work, we investigated to what degree the difference between the true location of the lead's tip and the location of the tip estimated from the MRI artifact varies depending on the MRI sequence parameters, acquisition plane, phase encoding direction, and the implant"s extracranial trajectory. Clinical Relevance- Results will help researchers and clinicians to estimate the true location of DBS leads and contacts from postoperative MRI scans.


Assuntos
Estimulação Encefálica Profunda , Estimulação Encefálica Profunda/métodos , Eletrodos Implantados , Humanos , Imageamento por Ressonância Magnética/métodos , Imagens de Fantasmas , Período Pós-Operatório
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