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Thygesen MM, Entezari S, Houlind N, Nielsen TH, Olsen NØ, Nielsen TD, Skov M, Borgstedt-Bendixen J, Tankisi A, Rasmussen M, Einarsson HB, Agger P, Orlowski D, Dyrskog SE, Thorup L, Pedersen M, Rasmussen MM. A 72-h sedated porcine model of traumatic spinal cord injury. BRAIN & SPINE 2024; 4:102813. [PMID: 38681174 PMCID: PMC11052900 DOI: 10.1016/j.bas.2024.102813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/20/2023] [Accepted: 01/17/2024] [Indexed: 05/01/2024]
Abstract
Introduction There is an increasing focus on the prevention of secondary injuries following traumatic spinal cord injury (TSCI), especially through improvement of spinal cord perfusion and immunological modulation. Such therapeutic strategies require translational and controlled animal models of disease progression of the acute phases of human TSCI. Research question Is it possible to establish a 72-h sedated porcine model of incomplete thoracic TSCI, enabling controlled use of continuous, invasive, and non-invasive modalities during the entire sub-acute phase of TSCI? Material and methods A sham-controlled trial was conducted to establish the model, and 10 animals were assigned to either sham or TSCI. All animals underwent a laminectomy, and animals in the TSCI group were subjected to a weight-drop injury. Animals were then kept sedated for 72 h. The amount of injury was assessed by ex-vivo measures MRI-based fiber tractography, histology and immunohistochemistry. Results In all animals, we were successful in maintaining sedation for 72 h without comprising vital physiological parameters. The MRI-based fiber tractography showed that all TSCI animals revealed a break in the integrity of spinal neurons, whereas histology demonstrated no transversal sections of the spine with complete injury. Notably, some animals displayed signs of secondary ischemic tissue in the cranial and caudal sections. Discussion and conclusions This study succeeded in producing a porcine model of incomplete TSCI, which was physiologically stable up to 72 h. We believe that this TSCI model will constitute a potential translational model to study the pathophysiology secondary to TSCI in humans.
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Affiliation(s)
- Mathias Møller Thygesen
- Department of Neurosurgery, Aarhus University Hospital, Denmark
- Department of Clinical Medicine CENSE, Aarhus University, Denmark
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | - Seyar Entezari
- Department of Neurosurgery, Aarhus University Hospital, Denmark
- Department of Clinical Medicine CENSE, Aarhus University, Denmark
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | - Nanna Houlind
- Department of Neurosurgery, Aarhus University Hospital, Denmark
- Department of Clinical Medicine CENSE, Aarhus University, Denmark
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | - Teresa Haugaard Nielsen
- Department of Neurosurgery, Aarhus University Hospital, Denmark
- Department of Clinical Medicine CENSE, Aarhus University, Denmark
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | - Nicholas Østergaard Olsen
- Department of Neurosurgery, Aarhus University Hospital, Denmark
- Department of Clinical Medicine CENSE, Aarhus University, Denmark
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | - Tim Damgaard Nielsen
- Department of Neurosurgery, Aarhus University Hospital, Denmark
- Department of Clinical Medicine CENSE, Aarhus University, Denmark
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | - Mathias Skov
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | | | - Alp Tankisi
- Department of Anesthesiology, Aarhus University Hospital, Denmark
| | - Mads Rasmussen
- Department of Anesthesiology, Aarhus University Hospital, Denmark
| | | | - Peter Agger
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | | | | | - Line Thorup
- Department of Intensive Care, Aarhus University Hospital, Denmark
| | - Michael Pedersen
- Department of Clinical Medicine Comparative Medicine Lab, Aarhus University, Denmark
| | - Mikkel Mylius Rasmussen
- Department of Neurosurgery, Aarhus University Hospital, Denmark
- Department of Clinical Medicine CENSE, Aarhus University, Denmark
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Moreira A, Santos Hernández DA, Caceros V, Barahona KC, Campos F, Reyes WA, Blanco A, Soto T, Ramirez J, Mejias R, Cruz C, Lovo EE. Dual-Target Radiosurgery for Concomitant Continuous Pain Presentation of Trigeminal Neuralgia: Radiomodulation Effect and Dose. Cureus 2024; 16:e51602. [PMID: 38313895 PMCID: PMC10836852 DOI: 10.7759/cureus.51602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 02/06/2024] Open
Abstract
OBJECTIVES Patients with trigeminal neuralgia (TN) experience concomitant continuous pain (CCP) that can be difficult to treat. A dual-target approach delivering a high dose of radiation to the nerve and the contralateral thalamus can develop a fast radiomodulation effect on lowering pain. We sought to determine if this effect was dose dependent. METHODS We retrospectively reviewed 21 patients treated with radiosurgery in CCP and severe TN pain, with a visual analog scale (VAS) score of nine out of 10 at the time of treatment. Ten patients were treated with a high dose (>120 Gy) in the thalamus 90 Gy to the nerve, and the rest with a low dose (<120 Gy) to the thalamus and >90 Gy to the nerve. RESULTS Of those who received the high dose to the thalamus, six patients (60%) received 140 Gy, and four (40%) received 120 Gy, with a median dose to the trigeminal nerve of 90 and 85 Gy, respectively. The high thalamus dose showed a radiomodulation effect from day 1. The low thalamus dose did not produce radiomodulation on any of the first four days. The percentage of VAS score reduction one month after treatment was higher in the high-thalamus dose group than in the low-thalamus dose group. At three months, VAS score was 2 in the high-dose group and 4 in the low-dose group. CONCLUSIONS The radiomodulation effect in pain and dual-target radiosurgery is dose dependent in CCP in TN; a high dose can provide a more consistent clinical result than a lower dose.
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Affiliation(s)
| | | | - Victor Caceros
- Radiation Oncology, International Cancer Center, San Salvador, SLV
| | - Kaory C Barahona
- Radiation Oncology, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Fidel Campos
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - William A Reyes
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | | | - Tatiana Soto
- Radiation, Robotic Radiosurgery Center, San Jose, CRI
| | - Juliana Ramirez
- Radiosurgery, Centro de Radiocirugia Robotica, San Jose, CRI
| | - Ricardo Mejias
- Medical Physics, Robotic Radiosurgery Center, San Jose, CRI
| | - Claudia Cruz
- Anesthesia and Pain Management, Hospital De Diagnóstico, San Salvador, SLV
| | - Eduardo E Lovo
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
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Lovo EE, Moreira A, Cruz C, Carvajal G, Barahona KC, Caceros V, Blanco A, Mejias R, Alho E, Soto T. Radiomodulation in Mixed, Complex Cancer Pain by Triple Target Irradiation in the Brain: A Preliminary Experience. Cureus 2022; 14:e25430. [PMID: 35774662 PMCID: PMC9236678 DOI: 10.7759/cureus.25430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Up to 30% of terminally ill cancer patients experiencing intense pain might be refractory to opioid treatment. Complex cancer pain can be a mixture of somatic, visceral, and neuropathic pain with few or no effective alternatives to ameliorate pain. Radiosurgery to treat refractory pain in cancer has been reported with different degrees of success. Radiomodulation in pain could be defined as a fast (<72 h), substantial (>50%) pain relief by focal irradiation to a peripheric, and/or central mediated pain circuitry. Based on our previous experience, mixed, refractory cancer pain is usually unresponsive to single target irradiation of the hypophysis. We treated three patients using a multi-target approach. Methods Three terminally ill oncological patients experiencing refractory, complex, mixed pain from bone, abdomen, thorax, and brachial plexus were treated with triple target irradiation which consisted of irradiating with a maximum dose (Dmax) of 90 Gy to the hypophysis using either an 8 mm collimator with gamma ray (Infini) (Shenzhen, China: Masep Medical Company) or a 7.5 circular collimator with Cyberknife (Sunnyvale, CA: Accuray Inc.), the other two targets were the mesial structures of the thalamus bilaterally using a 4 mm collimator with Infini and the 5 mm circular collimator with CK delivering 90 Gy Dmax to each region. Patients had a VAS of 10 despite the best medical treatment. A correlation was made between the 45 Gy and 20 Gy isodose curves of the two different technologies to the Morel stereotactic atlas of the thalamus and basal ganglia for further understanding of dose distribution reconstructions in accordance with the São Paulo-Würzburg atlas of the Human Brain Project were performed. Lastly, a scoping review of the literature regarding radiosurgery for oncological pain was performed. Results Radiomodulation effect was achieved in all patients; case 1 had a VAS of five at 72 h, three at 15 days, and three at the time of death (21 days after treatment). Case 2 had a VAS of six at 72 h, five at 15 days, and four at the time of death (29 days after treatment). Case 3 had a VAS of five at 72 h, six at 15 days, and six at the time of death (30 days). Morphine rescues for cases 1 and 2 were reduced to 84%, and 70% for case 3. Overall, there were no adverse effects to treatment although excessive sleepiness was reported by one patient. After reading the title and abstract, only 14 studies remained eligible for full-text evaluation, and only nine studies met inclusion criteria after full-text reading. For most reports (seven), the target was the hypophysis and in two reports, the target was the thalamus either with single or bilateral irradiation. Conclusions In complex, for refractory oncological pain of mixed nature (nociceptive, neuropathic, and visceral), very few, if any, treatment alternatives are currently available. We provide a small proof of concept that multitarget intracranial radiosurgery might be effective in ameliorating pain in this population. The doses administered per target are the lowest that have shown effectiveness thus far, a different strategy might be needed as opposed to single target “large” dose approach that has been tried in the past for complex mixed refractory oncological pain. By no means, in our experience, these treatments traduce in elimination of pain, clinical results might make pain to be more bearable and respond better to pain medication.
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Non-ablative doses of focal ionizing radiation alters function of central neural circuits. Brain Stimul 2022; 15:586-597. [PMID: 35395424 DOI: 10.1016/j.brs.2022.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/22/2022] [Accepted: 04/01/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Modulation of pathological neural circuit activity in the brain with a minimum of complications is an area of intense interest. OBJECTIVE The goal of the study was to alter neurons' physiological states without apparent damage of cellular integrity using stereotactic radiosurgery (SRS). METHODS We treated a 7.5 mm-diameter target on the visual cortex of Göttingen minipigs with doses of 40, 60, 80, and 100 Gy. Six months post-irradiation, the pigs were implanted with a 9 mm-wide, eight-shank multi-electrode probe, which spanned the radiation focus as well as the low-exposure neighboring areas. RESULTS Doses of 40 Gy led to an increase of spontaneous firing rate, six months post-irradiation, while doses of 60 Gy and greater were associated with a decrease. Subjecting the animals to visual stimuli resulted in typical visual evoked potentials (VEP). At 40 Gy, a significant reduction of the P1 peak time, indicative of higher network excitability was observed. At 80 Gy, P1 peak time was not affected, while a minor reduction at 60 Gy was seen. No distance-dependent effects on spontaneous firing rate, or on VEP were observed. Post-mortem histology revealed no evidence of necrosis at doses below 60 Gy. In an in vitro assay comprising of iPS-derived human neuron-astrocyte co-cultures, we found a higher vulnerability of inhibitory neurons than excitatory neurons with respect to radiation, which might provide the cellular mechanism of the disinhibitory effect observed in vivo. CONCLUSION We provide initial evidence for a rather circuit-wide, long-lasting disinhibitory effect of low sub-ablative doses of SRS.
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Ganz JC. Radiobiology. PROGRESS IN BRAIN RESEARCH 2022; 268:23-48. [PMID: 35074083 DOI: 10.1016/bs.pbr.2021.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
New understandings of the biology of radiosurgery are considered. Differences from the radiobiology of fractionated radiotherapy are outlined. It is noted DNA damage alone is insufficient to account for the tissue changes which occur. Changes in blood vessels and immunological mechanisms are also involved. Tissue repair is more rapid than previously thought so that dose rate (the rate of delivery of radiation to the tissues) has been seen to be more important. The value of fractionation is examined. The effect of radiosurgery on normal brain (so called functional radiosurgery) is considered. The desired effects may be achieved by a focal stable destruction of brain from a high radiation dose. They may also be achieved using a lower dose which acts through the mechanism known as radiosurgical neuromodulation.
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Affiliation(s)
- Jeremy C Ganz
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
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Wu X, Chen W, Lin Y, Liang R. The Impact of Volume Factor on the Long-Term Outcome of Gamma Knife Radiosurgery for Sporadic Cerebral Cavernous Malformations. World Neurosurg 2021; 158:e627-e635. [PMID: 34775093 DOI: 10.1016/j.wneu.2021.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We aimed to evaluate the long-term outcome of gamma knife radiosurgery (GKRS) for the treatment of sporadic cerebral cavernous malformation (CCM), especially the influence of lesion volume on annual hemorrhage rate (AHR) of patients with CCM after GKRS. METHODS Fifty-one single-lesion patients with a history of hemorrhage who underwent radiosurgery at our institution were included and divided into 2 groups (A and B), based on their lesion volume. Group A included 25 patients with lesion volumes >1 cm3, whereas group B included 26 patients with lesion volumes ≤1 cm3. The clinical data of the patients were retrospectively analyzed. RESULTS All patients were followed up for more than 4 years after GKRS. The calculated AHR before GKRS was 18.49% in group A and 10.16% in group B. The calculated AHR after GKRS was 5.43% and 0.99% for groups A and B, respectively. Significant differences in AHR after GKRS were identified between group A and group B (P = 0.011). Thirty-seven patients with sporadic CCM (14 in group A, 23 in group B) experienced symptom improvement, and significant differences in symptom improvement were observed between group A and group B (P = 0.009). CONCLUSIONS GKRS decreased the risk of hemorrhage and was beneficial for symptomatic improvement in patients with sporadic CCM with a history of hemorrhage. The long-term clinical outcomes for patients with sporadic CCM with small lesion volumes (≤1 cm3) were better than those of patients with sporadic CCM with large lesion volumes (>1 cm3).
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Affiliation(s)
- Xiyao Wu
- Department of Neurosurgery, Fujian Medical University Union Hospital, Neurosurgical Institute of Fujian Province, Fuzhou, Fujian, China
| | - Weitao Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Neurosurgical Institute of Fujian Province, Fuzhou, Fujian, China
| | - Yaojing Lin
- Department of Neurosurgery, Fujian Medical University Union Hospital, Neurosurgical Institute of Fujian Province, Fuzhou, Fujian, China
| | - Risheng Liang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Neurosurgical Institute of Fujian Province, Fuzhou, Fujian, China.
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7
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Zaer H, Deshmukh A, Orlowski D, Fan W, Prouvot PH, Glud AN, Jensen MB, Worm ES, Lukacova S, Mikkelsen TW, Fitting LM, Adler JR, Schneider MB, Jensen MS, Fu Q, Go V, Morizio J, Sørensen JCH, Stroh A. An Intracortical Implantable Brain-Computer Interface for Telemetric Real-Time Recording and Manipulation of Neuronal Circuits for Closed-Loop Intervention. Front Hum Neurosci 2021; 15:618626. [PMID: 33613212 PMCID: PMC7887289 DOI: 10.3389/fnhum.2021.618626] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/14/2021] [Indexed: 11/13/2022] Open
Abstract
Recording and manipulating neuronal ensemble activity is a key requirement in advanced neuromodulatory and behavior studies. Devices capable of both recording and manipulating neuronal activity brain-computer interfaces (BCIs) should ideally operate un-tethered and allow chronic longitudinal manipulations in the freely moving animal. In this study, we designed a new intracortical BCI feasible of telemetric recording and stimulating local gray and white matter of visual neural circuit after irradiation exposure. To increase the translational reliance, we put forward a Göttingen minipig model. The animal was stereotactically irradiated at the level of the visual cortex upon defining the target by a fused cerebral MRI and CT scan. A fully implantable neural telemetry system consisting of a 64 channel intracortical multielectrode array, a telemetry capsule, and an inductive rechargeable battery was then implanted into the visual cortex to record and manipulate local field potentials, and multi-unit activity. We achieved a 3-month stability of the functionality of the un-tethered BCI in terms of telemetric radio-communication, inductive battery charging, and device biocompatibility for 3 months. Finally, we could reliably record the local signature of sub- and suprathreshold neuronal activity in the visual cortex with high bandwidth without complications. The ability to wireless induction charging combined with the entirely implantable design, the rather high recording bandwidth, and the ability to record and stimulate simultaneously put forward a wireless BCI capable of long-term un-tethered real-time communication for causal preclinical circuit-based closed-loop interventions.
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Affiliation(s)
- Hamed Zaer
- Department of Neurosurgery, Center for Experimental Neuroscience (CENSE), Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ashlesha Deshmukh
- Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States
| | - Dariusz Orlowski
- Department of Neurosurgery, Center for Experimental Neuroscience (CENSE), Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Wei Fan
- Leibniz Institute for Resilience Research, Mainz, Germany
| | | | - Andreas Nørgaard Glud
- Department of Neurosurgery, Center for Experimental Neuroscience (CENSE), Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten Bjørn Jensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Oncology, Radiation Therapy, and Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Esben Schjødt Worm
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Oncology, Radiation Therapy, and Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Slávka Lukacova
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Oncology, Radiation Therapy, and Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Trine Werenberg Mikkelsen
- Department of Neurosurgery, Center for Experimental Neuroscience (CENSE), Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lise Moberg Fitting
- Department of Neurosurgery, Center for Experimental Neuroscience (CENSE), Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - John R. Adler
- Zap Surgical Systems, Inc., San Carlos, CA, United States
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - M. Bret Schneider
- Zap Surgical Systems, Inc., San Carlos, CA, United States
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Martin Snejbjerg Jensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Nuclear Medicine and PET Center, Institute of Clinical Medicine, Aarhus University and Hospital, Aarhus, Denmark
| | - Quanhai Fu
- Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States
| | - Vinson Go
- Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States
| | - James Morizio
- Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States
| | - Jens Christian Hedemann Sørensen
- Department of Neurosurgery, Center for Experimental Neuroscience (CENSE), Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Albrecht Stroh
- Leibniz Institute for Resilience Research, Mainz, Germany
- Institute of Pathophysiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Zaer H, Fan W, Orlowski D, Glud AN, Andersen ASM, Schneider MB, Adler JR, Stroh A, Sørensen JCH. A Perspective of International Collaboration Through Web-Based Telecommunication-Inspired by COVID-19 Crisis. Front Hum Neurosci 2020; 14:577465. [PMID: 33328931 PMCID: PMC7719753 DOI: 10.3389/fnhum.2020.577465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/27/2020] [Indexed: 11/25/2022] Open
Abstract
The tsunami effect of the COVID-19 pandemic is affecting many aspects of scientific activities. Multidisciplinary experimental studies with international collaborators are hindered by the closing of the national borders, logistic issues due to lockdown, quarantine restrictions, and social distancing requirements. The full impact of this crisis on science is not clear yet, but the above-mentioned issues have most certainly restrained academic research activities. Sharing innovative solutions between researchers is in high demand in this situation. The aim of this paper is to share our successful practice of using web-based communication and remote control software for real-time long-distance control of brain stimulation. This solution may guide and encourage researchers to cope with restrictions and has the potential to help expanding international collaborations by lowering travel time and costs.
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Affiliation(s)
- Hamed Zaer
- Department of Neurosurgery-Center for Experimental Neuroscience (CENSE), Aarhus University Hospital, Aarhus, Denmark
| | - Wei Fan
- Leibniz Institute for Resilience Research, Mainz, Germany
| | - Dariusz Orlowski
- Department of Neurosurgery-Center for Experimental Neuroscience (CENSE), Aarhus University Hospital, Aarhus, Denmark
| | - Andreas N Glud
- Department of Neurosurgery-Center for Experimental Neuroscience (CENSE), Aarhus University Hospital, Aarhus, Denmark
| | - Anne S M Andersen
- Department of Neurosurgery-Center for Experimental Neuroscience (CENSE), Aarhus University Hospital, Aarhus, Denmark
| | - M Bret Schneider
- Stanford University School of Medicine, Stanford, CA, United States.,Zap Surgical Systems, Inc., San Carlos, CA, United States
| | - John R Adler
- Stanford University School of Medicine, Stanford, CA, United States.,Zap Surgical Systems, Inc., San Carlos, CA, United States
| | - Albrecht Stroh
- Leibniz Institute for Resilience Research, Mainz, Germany.,Institute for Pathophysiology, University Medical Center, Mainz, Germany
| | - Jens C H Sørensen
- Department of Neurosurgery-Center for Experimental Neuroscience (CENSE), Aarhus University Hospital, Aarhus, Denmark
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