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Kadaba Sridhar S, Dysterheft Robb J, Gupta R, Cheong S, Kuang R, Samadani U. Structural neuroimaging markers of normal pressure hydrocephalus versus Alzheimer's dementia and Parkinson's disease, and hydrocephalus versus atrophy in chronic TBI-a narrative review. Front Neurol 2024; 15:1347200. [PMID: 38576534 PMCID: PMC10991762 DOI: 10.3389/fneur.2024.1347200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/07/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Normal Pressure Hydrocephalus (NPH) is a prominent type of reversible dementia that may be treated with shunt surgery, and it is crucial to differentiate it from irreversible degeneration caused by its symptomatic mimics like Alzheimer's Dementia (AD) and Parkinson's Disease (PD). Similarly, it is important to distinguish between (normal pressure) hydrocephalus and irreversible atrophy/degeneration which are among the chronic effects of Traumatic Brain Injury (cTBI), as the former may be reversed through shunt placement. The purpose of this review is to elucidate the structural imaging markers which may be foundational to the development of accurate, noninvasive, and accessible solutions to this problem. Methods By searching the PubMed database for keywords related to NPH, AD, PD, and cTBI, we reviewed studies that examined the (1) distinct neuroanatomical markers of degeneration in NPH versus AD and PD, and atrophy versus hydrocephalus in cTBI and (2) computational methods for their (semi-) automatic assessment on Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans. Results Structural markers of NPH and those that can distinguish it from AD have been well studied, but only a few studies have explored its structural distinction between PD. The structural implications of cTBI over time have been studied. But neuroanatomical markers that can predict shunt response in patients with either symptomatic idiopathic NPH or post-traumatic hydrocephalus have not been reliably established. MRI-based markers dominate this field of investigation as compared to CT, which is also reflected in the disproportionate number of MRI-based computational methods for their automatic assessment. Conclusion Along with an up-to-date literature review on the structural neurodegeneration due to NPH versus AD/PD, and hydrocephalus versus atrophy in cTBI, this article sheds light on the potential of structural imaging markers as (differential) diagnostic aids for the timely recognition of patients with reversible (normal pressure) hydrocephalus, and opportunities to develop computational tools for their objective assessment.
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Affiliation(s)
- Sharada Kadaba Sridhar
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
| | - Jen Dysterheft Robb
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
| | - Rishabh Gupta
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
- University of Minnesota Twin Cities Medical School, Minneapolis, MN, United States
| | - Scarlett Cheong
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
| | - Rui Kuang
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Uzma Samadani
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
- University of Minnesota Twin Cities Medical School, Minneapolis, MN, United States
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, United States
- Division of Neurosurgery, Department of Surgery, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
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Kadaba Sridhar S, Kuang R, Dysterheft Robb J, Samadani U. A ventriculomegaly feature computational pipeline to improve the screening of normal pressure hydrocephalus on CT. J Neurosurg 2024:1-11. [PMID: 38457801 DOI: 10.3171/2023.12.jns231780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/13/2023] [Indexed: 03/10/2024]
Abstract
OBJECTIVE The objective of this study was to develop a computational pipeline that extracts objective features of ventriculomegaly from non-contrast CT (NCCT) for the accurate classification of idiopathic normal pressure hydrocephalus (NPH) from headache controls (HCs), Alzheimer's dementia (AD), and posttraumatic encephalomalacia (PTE). METHODS Patients with possible NPH (n = 79) and a subset with definite NPH (DefNPH; n = 29) were retrospectively identified in the Veterans Affairs Informatics and Computing Infrastructure system, along with the AD (n = 62), PTE (n = 53), and HC (n = 59) cohorts. Image-processing pipelines were developed to extract a novel feature capturing the maximum eccentricity of the lateral ventricles (MaxEccLV), a proxy splenial angle (p-SA), the Evans indices (EI-x, -y, and -z), callosal angle, normalized maximum third-ventricle width, and CSF to brain volume ratio from their NCCT scans. The authors used t-tests to examine group differences in the features and multivariate logistic regression models for classification. Additionally, the NPH versus HC classifier was validated on external data. RESULTS When NPH and DefNPH were compared with HC, AD, and PTE, significant differences were found in all features except the p-SA, which only significantly differed between NPH and PTE. The test-set area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were 0.98, 100%, and 98.3% for NPH versus HC classification; 0.94, 87.3%, and 85.5% for NPH versus AD; 0.96, 92.4%, and 90.6% for NPH versus PTE; and 0.96, 94%, and 88% for NPH versus the other groups using logistic regression under five-fold cross-validation. Consistently high performance was noted for DefNPH. The NPH versus HC classifier provided an AUC of 0.84, sensitivity of 76.9%, and specificity of 90% when assessed on external data. CONCLUSIONS Including the novel MaxEccLV, this framework computes useful features of ventriculomegaly, which had not previously been algorithmically assessed on NCCT. This framework successfully classified possible and definite NPH from HC, AD, and PTE. Following validation on larger representative cohorts, this objective and accessible tool may aid in screening for NPH and differentiating it from symptomatic mimics such as AD and PTE.
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Affiliation(s)
- Sharada Kadaba Sridhar
- 2Department of Bioinformatics and Computational Biology, University of Minnesota
- 4Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, Minnesota
| | - Rui Kuang
- 2Department of Bioinformatics and Computational Biology, University of Minnesota
- 3Department of Computer Science and Engineering, University of Minnesota; and
| | - Jen Dysterheft Robb
- 4Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, Minnesota
| | - Uzma Samadani
- 1Division of Neurosurgery, Department of Surgery, Minneapolis Veterans Affairs Health Care System
- 2Department of Bioinformatics and Computational Biology, University of Minnesota
- 4Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, Minnesota
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Fehlings MG, Tetreault LA, Hachem L, Evaniew N, Ganau M, McKenna SL, Neal CJ, Nagoshi N, Rahimi-Movaghar V, Aarabi B, Hofstetter CP, Wengel VT, Nakashima H, Martin AR, Kirshblum S, Rodrigues Pinto R, Marco RAW, Wilson JR, Kahn DE, Newcombe VFJ, Zipser CM, Douglas S, Kurpad SN, Lu Y, Saigal R, Samadani U, Arnold PM, Hawryluk GWJ, Skelly AC, Kwon BK. An Update of a Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role and Timing of Decompressive Surgery. Global Spine J 2024; 14:174S-186S. [PMID: 38526922 DOI: 10.1177/21925682231181883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
STUDY DESIGN Clinical practice guideline development. OBJECTIVES Acute spinal cord injury (SCI) can result in devastating motor, sensory, and autonomic impairment; loss of independence; and reduced quality of life. Preclinical evidence suggests that early decompression of the spinal cord may help to limit secondary injury, reduce damage to the neural tissue, and improve functional outcomes. Emerging evidence indicates that "early" surgical decompression completed within 24 hours of injury also improves neurological recovery in patients with acute SCI. The objective of this clinical practice guideline (CPG) is to update the 2017 recommendations on the timing of surgical decompression and to evaluate the evidence with respect to ultra-early surgery (in particular, but not limited to, <12 hours after acute SCI). METHODS A multidisciplinary, international, guideline development group (GDG) was formed that consisted of spine surgeons, neurologists, critical care specialists, emergency medicine doctors, physical medicine and rehabilitation professionals, as well as individuals living with SCI. A systematic review was conducted based on accepted methodological standards to evaluate the impact of early (within 24 hours of acute SCI) or ultra-early (in particular, but not limited to, within 12 hours of acute SCI) surgery on neurological recovery, functional outcomes, administrative outcomes, safety, and cost-effectiveness. The GRADE approach was used to rate the overall strength of evidence across studies for each primary outcome. Using the "evidence-to-recommendation" framework, recommendations were then developed that considered the balance of benefits and harms, financial impact, patient values, acceptability, and feasibility. The guideline was internally appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. RESULTS The GDG recommended that early surgery (≤24 hours after injury) be offered as the preferred option for adult patients with acute SCI regardless of level. This recommendation was based on moderate evidence suggesting that patients were 2 times more likely to recover by ≥ 2 ASIA Impairment Score (AIS) grades at 6 months (RR: 2.76, 95% CI 1.60 to 4.98) and 12 months (RR: 1.95, 95% CI 1.26 to 3.18) if they were decompressed within 24 hours compared to after 24 hours. Furthermore, patients undergoing early surgery improved by an additional 4.50 (95% 1.70 to 7.29) points on the ASIA Motor Score compared to patients undergoing surgery after 24 hours post-injury. The GDG also agreed that a recommendation for ultra-early surgery could not be made on the basis of the current evidence because of the small sample sizes, variable definitions of what constituted ultra-early in the literature, and the inconsistency of the evidence. CONCLUSIONS It is recommended that patients with an acute SCI, regardless of level, undergo surgery within 24 hours after injury when medically feasible. Future research is required to determine the differential effectiveness of early surgery in different subpopulations and the impact of ultra-early surgery on neurological recovery. Moreover, further work is required to define what constitutes effective spinal cord decompression and to individualize care. It is also recognized that a concerted international effort will be required to translate these recommendations into policy.
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Affiliation(s)
- Michael G Fehlings
- Department of Surgery, Division of Neurosurgery and Spine Program, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | | | - Laureen Hachem
- Department of Surgery, Division of Neurosurgery and Spine Program, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Nathan Evaniew
- Department of Surgery, Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mario Ganau
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Chris J Neal
- Department of Surgery, Uniformed Services University, Bethesda, MD, USA
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Valerie Ter Wengel
- Department of Neurosurgery, Amsterdam UMC VUMC Site, Amsterdam, Netherlands
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Allan R Martin
- Department of Neurological Surgery, University of California-Davis, Sacramento, CA, USA
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ricardo Rodrigues Pinto
- Spinal Unit (UVM), Centro Hospitalar Universitário de Santo António, Hospital CUF Trindade, Porto, Portugal
| | - Rex A W Marco
- Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Jefferson R Wilson
- Department of Surgery, Division of Neurosurgery and Spine Program, University of Toronto, Toronto, ON, Canada
| | - David E Kahn
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Virginia F J Newcombe
- Department of Medicine, University Division of Anaesthesia and PACE, University of Cambridge, Cambridge, UK
| | - Carl M Zipser
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Sam Douglas
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yi Lu
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Rajiv Saigal
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Uzma Samadani
- Department of Surgery, Minneapolis Veterans Affairs, Minneapolis, MN, USA
| | - Paul M Arnold
- Department of Neurosurgery, University of Illinois Champaign-Urbana, Urbana, IL, USA
| | | | | | - Brian K Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
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Caceres E, Divani AA, Rubinos CA, Olivella-Gómez J, Viñán-Garcés AE, González A, Alvarado-Arias A, Bathia K, Samadani U, Reyes LF. PaCO2 Association with Traumatic Brain Injury Patients Outcomes at High Altitude: A Prospective Single-Center Cohort Study. Res Sq 2024:rs.3.rs-3876988. [PMID: 38343855 PMCID: PMC10854293 DOI: 10.21203/rs.3.rs-3876988/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Background partial pressure of carbon dioxide (PaCO2) is generally known to influence outcome in patients with traumatic brain injury (TBI) at normal altitudes. Less is known about specific relationships of PaCO2 levels and clinical outcomes at high altitudes. Methods This is a prospective single-center cohort of consecutive TBI patients admitted to a trauma center located at 2600 meter above sea level. An unfavorable outcome was defined as the Glasgow Outcome Scale-Extended (GOSE) < 4 at 6-month follow-up. Results 81 patients with complete data, 80% (65/81) were men, and median (IQR) age was 36 (25-50) years). Median Glasgow Coma Scale (GCS) on admission was 9 (6-14), 49% (40/81) were severe (GCS: 3-8), 32% (26/81) moderate (GCS 12 - 9), and 18% (15/81) mild (GCS 13-15) TBI. The median (IQR) Abbreviated Injury Score of the Head (AISh) was 3 (2-4). Frequency of an unfavorable outcome (GOSE < 4) was 30% (25/81), median GOSE was 4 (2-5), and 6-month mortality was 24% (20/81). Comparison between patients with favorable and unfavorable outcomes revealed that those with unfavorable outcome were older, median [49 (30-72) vs. 29 (22-41), P < 0.01], had lower admission GCS [6 (4-8) vs. 13 (8-15), P < 0.01], higher AIS head [4 (4-4) vs. 3(2-4), p < 0.01], higher APACHE II score [17(15-23) vs 10 (6-14), < 0.01), higher Charlson score [0(0-2) vs. 0 (0-0), P < 0.01] and higher PaCO2 (mmHg), mean ± SD, 39 ± 9 vs. 32 ± 6, P < 0.01. In a multivariate analysis, age (OR 1.14 95% CI 1.1-1.30, P < 0.01), AISh (OR 4.7 95% CI 1.55-21.0, P < 0.05), and PaCO2 (OR 1.23 95% CI: 1.10-1.53, P < 0.05) were significantly associated with the unfavorable outcomes. When applying the same analysis to the subgroup on mechanical ventilation, AISh (OR 5.4 95% CI: 1.61-28.5, P = 0.017) and PaCO2 (OR 1.36 95% CI: 1.13-1.78, P = 0.015) remained significantly associated with the unfavorable outcome. Conclusion Higher PaCO2 levels are associated with an unfavorable outcome in ventilated TBI patients. These results underscore the importance of PaCO2 level in TBI patients and whether it should be adjusted for populations living at higher altitudes.
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Affiliation(s)
| | - Afshin A Divani
- University of New Mexico - Albuquerque: The University of New Mexico
| | - Clio A Rubinos
- University of North Carolina at Chapel Hill Health Sciences Library: The University of North Carolina at Chapel Hill
| | | | | | | | - Alexis Alvarado-Arias
- University of Mississippi University Hospital: The University of Mississippi Medical Center
| | - Kunal Bathia
- University of Mississippi University Hospital: The University of Mississippi Medical Center
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Hoglund BK, Zurn CA, Madden LR, Hoover C, Slopsema JP, Balser D, Parr A, Samadani U, Johnson MD, Netoff TI, Darrow DP. Mapping Spinal Cord Stimulation-Evoked Muscle Responses in Patients With Chronic Spinal Cord Injury. Neuromodulation 2023; 26:1371-1380. [PMID: 36517395 DOI: 10.1016/j.neurom.2022.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/23/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Epidural spinal cord stimulation (eSCS) has shown promise for restoring some volitional motor control after spinal cord injury (SCI). Maximizing therapeutic response requires effective spatial stimulation generated through careful configuration of anodes and cathodes on the eSCS lead. By exploring the way the spatial distribution of low frequency stimulation affects muscle activation patterns, we investigated the spatial specificity of stimulation-evoked responses for targeted muscle groups for restoration after chronic SCI (cSCI) in participants in the Epidural Stimulation After Neurologic Damage (E-STAND) trial. MATERIALS AND METHODS Fifteen participants with Abbreviated Injury Scale A cSCI from the E-STAND study were evaluated with a wide range of bipolar spatial patterns. Surface electromyography captured stimulation-evoked responses from the rectus abdominis (RA), intercostal, paraspinal, iliopsoas, rectus femoris (RF), tibialis anterior (TA), extensor hallucis longus (EHL), and gastrocnemius muscle groups bilaterally. Peak-to-peak amplitudes were analyzed for each pulse across muscles. Stimulation patterns with dipoles parallel (vertical configurations), perpendicular (horizontal configurations), and oblique (diagonal configurations) relative to the rostral-caudal axis were evaluated. RESULTS Cathodic stimulation in the transverse plane indicated ipsilaterally biased activation in RA, intercostal, paraspinal, iliopsoas, RF, TA, EHL, and gastrocnemius muscles (p < 0.05). We found that caudal cathodic stimulation was significantly more activating only in the RF and EHL muscle groups than in the rostral (p < 0.037 and p < 0.006, respectively). Oblique stimulation was found to be more activating in the RA, intercostal, paraspinal, iliopsoas, and TA muscle groups than in the transverse (p < 0.05). CONCLUSIONS Cathodic stimulation provides uniform specificity for targeting laterality. Few muscle groups responded specifically to variation in rostral/caudal stimulation, and oblique stimulation improved stimulation responses when compared with horizontal configurations. These relations may enable tailored targeting of muscle groups, but the surprising amount of variation observed suggests that monitoring these evoked muscle responses will play a key role in this tailoring process. CLINICAL TRIAL REGISTRATION The Clinicaltrials.gov registration number for the study is NCT03026816.
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Affiliation(s)
| | - Claire A Zurn
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Lauren R Madden
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Caleb Hoover
- Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Julia P Slopsema
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - David Balser
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Ann Parr
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Uzma Samadani
- Department of Surgery, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Matthew D Johnson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Theoden I Netoff
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - David P Darrow
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA; Division of Neurosurgery, Department of Surgery, Hennepin County Medical Center, Minneapolis, MN, USA.
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Singh RE, Ahmadi A, Parr AM, Samadani U, Krassioukov AV, Netoff TI, Darrow DP. Epidural stimulation restores muscle synergies by modulating neural drives in participants with sensorimotor complete spinal cord injuries. J Neuroeng Rehabil 2023; 20:59. [PMID: 37138361 PMCID: PMC10155428 DOI: 10.1186/s12984-023-01164-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Multiple studies have corroborated the restoration of volitional motor control after motor-complete spinal cord injury (SCI) through the use of epidural spinal cord stimulation (eSCS), but rigorous quantitative descriptions of muscle coordination have been lacking. Six participants with chronic, motor and sensory complete SCI underwent a brain motor control assessment (BMCA) consisting of a set of structured motor tasks with and without eSCS. We investigated how muscle activity complexity and muscle synergies changed with and without stimulation. We performed this analysis to better characterize the impact of stimulation on neuromuscular control. We also recorded data from nine healthy participants as controls. Competition exists between the task origin and neural origin hypotheses underlying muscle synergies. The ability to restore motor control with eSCS in participants with motor and sensory complete SCI allows us to test whether changes in muscle synergies reflect a neural basis in the same task. Muscle activity complexity was computed with Higuchi Fractal Dimensional (HFD) analysis, and muscle synergies were estimated using non-negative matrix factorization (NNMF) in six participants with American Spinal Injury Association (ASIA) Impairment Score (AIS) A. We found that the complexity of muscle activity was immediately reduced by eSCS in the SCI participants. We also found that over the follow-up sessions, the muscle synergy structure of the SCI participants became more defined, and the number of synergies decreased over time, indicating improved coordination between muscle groups. Lastly, we found that the muscle synergies were restored with eSCS, supporting the neural hypothesis of muscle synergies. We conclude that eSCS restores muscle movements and muscle synergies that are distinct from those of healthy, able-bodied controls.
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Affiliation(s)
- Rajat Emanuel Singh
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
- Department of Kinesiology, Northwestern College, Orange, IA, USA
| | - Aliya Ahmadi
- Division of Neurosurgery, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Ann M Parr
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Uzma Samadani
- Department of Bioinformatics & Computational Biology, UMN, Minneapolis, MN, USA
- Minneapolis Veteran Affairs Medical Center, Minneapolis, MN, USA
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia (UBC), Vancouver, Canada
- Division of Physical Medicine & Rehabilitation, Department of Medicine, UBC, British Columbia , BC, Canada
- GF Strong Rehabilitation Center, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Theoden I Netoff
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - David P Darrow
- Division of Neurosurgery, Hennepin County Medical Center, Minneapolis, MN, USA.
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
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Shackleton C, Samejima S, Miller T, Sachdeva R, Parr A, Samadani U, Netoff T, Hocaloski S, Elliott S, Walter M, Darrow D, Krassioukov A. Effect of epidural spinal cord stimulation on female sexual function after spinal cord injury. Front Neurosci 2023; 17:1155796. [PMID: 37179555 PMCID: PMC10167769 DOI: 10.3389/fnins.2023.1155796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/07/2023] [Indexed: 04/09/2023] Open
Abstract
Sexual dysfunction is a common consequence for women with spinal cord injury (SCI); however, current treatments are ineffective, especially in the under-prioritized population of women with SCI. This case-series, a secondary analysis of the Epidural Stimulation After Neurologic Damage (E-STAND) clinical trial aimed to investigate the effect of epidural spinal cord stimulation (ESCS) on sexual function and distress in women with SCI. Three females, with chronic, thoracic, sensorimotor complete SCI received daily (24 h/day) tonic ESCS for 13 months. Questionnaires, including the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale (FSDS) were collected monthly. There was a 3.2-point (13.2%) mean increase in total FSFI from baseline (24.5 ± 4.1) to post-intervention (27.8 ± 6.6), with a 4.8-50% improvement in the sub-domains of desire, arousal, orgasm and satisfaction. Sexual distress was reduced by 55%, with a mean decrease of 12 points (55.4%) from baseline (21.7 ± 17.2) to post-intervention (9.7 ± 10.8). There was a clinically meaningful change of 14 points in the International Standards for Neurological Classification of Spinal Cord Injury total sensory score from baseline (102 ± 10.5) to post-intervention (116 ± 17.4), without aggravating dyspareunia. ESCS is a promising treatment for sexual dysfunction and distress in women with severe SCI. Developing therapeutic interventions for sexual function is one of the most meaningful recovery targets for people with SCI. Additional large-scale investigations are needed to understand the long-term safety and feasibility of ESCS as a viable therapy for sexual dysfunction. Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT03026816, NCT03026816.
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Affiliation(s)
- Claire Shackleton
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Soshi Samejima
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tiev Miller
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rahul Sachdeva
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ann Parr
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
| | - Uzma Samadani
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
- Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, United States
| | - Theoden Netoff
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Shea Hocaloski
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Stacy Elliott
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
- Department of Psychiatry, Vancouver Coastal Health Authority, Vancouver, BC, Canada
- Department of Urologic Sciences, Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | - Matthias Walter
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Darrow
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
- Hennepin County Medical Center, Minneapolis, MN, United States
| | - Andrei Krassioukov
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
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Hoover C, Schuerger W, Balser D, McCracken P, Murray TA, Morse L, Parr A, Samadani U, Netoff TI, Darrow DP. Neuromodulation Through Spinal Cord Stimulation Restores Ability to Voluntarily Cycle After Motor Complete Paraplegia. J Neurotrauma 2023. [PMID: 36719784 DOI: 10.1089/neu.2022.0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Abstract Epidural spinal cord stimulation (eSCS) of the lower thoracic spinal cord has been shown to partially restore volitional movement in patients with complete chronic spinal cord injury (cSCI). Combining eSCS with intensive locomotor training improves motor function, including standing and stepping, but many patients with cSCI suffer from long-standing muscle atrophy and loss of bone mineral density, which may prohibit safe implementation. Safe, accessible, and effective avenues for pairing neuromodulation with activity-based therapy remain unexplored. Cycling is one such option that can be utilized as an eSCS therapy given its low-risk and low-weight-bearing requirement. We investigated the feasibility and kinematics of motor-assisted and passive cycle-based therapy for cSCI patients with epidural spinal cord stimulation. Seven participants who underwent spinal cord stimulation surgery in the Epidural Stimulation After Neurologic Damage (E-STAND) trial (NCT03026816) participated in a cycling task using the motor assist MOTOmed Muvi 300. A factorial design was used such that participants were asked to cycle with and without conscious effort with and without stimulation. We used mixed effects models assessing maximum power output and time pedaling unassisted to evaluate the interaction between stimulation and conscious effort. Cycling was well-tolerated and we observed no adverse events, including in participants up to 17 years post-initial injury and up to 58 years old. All participants were found to be able to pedal without motor assist, which primarily occurred when stimulation and effort were applied together (p = 0.001). Additionally, the combination of stimulation and intention was significantly associated with higher maximum power production (p < 0.0001) and distance pedaled (p = 0.0001). No association was found between volitional movement and participant factors: age, time since injury, and spinal cord atrophy. With stimulation and conscious effort, all participants were able to achieve active cycling without motor assistance. Thus, our stationary cycling factorial study design demonstrated volitional movement restoration with eSCS in a diverse study population of cSCI participants. Further, motor-assist cycling was well-tolerated without any adverse events. Cycling has the potential to be a safe research assessment and physical therapy modality for cSCI patients utilizing eSCS who have a high risk of injury with weight bearing exercise. The cycling modality in this study was demonstrated to be a straightforward assessment of motor function and safe for all participants regardless of age or time since initial injury.
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Affiliation(s)
- Caleb Hoover
- University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
| | - Willis Schuerger
- University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
| | - David Balser
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Patricia McCracken
- Department of Physical Medicine and Rehabilitation, Veteran Affairs, Minneapolis, Minnesota, USA
| | - Thomas A Murray
- Department of Biostatistics, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Leslie Morse
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ann Parr
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Uzma Samadani
- Department of Neurosurgery, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Theoden I Netoff
- Department of Biomedical Engineering, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - David P Darrow
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota, USA
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9
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Gupta R, Johnson R, Samadani U. Recovery of volitional movement with epidural stimulation after "complete" spinal cord injury due to gunshot: A case report and literature review. Surg Neurol Int 2023; 14:68. [PMID: 36895241 PMCID: PMC9990798 DOI: 10.25259/sni_61_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/08/2023] [Indexed: 03/11/2023] Open
Abstract
Background Epidural spinal cord stimulation (eSCS) restores volitional movement and improves autonomic function after nonpenetrating and traumatic spinal cord injury (SCI). There is limited evidence of its utility for penetrating SCI (pSCI). Case Description A 25-year-old male sustained a gunshot wound (GSW) resulting in T6 motor/sensory paraplegia and complete loss of bowel and bladder function. Following eSCS placement, he regained partial volitional movement and has independent bowel movements 40% of the time. Conclusion A 25-year-old pSCI patient who, following a GSW resulting in T6-level paraplegia, sustained marked recovery of volitional movement and autonomic function following eSCS placement.
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Affiliation(s)
- Rishabh Gupta
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, United States
| | - Reid Johnson
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, United States
| | - Uzma Samadani
- Department of Surgery, Minneapolis Veterans Affairs, Minneapolis, United States
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10
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Samadani U, Spinner RJ, Dynkowski G, Kirelik S, Schaaf T, Wall SP, Huang P. Eye tracking for classification of concussion in adults and pediatrics. Front Neurol 2022; 13:1039955. [DOI: 10.3389/fneur.2022.1039955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022] Open
Abstract
IntroductionIn order to obtain FDA Marketing Authorization for aid in the diagnosis of concussion, an eye tracking study in an intended use population was conducted.MethodsPotentially concussed subjects recruited in emergency department and concussion clinic settings prospectively underwent eye tracking and a subset of the Sport Concussion Assessment Tool 3 at 6 sites. The results of an eye tracking-based classifier model were then validated against a pre-specified algorithm with a cutoff for concussed vs. non-concussed. The sensitivity and specificity of eye tracking were calculated after plotting of the receiver operating characteristic curve and calculation of the AUC (area under curve).ResultsWhen concussion is defined by SCAT3 subsets, the sensitivity and specificity of an eye tracking algorithm was 80.4 and 66.1%, The AUC was 0.718. The misclassification rate (n = 282) was 31.6%.ConclusionA pre-specified algorithm and cutoff for diagnosis of concussion vs. non-concussion has a sensitivity and specificity that is useful as a baseline-free aid in diagnosis of concussion. Eye tracking has potential to serve as an objective “gold-standard” for detection of neurophysiologic disruption due to brain injury.
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11
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Venkatesh S, Bravo M, Schaaf T, Koller M, Sundeen K, Samadani U. Consequences of inequity in the neurosurgical workforce: Lessons from traumatic brain injury. Front Surg 2022; 9:962867. [PMID: 36117842 PMCID: PMC9475291 DOI: 10.3389/fsurg.2022.962867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Women and minorities leave or fail to advance in the neurosurgical workforce more frequently than white men at all levels from residency to academia. The consequences of this inequity are most profound in fields such as traumatic brain injury (TBI), which lacks objective measures. We evaluated published articles on TBI clinical research and found that TBI primary investigators or corresponding authors were 86·5% White and 59·5% male. First authors from the resulting publications were 92.6% white. Most study participants were male (68%). 64·4% of NIH-funded TBI clinical trials did not report or recruit any black subjects and this number was even higher for other races and the Hispanic ethnicity. We propose several measures for mitigation of the consequences of the inequitable workforce in traumatic brain injury that could potentially contribute to more equitable outcomes. The most immediately feasible of these is validation and establishment of objective measures for triage and prognostication that are less susceptible to bias than current protocols. We call for incorporation of gender and race neutral metrics for TBI evaluation to standardize classification of injury. We offer insights into how socioeconomic factors contribute to increased death rates from women and minority groups. We propose the need to study how these disparities are caused by unfair health insurance reimbursement practices. Surgical and clinical research inequities have dire consequences, and until those inequities can be corrected, mitigation of those consequences requires system wide change.
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Affiliation(s)
- Shivani Venkatesh
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MNUnited States
| | - Marcela Bravo
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MNUnited States
| | - Tory Schaaf
- Surgical Services, Minneapolis VA Medical Center, Minneapolis, MNUnited States
| | - Michael Koller
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MNUnited States
| | - Kiera Sundeen
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MNUnited States
| | - Uzma Samadani
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MNUnited States
- Surgical Services, Minneapolis VA Medical Center, Minneapolis, MNUnited States
- Correspondence: Uzma Samadani
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Mansour NM, Peña Pino I, Freeman D, Carrabre K, Venkatesh S, Darrow D, Samadani U, Parr AM. Advances in Epidural Spinal Cord Stimulation to Restore Function after Spinal Cord Injury: History and Systematic Review. J Neurotrauma 2022; 39:1015-1029. [PMID: 35403432 DOI: 10.1089/neu.2022.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Epidural spinal cord stimulation (eSCS) has been recently recognized as a potential therapy for chronic spinal cord injury (SCI). eSCS has been shown to uncover residual pathways within the damaged spinal cord. The purpose of this review is to summarize the key findings to date regarding the use of eSCS in SCI. Searches were carried out using MEDLINE, EMBASE, and Web of Science database and reference lists of the included articles. A combination of medical subject heading terms and keywords was used to find studies investigating the use of eSCS in SCI patients to facilitate volitional movement and to restore autonomic function. The risk of bias was assessed using Risk Of Bias In Non-Randomized Studies of Interventions tool for nonrandomized studies. We were able to include 40 articles that met our eligibility criteria. The studies included a total of 184 patient experiences with incomplete or complete SCI. The majority of the studies used the Medtronic 16 paddle lead. Around half of the studies reported lead placement between T11- L1. We included studies that assessed motor (n = 28), autonomic (n = 13), and other outcomes (n = 10). The majority of the studies reported improvement in outcomes assessed. The wide range of included outcomes demonstrates the effectiveness of eSCS in treating a diverse SCI population. However, the current studies cannot definitively conclude which patients benefit the most from this intervention. Further study in this area is needed to allow improvement of the eSCS technology and allow it to be more widely available for chronic SCI patients.
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Affiliation(s)
- Nadine M Mansour
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Isabela Peña Pino
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - David Freeman
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kailey Carrabre
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shivani Venkatesh
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - David Darrow
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Neurosurgery, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Uzma Samadani
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Neurosurgery, VA Healthcare System, Minneapolis, Minnesota, USA
| | - Ann M Parr
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Neurosurgery, Hennepin County Medical Center, Minneapolis, Minnesota, USA
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13
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Darrow DP, Balser DY, Freeman D, Pelrine E, Krassioukov A, Phillips A, Netoff T, Parr A, Samadani U. Effect of epidural spinal cord stimulation after chronic spinal cord injury on volitional movement and cardiovascular function: study protocol for the phase II open label controlled E-STAND trial. BMJ Open 2022; 12:e059126. [PMID: 35851008 PMCID: PMC9297213 DOI: 10.1136/bmjopen-2021-059126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) leads to significant changes in morbidity, mortality and quality of life (QOL). Currently, there are no effective therapies to restore function after chronic SCI. Preliminary studies have indicated that epidural spinal cord stimulation (eSCS) is a promising therapy to improve motor control and autonomic function for patients with chronic SCI. The aim of this study is to assess the effects of tonic eSCS after chronic SCI on quantitative outcomes of volitional movement and cardiovascular function. Our secondary objective is to optimise spinal cord stimulation parameters for volitional movement. METHODS AND ANALYSIS The Epidural Stimulation After Neurologic Damage (ESTAND) trial is a phase II single-site self-controlled trial of epidural stimulation with the goal of restoring volitional movement and autonomic function after motor complete SCI. Participants undergo epidural stimulator implantation and are followed up over 15 months while completing at-home, mobile application-based movement testing. The primary outcome measure integrates quantity of volitional movement and similarity to normal controls using the volitional response index (VRI) and the modified Brain Motor Control Assessment. The mobile application is a custom-designed platform to support participant response and a kinematic task to optimise the settings for each participant. The application optimises stimulation settings by evaluating the parameter space using movement data collected from the tablet application and accelerometers. A subgroup of participants with cardiovascular dysautonomia are included for optimisation of blood pressure stabilisation. Indirect effects of stimulation on cardiovascular function, pain, sexual function, bowel/bladder, QOL and psychiatric measures are analysed to assess generalisability of this targeted intervention. ETHICS AND DISSEMINATION This study has been approved after full review by the Minneapolis Medical Research Foundation Institutional Review Board and by the Minneapolis VA Health Care System. This project has received Food and Drug Administration investigational device exemption approval. Trial results will be disseminated through peer-reviewed publications, conference presentations and seminars. TRIAL REGISTRATION NUMBER NCT03026816.
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Affiliation(s)
- David P Darrow
- Neurosurgery, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
- Division of Neurosurgery, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - David Young Balser
- Rehabilitation Medicine, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
| | - David Freeman
- Neurosurgery, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
| | - Eliza Pelrine
- Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Andrei Krassioukov
- Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron Phillips
- Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
| | - Theoden Netoff
- Biomedical Engineering, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Ann Parr
- Neurosurgery, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
| | - Uzma Samadani
- Surgery, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
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14
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Pino IP, Nightingale TE, Hoover C, Zhao Z, Cahalan M, Dorey TW, Walter M, Soriano JE, Netoff TI, Parr A, Samadani U, Phillips AA, Krassioukov AV, Darrow DP. The safety of epidural spinal cord stimulation to restore function after spinal cord injury: post-surgical complications and incidence of cardiovascular events. Spinal Cord 2022; 60:903-910. [PMID: 35701485 DOI: 10.1038/s41393-022-00822-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cohort prospective study. OBJECTIVES Epidural spinal cord stimulation (eSCS) improves volitional motor and autonomic function after spinal cord injury (SCI). While eSCS has an established history of safety for chronic pain, it remains unclear if eSCS in the SCI population presents the same risk profile. We aimed to assess safety and autonomic monitoring data for the first 14 participants in the E-STAND trial. SETTING Hennepin County Medical Center, Minneapolis and Minneapolis Veterans Affairs Medical Center, Minnesota, USA. METHODS Monthly follow-up visits assessed surgical and medical device-related safety outcomes as well as stimulation usage. Beat-by-beat blood pressure (BP) and continuous electrocardiogram data were collected during head-up tilt-table testing with and without eSCS. RESULTS All participants had a motor-complete SCI. Mean (SD) age and time since injury were 38 (10) and 7 (5) years, respectively. There were no surgical complications but one device malfunction 4 months post implantation. Stimulation was applied for up to 23 h/day, across a broad range of parameters: frequency (18-700 Hz), pulse width (100-600 µs), and amplitude (0.4-17 mA), with no adverse events reported. Tilt-table testing with eSCS demonstrated no significant increases in the incidence of elevated systolic BP or a greater frequency of arrhythmias. CONCLUSIONS eSCS to restore autonomic and volitional motor function following SCI has a similar safety profile as when used to treat chronic pain, despite the prevalence of significant comorbidities and the wide variety of stimulation parameters tested.
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Affiliation(s)
- Isabela Peña Pino
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA.,Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.,Division of Neurosurgery, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Thomas E Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia (UBC), Vancouver, BC, Canada.,Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Caleb Hoover
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, USA
| | - Zixi Zhao
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Mark Cahalan
- MD Undergraduate Program, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Tristan W Dorey
- Cardiovascular and Respiratory Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia (UBC), Vancouver, BC, Canada.,Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jan E Soriano
- Departments of Physiology and Pharmacology, Cardiac Sciences, Clinical Neurosciences, Hotchkiss Brain Institute, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Theoden I Netoff
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Ann Parr
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Uzma Samadani
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, USA.,Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Aaron A Phillips
- Departments of Physiology and Pharmacology, Cardiac Sciences, Clinical Neurosciences, Hotchkiss Brain Institute, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia (UBC), Vancouver, BC, Canada. .,Department of Medicine, Division of Physical Medicine and Rehabilitation, UBC, Vancouver, BC, Canada. .,GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.
| | - David P Darrow
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA. .,Division of Neurosurgery, Hennepin County Medical Center, Minneapolis, MN, USA.
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15
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Johnson RA, Cramer SW, Dusenbery K, Samadani U. Resection of disseminated recurrent myxopapillary ependymoma with more than 4-year follow-up: operative nuance for prolonged prone position. Illustrative case. Journal of Neurosurgery: Case Lessons 2022; 3:CASE2235. [PMID: 36303501 PMCID: PMC9379707 DOI: 10.3171/case2235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Symptomatic disseminated myxopapillary ependymoma (MPE) in a young person presents a daunting challenge because the risks of prolonged prone positioning and spinal cord injury may outweigh the likelihood of attaining the benefit of gross total resection. OBSERVATIONS The authors reported the case of a 15-year-old girl with five discrete recurrent spinal cord ependymomas. The patient received a 25-hour surgical procedure for gross total resection of the tumors and fusion over an approximately 33-hour period. She experienced complete resolution of all preoperative neurological symptoms and subsequently received adjuvant radiation therapy. At 52 months after surgery, she was still experiencing neurologically intact, progression-free survival. This case illustrated one of the most extensive recurrent tumor resections for MPE with prolonged disease-free survival reported to date. It may also represent the longest prone position spinal case reported and was notable for a lack of any of the complications commonly associated with the prolonged prone position. LESSONS The authors discussed the complexity of surgical decision-making in a symptomatic patient with multiple disseminated metastases, technical considerations for resection of intradural and intramedullary spinal cord tumors, and considerations for avoiding complications during prolonged positioning necessary for spinal surgery.
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Affiliation(s)
- Reid A. Johnson
- University of Minnesota Medical School, Minneapolis, Minnesota
| | | | | | - Uzma Samadani
- Surgical Services, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota; and
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16
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Venkatesh S, Schaaf T, Bravo M, Sundeen K, Samadani U. 103 Participants in Clinical Trials for Traumatic Brain Injury Are Not Representative of the Injured Population. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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17
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Zuckerman SL, Yengo-Kahn AM, Tang AR, Bailes JE, Beauchamp K, Berger MS, Bonfield CM, Camarata PJ, Cantu RC, Davis GA, Ellenbogen RG, Ellis MJ, Feuer H, Guazzo E, Harris OA, Heppner P, Honeybul S, Manley G, Maroon JC, Miele VJ, Nahed BV, Okonkwo DO, Oppenlander ME, Petty J, Sabin HI, Samadani U, Sherburn EW, Sheridan M, Tator CH, Theodore N, Timmons SD, Woodworth GF, Solomon GS, Sills AK. Sport-Related Structural Brain Injury and Return to Play: Systematic Review and Expert Insight. Neurosurgery 2021; 88:E495-E504. [PMID: 33693899 DOI: 10.1093/neuros/nyab041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sport-related structural brain injury (SRSBI) is intracranial pathology incurred during sport. Management mirrors that of non-sport-related brain injury. An empirical vacuum exists regarding return to play (RTP) following SRSBI. OBJECTIVE To provide key insight for operative management and RTP following SRSBI using a (1) focused systematic review and (2) survey of expert opinions. METHODS A systematic literature review of SRSBI from 2012 to present in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and a cross-sectional survey of RTP in SRSBI by 31 international neurosurgeons was conducted. RESULTS Of 27 included articles out of 241 systematically reviewed, 9 (33.0%) case reports provided RTP information for 12 athletes. To assess expert opinion, 31 of 32 neurosurgeons (96.9%) provided survey responses. For acute, asymptomatic SRSBI, 12 (38.7%) would not operate. Of the 19 (61.3%) who would operate, midline shift (63.2%) and hemorrhage size > 10 mm (52.6%) were the most common indications. Following SRSBI with resolved hemorrhage, with or without burr holes, the majority of experts (>75%) allowed RTP to high-contact/collision sports at 6 to 12 mo. Approximately 80% of experts did not endorse RTP to high-contact/collision sports for athletes with persistent hemorrhage. Following craniotomy for SRSBI, 40% to 50% of experts considered RTP at 6 to 12 mo. Linear regression revealed that experts allowed earlier RTP at higher levels of play (β = -0.58, 95% CI -0.111, -0.005, P = .033). CONCLUSION RTP decisions following structural brain injury in athletes are markedly heterogeneous. While individualized RTP decisions are critical, aggregated expert opinions from 31 international sports neurosurgeons provide key insight. Level of play was found to be an important consideration in RTP determinations.
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Affiliation(s)
- Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alan R Tang
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Julian E Bailes
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Kathryn Beauchamp
- Division of Neurological Surgery, Denver Health Medical Center, Department of Neurological Surgery University of Colorado, Denver, Colorado, USA
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Christopher M Bonfield
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul J Camarata
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Gavin A Davis
- Department of Neurosurgery, Austin and Cabrini Health, Melbourne, Australia
| | - Richard G Ellenbogen
- Department of Neurological Surgery, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA
| | - Michael J Ellis
- Department of Surgery and Pediatrics, Section of Neurosurgery, University of Manitoba, Pan Am Concussion Program, Winnipeg, Canada
| | - Hank Feuer
- Player Health and Safety Department, National Football League, New York, New York, USA
| | - Eric Guazzo
- Department of Neurosurgery, Townsville University Hospital, Townsville, Australia
| | - Odette A Harris
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Peter Heppner
- Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand
| | - Stephen Honeybul
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth Western Australia
| | - Geoff Manley
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Joseph C Maroon
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Vincent J Miele
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mark E Oppenlander
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jerry Petty
- Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, USA
| | | | - Uzma Samadani
- Division of Neurosurgery, Minneapolis VAMC; Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Eric W Sherburn
- The Center for Concussion, University of Oklahoma College of Medicine, Tulsa, Oklahoma, USA
| | - Mark Sheridan
- Department of Neurosurgery, Liverpool Hospital, Liverpool, Australia
| | - Charles H Tator
- Canadian Concussion Centre and Division of Neurosurgery, Toronto Western Hospital and University of Toronto, Toronto, Canada
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University Medical Center, Baltimore, Maryland, USA
| | - Shelly D Timmons
- Department of Neurological Surgery, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana, USA
| | - Graeme F Woodworth
- Department of Neurosurgery & R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Player Health and Safety Department, National Football League, New York, New York, USA
| | - Allen K Sills
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Player Health and Safety Department, National Football League, New York, New York, USA
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Mahan MY, Rafter DJ, Truwit CL, Oswood M, Samadani U. Evaluation of diffusion measurements reveals radial diffusivity indicative of microstructural damage following acute, mild traumatic brain injury. Magn Reson Imaging 2020; 77:137-147. [PMID: 33359428 DOI: 10.1016/j.mri.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/25/2020] [Accepted: 12/20/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Mild TBI, characterized by microstructural damage, often undetectable on conventional imaging techniques, is a pervasive condition that disturbs brain function and can potentially result in long-term deficits. Deciphering the underlying microstructural damage in mild TBI is crucial for establishing a reliable diagnosis and enabling effective therapeutics. Efforts to capture this damage have been extensive, but results have been inconsistent and incomplete. METHODS To that effect, we set out to examine the shape of the diffusion tensor in mild TBI during the acute phase of injury. We inspected diffusivity and geometric measurements describing the diffusion tensor's shape and compared mild TBI (N = 34, 20.4-66.6 yo) measurements with those from healthy control (N = 42, 20.7-67.2 yo) participants using voxelwise tract-based spatial statistics. Subsequently, to explore associations between the diffusion measurements in mild TBI, we performed nonparametric statistics and machine learning techniques. RESULTS Overall, mild TBI displayed a diffuse increase in Dλ2, Dλ3, Dradial, Dmean, and Cspherical, with a diffuse decrease in Afractional, Amode, and Clinear, in addition to no change in Daxial or Cplanar. Most notably, our results provide evidence for Dradial as a potential biomarker for microstructural damage, specifically its main component Dλ2, based on their performance in discriminating between mild TBI and control groups. Afractional was also found to be important for discriminating between groups. CONCLUSION Our results revealed the importance of a diffusion measurement often overlooked, Dradial, in assessing TBI and suggest differentiating diffusion measurements has the potential utility to detect variations in the underlying pathophysiology after injury.
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Affiliation(s)
- Margaret Y Mahan
- Department of Biomedical Informatics and Computational Biology, University of Minnesota, 101 Pleasant St SE, Minneapolis, MN 55455, USA.
| | - Daniel J Rafter
- Department of Biomedical Informatics and Computational Biology, University of Minnesota, 101 Pleasant St SE, Minneapolis, MN 55455, USA
| | - Charles L Truwit
- Diagnostic Imaging, Philips Global, 6655 Wedgwood Rd N #105, Maple Grove, MN 55311, USA; Department of Radiology, Hennepin Healthcare, 701 Park Ave, Minneapolis, MN 55415, USA.
| | - Mark Oswood
- Department of Radiology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA; Department of Radiology, Hennepin Healthcare, 701 Park Ave, Minneapolis, MN 55415, USA.
| | - Uzma Samadani
- Department of Biomedical Informatics and Computational Biology, University of Minnesota, 101 Pleasant St SE, Minneapolis, MN 55455, USA; Department of Neurosurgery, Minneapolis VA Medical Center, 1 Veterans Drive, Minneapolis, MN 55417, USA.
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Rafter DJ, Li Z, Sterk B, Kuang R, Samadani U. Serum GFAP and UCH-L1 Distinguish Brain Injury Caused by High Velocity Trauma versus Anoxia/Hypoxia, Spontaneous Hemorrhage, and Other Etiologies. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rafter D, Vasdev R, Hurrelbrink D, Gormley M, Chettupally T, Shen FX, Samadani U. Litigation risks despite guideline adherence for acute spinal cord injury: time is spine. Neurosurg Focus 2020; 49:E17. [PMID: 33130619 DOI: 10.3171/2020.8.focus20607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Current guidelines do not specify timing for management of acute spinal cord injury (aSCI) due to lack of high-quality evidence supporting specific intervals for intervention. Randomized prospective trials may be unethical. Nonetheless, physicians have been sued for delays in diagnosis and intervention. METHODS The authors reviewed both the medical literature supporting the guidelines and the legal cases reported in the Westlaw and Lexis Advance databases from 1972 to 2018 resulting in awards or settlements, to identify whether surgeons are vulnerable to litigation despite the existence of guidelines not mandating specific timing of care. RESULTS Timing of intervention was related to claims in 59 (36%) of 163 cases involving SCI. All 22 trauma cases identified cited timing of intervention, sometimes related to delayed diagnosis, as a reason for the lawsuit. The mean award of 10 cases in which the plaintiffs' awards were disclosed was $4,294,384. In the majority of cases, award amounts were not disclosed. CONCLUSIONS Because conduct of a prospective, randomized trial to investigate surgical timing of intervention for aSCI may not be achievable, evidence-based guidelines will be unlikely to mandate specific timing. Nonetheless, surgeons who unreasonably delay intervention for aSCI may be at risk for litigation due to treatment delay. This is increasingly likely in an environment where "complete" SCI is difficult to verify. SCI may at some point be recognized as a surgical emergency, as brain injury generally is, despite a lack of prospective randomized trials supporting this implementation, challenging the feasibility of the US trauma infrastructure to provide care for these patients.
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Affiliation(s)
- Daniel Rafter
- 1Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota
| | - Ranveer Vasdev
- 1Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota
| | - Duncan Hurrelbrink
- 1Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota
| | - Mark Gormley
- 1Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota
| | - Tabitha Chettupally
- 1Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota
| | - Francis X Shen
- 2University of Minnesota Law School, Minneapolis, Minnesota.,3Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Uzma Samadani
- 1Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota.,4Neurosurgery Section, Department of Neurosurgery, Minneapolis VA, Minneapolis, Minnesota
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21
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Mahan M, Rafter D, Casey H, Engelking M, Abdallah T, Truwit C, Oswood M, Samadani U. tbiExtractor: A framework for extracting traumatic brain injury common data elements from radiology reports. PLoS One 2020; 15:e0214775. [PMID: 32609723 PMCID: PMC7329124 DOI: 10.1371/journal.pone.0214775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/18/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The manual extraction of valuable data from electronic medical records is cumbersome, error-prone, and inconsistent. By automating extraction in conjunction with standardized terminology, the quality and consistency of data utilized for research and clinical purposes would be substantially improved. Here, we set out to develop and validate a framework to extract pertinent clinical conditions for traumatic brain injury (TBI) from computed tomography (CT) reports. METHODS We developed tbiExtractor, which extends pyConTextNLP, a regular expression algorithm using negation detection and contextual features, to create a framework for extracting TBI common data elements from radiology reports. The algorithm inputs radiology reports and outputs a structured summary containing 27 clinical findings with their respective annotations. Development and validation of the algorithm was completed using two physician annotators as the gold standard. RESULTS tbiExtractor displayed high sensitivity (0.92-0.94) and specificity (0.99) when compared to the gold standard. The algorithm also demonstrated a high equivalence (94.6%) with the annotators. A majority of clinical findings (85%) had minimal errors (F1 Score ≥ 0.80). When compared to annotators, tbiExtractor extracted information in significantly less time (0.3 sec vs 1.7 min per report). CONCLUSION tbiExtractor is a validated algorithm for extraction of TBI common data elements from radiology reports. This automation reduces the time spent to extract structured data and improves the consistency of data extracted. Lastly, tbiExtractor can be used to stratify subjects into groups based on visible damage by partitioning the annotations of the pertinent clinical conditions on a radiology report.
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Affiliation(s)
- Margaret Mahan
- Department of Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Daniel Rafter
- Department of Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Hannah Casey
- Department of Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Marta Engelking
- Department of Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Tessneem Abdallah
- Department of Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Charles Truwit
- Diagnostic Imaging, Philips Global, Maple Grove, Minnesota, United States of America
| | - Mark Oswood
- Department of Radiology, Hennepin Healthcare, Minneapolis, Minnesota, United States of America
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Uzma Samadani
- Department of Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Neurosurgery, Minneapolis VA Medical Center, Minneapolis, Minnesota, United States of America
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Peña Pino I, Hoover C, Venkatesh S, Ahmadi A, Sturtevant D, Patrick N, Freeman D, Parr A, Samadani U, Balser D, Krassioukov A, Phillips A, Netoff TI, Darrow D. Long-Term Spinal Cord Stimulation After Chronic Complete Spinal Cord Injury Enables Volitional Movement in the Absence of Stimulation. Front Syst Neurosci 2020; 14:35. [PMID: 32714156 PMCID: PMC7340010 DOI: 10.3389/fnsys.2020.00035] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Chronic spinal cord injury (SCI) portends a low probability of recovery, especially in the most severe subset of motor-complete injuries. Active spinal cord stimulation with or without intensive locomotor training has been reported to restore movement after traumatic SCI. Only three cases have been reported where participants developed restored volitional movement with active stimulation turned off after a period of chronic stimulation and only after intensive rehabilitation with locomotor training. It is unknown whether restoration of movement without stimulation is possible after stimulation alone. Objective: We describe the development of spontaneous volitional movement (SVM) without active stimulation in a subset of participants in the Epidural Stimulation After Neurologic Damage (ESTAND) trial, in which locomotor training is not prescribed as part of the study protocol, and subject’s rehabilitation therapies are not modified. Methods: Volitional movement was evaluated with the Brain Motor Control Assessment using sEMG recordings and visual examination at baseline and at follow-up visits with and without stimulation. Additional functional assessment with a motor-assisted bicycle exercise at follow-up with and without stimulation identified generated work with and without effort. Results: The first seven participants had ASIA Impairment Scale (AIS) A or B thoracic SCI, a mean age of 42 years, and 7.7 years post-injury on average. Four patients developed evidence of sustained volitional movement, even in the absence of active stimulation after undergoing chronic epidural spinal cord stimulation (eSCS). Significant increases in volitional power were found between those observed to spontaneously move without stimulation and those unable (p < 0.0005). The likelihood of recovery of spontaneous volitional control was correlated with spasticity scores prior to the start of eSCS therapy (p = 0.048). Volitional power progressively improved over time (p = 0.016). Additionally, cycling was possible without stimulation (p < 0.005). Conclusion: While some SVM after eSCS has been reported in the literature, this study demonstrates sustained restoration without active stimulation after long-term eSCS stimulation in chronic and complete SCI in a subset of participants. This finding supports previous studies suggesting that “complete” SCI is likely not as common as previously believed, if it exists at all in the absence of transection and that preserved pathways are substrates for eSCS-mediated recovery in clinically motor-complete SCI. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03026816.
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Affiliation(s)
- Isabela Peña Pino
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Caleb Hoover
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
| | - Shivani Venkatesh
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
| | - Aliya Ahmadi
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
| | - Dylan Sturtevant
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
| | - Nick Patrick
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - David Freeman
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
| | - Ann Parr
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
| | - Uzma Samadani
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States.,Division of Neurosurgery, VA Healthcare System, Minneapolis, MN, United States
| | - David Balser
- International Collaboration on Repair Discoveries, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
| | - Andrei Krassioukov
- International Collaboration on Repair Discoveries, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
| | - Aaron Phillips
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Theoden I Netoff
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - David Darrow
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States.,Division of Neurosurgery, Hennepin County Medical Center, Minneapolis, MN, United States
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Koller M, Rafter D, Shok G, Murphy S, Kiaei S, Samadani U. A retrospective descriptive study of cranioplasty failure rates and contributing factors in novel 3D printed calcium phosphate implants compared to traditional materials. 3D Print Med 2020; 6:14. [PMID: 32556704 PMCID: PMC7298748 DOI: 10.1186/s41205-020-00066-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/19/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Failure rates with cranioplasty procedures have driven efforts to improve graft material and reduce reoperation. One promising allograft source is a 3D-printed titanium mesh with calcium phosphate filler. This study evaluated failure rates and pertinent characteristics of these novel 3D-grafts compared to traditional materials. METHODS Sixty patients were retrospectively identified who underwent a cranioplasty between January 2015-December 2017. Specific data points related to graft failure were collected for all surgical admissions, from the primary injury to their most recent. These included, but were not limited to, initial physical exam findings, vitals, comorbid conditions, surgery length, estimated blood loss, incision type, and need for revision. Failure rates of 3D-printed allografts were compared to traditional grafts. RESULTS A total of 60 subjects were identified who underwent 71 unique cranioplasty procedures (3D = 13, Synthetic = 12, Autologous = 46). There were 14 total failures, demonstrating a 19.7% overall failure rate. Specifically, 15.4% (n = 2) of 3D, 19.6% (n = 9) of autologous, and 25.0% (n = 3) of synthetic grafts required revision. Patients receiving 3D-grafts had the shortest overall mean surgery times (200.8 ± 54.3 min) and lowest infection rates (7.7%) compared to autologous (210.5 ± 47.9 min | 25.0%) and synthetic models (217.6 ± 77.3 min | 8.7%), though significance was unable to be determined. Tobacco use and trap-door incisions were associated with increased failure rates relative to straight or curved incisions in autologous grafts. Cranioplasties performed less than 3 months after craniectomy appeared to fail more often than those performed at least three months after craniectomy, for the synthetic group. CONCLUSION We concluded that 3D-printed cranioplasty grafts may lead to lower failure rates and shorter surgery times compared to traditional cranioplasty materials in our limited population. 3D-implants hold promise for cranial reconstruction after TBI.
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Affiliation(s)
- Michael Koller
- Department of Bioinformatics and Computational Biology, University of Minnesota, 101 Pleasant Street Southeast, Minneapolis, MN, 55455, USA.
| | - Daniel Rafter
- Department of Bioinformatics and Computational Biology, University of Minnesota, 101 Pleasant Street Southeast, Minneapolis, MN, 55455, USA
- Department of Neurosurgery, Minneapolis VA Medical Center, 1 Veterans Drive, Minneapolis, MN, 55417, USA
| | - Gillian Shok
- Department of Bioinformatics and Computational Biology, University of Minnesota, 101 Pleasant Street Southeast, Minneapolis, MN, 55455, USA
| | - Sean Murphy
- Department of Bioinformatics and Computational Biology, University of Minnesota, 101 Pleasant Street Southeast, Minneapolis, MN, 55455, USA
| | - Sheena Kiaei
- Department of Bioinformatics and Computational Biology, University of Minnesota, 101 Pleasant Street Southeast, Minneapolis, MN, 55455, USA
| | - Uzma Samadani
- Department of Bioinformatics and Computational Biology, University of Minnesota, 101 Pleasant Street Southeast, Minneapolis, MN, 55455, USA
- Department of Neurosurgery, Minneapolis VA Medical Center, 1 Veterans Drive, Minneapolis, MN, 55417, USA
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24
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Soriano JE, Saleem S, Netoff TI, Squair JW, Samadani U, Krassioukov AV, Darrow D, Phillips AA. Epidural electrical stimulation and hemodynamic control after spinal cord injury. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.02128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Background: As football comes under greater scrutiny because of concussions and other injuries, many people are searching for safer alternatives, especially for youth athletes. The injury rate in TackleBar football, one such alternative, is not currently known. Purpose: To describe TackleBar football and calculate its injury rate over a single season to compare it with both traditional tackle and flag football. Study Design: Descriptive epidemiology study. Methods: TackleBar football was described, and injuries of male athletes (age range, 9-14 years) participating in TackleBar football were tracked over the course of a season (August 5 through October 27, 2018) and compared with published injury rates for traditional tackle and flag football. Results: The overall injury rate of TackleBar football was found to be 0.31 per 1000 athlete-exposures (AEs), which is lower than youth tackle (2.25-2.60/1000 AEs) and flag (5.77/1000 AEs) football. Conclusion: TackleBar football may represent a reasonable alternative to tackle and flag football with regard to injuries.
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Affiliation(s)
- Joseph Toninato
- Research & Development, UnitedHealth Group, Minnetonka, Minnesota, USA
| | - Tim Healy
- TackleBar, Long Lake, Minnesota, USA
| | - Uzma Samadani
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA.,Bioinformatics and Computational Biology Program, University of Minnesota College of Science and Engineering, Minneapolis, Minnesota, USA.,CentraCare Health, St Cloud, Minnesota, USA.,Division of Neurosurgery, Minneapolis VA Medical Center, Minneapolis, Minnesota, USA
| | - Eric Christianson
- Emergency Services, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
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26
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Mahan MY, Samadani U. Editorial. Lessons from the failure of diffusion tensor imaging to differentiate concussed from nonconcussed NFL players. J Neurosurg 2019; 133:1-4. [PMID: 31491767 DOI: 10.3171/2019.5.jns19892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Uzma Samadani
- Departments of1Bioinformatics and Computational Biology
- 2Neurosurgery, and
- 3Neuroscience, University of Minnesota, Minneapolis, Minnesota
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27
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Mahan MY, Thorpe M, Ahmadi A, Abdallah T, Casey H, Sturtevant D, Judge-Yoakam S, Hoover C, Rafter D, Miner J, Richardson C, Samadani U. Glial Fibrillary Acidic Protein (GFAP) Outperforms S100 Calcium-Binding Protein B (S100B) and Ubiquitin C-Terminal Hydrolase L1 (UCH-L1) as Predictor for Positive Computed Tomography of the Head in Trauma Subjects. World Neurosurg 2019; 128:e434-e444. [PMID: 31051301 DOI: 10.1016/j.wneu.2019.04.170] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Traumatic brain injuries (TBIs) are largely underdiagnosed and may have persistent refractory consequences. Current assessments for acute TBI are limited to physical examination and imaging. Biomarkers such as glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCH-L1), and S100 calcium-binding protein B (S100B) have shown predictive value as indicators of TBI and potential screening tools. METHODS In total, 37 controls and 118 unique trauma subjects who received a clinically ordered head computed tomography (CT) in the emergency department of a level 1 trauma center were evaluated. Blood samples collected at 0-8 hours (initial) and 12-32 hours (delayed) postinjury were analyzed for GFAP, UCH-L1, and S100B concentrations. These were then compared in CT-negative and CT-positive subjects. RESULTS Median GFAP, UCH-L1, and S100B concentrations were greater in CT-positive subjects at both timepoints compared with CT-negative subjects. In addition, median UCH-L1 and S100B concentrations were lower at the delayed timepoint, whereas median GFAP concentrations were increased. As predictors of a positive CT of the head, GFAP outperformed UCH-L1 and S100B at both timepoints (initial: 0.89 sensitivity, 0.62 specificity; delayed: 0.94 sensitivity, 0.67 specificity). GFAP alone also outperformed all possible combinations of biomarkers. CONCLUSIONS GFAP, UCH-L1, and S100B demonstrated utility for rapid prediction of a CT-positive TBI within 0-8 hours of injury. GFAP exhibited the greatest predictive power at 12-32 hours. Furthermore, these results suggest that GFAP alone has greater utility for predicting a positive CT of the head than UCH-L1, S100B, or any combination of the 3.
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Affiliation(s)
- Margaret Y Mahan
- Department of Neurosurgery, Hennepin Healthcare, Minneapolis, Minnesota, USA; Department of Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maxwell Thorpe
- Department of Neurosurgery, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Aliya Ahmadi
- Department of Neurosurgery, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Tessneem Abdallah
- Department of Neurosurgery, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Hannah Casey
- Department of Neurosurgery, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Dylan Sturtevant
- Department of Neurosurgery, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Sénait Judge-Yoakam
- Department of Neurosurgery, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Caleb Hoover
- Department of Neurosurgery, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Daniel Rafter
- Department of Neurosurgery, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - James Miner
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Chad Richardson
- Department of General Surgery, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Uzma Samadani
- Department of Neurosurgery, Hennepin Healthcare, Minneapolis, Minnesota, USA; Department of Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota, USA; Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
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Saleem S, Darrow DA, Netoff TI, Tzeng Y, Samadani U, Krassioukov A, Phillips A. Epidural stimulation improves cerebral autoregulation and autonomic cardiac control in humans with spinal cord injury. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.533.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Saqib Saleem
- Department of Electrical and Computer EngineeringCOMSATS University Islamabad, Sahiwal CampusSahiwalPakistan
| | - David A Darrow
- Department of Surgery, Division of NeurosurgeryUniversity of MinnesotaMinneapolisMN
| | - Theoden I Netoff
- Department of Biomedical EngineeringUniversity of MinnesotaMinneapolisMN
| | - Yu‐Chieh Tzeng
- Department of Surgery and AnesthesiaUniversity of OtagoWellingtonNew Zealand
| | - Uzma Samadani
- Department of Surgery, Division of NeurosurgeryUniversity of MinnesotaMinneapolisMN
- Department of NeurosurgeryUniversity of MinnesotaMinneapolisMN
- Department of NeurosurgeryHennepin County Medical CenterMinneapolisMN
| | - Andrei Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Department of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Aaron Phillips
- Departments of Physiology and Pharmacology, Cardiac Sciences & Clinical NeurosciencesLibin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of CalgaryCalgaryABCanada
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Darrow D, Balser D, Netoff TI, Krassioukov A, Phillips A, Parr A, Samadani U. Epidural Spinal Cord Stimulation Facilitates Immediate Restoration of Dormant Motor and Autonomic Supraspinal Pathways after Chronic Neurologically Complete Spinal Cord Injury. J Neurotrauma 2019; 36:2325-2336. [PMID: 30667299 PMCID: PMC6648195 DOI: 10.1089/neu.2018.6006] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Epidural Spinal Cord Stimulation (eSCS) in combination with extensive rehabilitation has been reported to restore volitional movement in a select group of subjects after motor-complete spinal cord injury (SCI). Numerous questions about the generalizability of these findings to patients with longer term SCI have arisen, especially regarding the possibility of restoring autonomic function. To better understand the effect of eSCS on volitional movement and autonomic function, two female participants five and 10 years after injury at ages 48 and 52, respectively, with minimal spinal cord preservation on magnetic resonance imaging were implanted with an eSCS system at the vertebral T12 level. We demonstrated that eSCS can restore volitional movement immediately in two female participants in their fifth and sixth decade of life with motor and sensory-complete SCI, five and 10 years after sustaining severe radiographic injuries, and without prescribed or significant pre-habilitation. Both patients experienced significant improvements in surface electromyography power during a volitional control task with eSCS on. Cardiovascular function was also restored with eSCS in one participant with cardiovascular dysautonomia using specific eSCS settings during tilt challenge while not affecting function in a participant with normal cardiovascular function. Orgasm was achieved for the first time since injury in one participant with and immediately after eSCS. Bowel-bladder synergy improved in both participants while restoring volitional urination in one with eSCS. While numerous questions remain, the ability to restore some supraspinal control over motor function below the level of injury, cardiovascular function, sexual function, and bowel and bladder function should promote intense efforts to investigate and develop optimization strategies to maximize recovery in all participants with chronic SCI.
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Affiliation(s)
- David Darrow
- 1Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| | - David Balser
- 2Department of Surgery, Division of Neurosurgery, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Theoden I Netoff
- 3Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Andrei Krassioukov
- 4International Collaboration on Repair Discoveries; Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron Phillips
- 5Departments of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ann Parr
- 1Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| | - Uzma Samadani
- 6Department of Neurosurgery, Hennepin County Medical Center, Minneapolis, Minnesota
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Bin Zahid A, Balser D, Thomas R, Mahan MY, Hubbard ME, Samadani U. Increase in brain atrophy after subdural hematoma to rates greater than associated with dementia. J Neurosurg 2018; 129:1579-1587. [DOI: 10.3171/2017.8.jns17477] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 08/21/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEChronic subdural hematoma (cSDH) is a highly morbid condition associated with brain atrophy in the elderly. It has a reported 30% 1-year mortality rate. Approximately half of afflicted individuals report either no or relatively unremarkable trauma preceding their diagnosis, raising the possibility that cSDH is a manifestation of degenerative or inflammatory disease rather than trauma. The purpose of this study was to compare the rates of cerebral atrophy before and after cSDH to determine whether it is more likely that cSDH causes atrophy or that atrophy causes cSDH. The authors also compared atrophy rates in patients with cSDH to the rates in patients with and without dementia.METHODSThe authors developed algorithmic segmentation analysis software to measure whole-brain, CSF, and intracranial space volumes. They then identified military veterans who had undergone at least 4 brain CT scans over a period of 10 years. Within this database, the authors identified 146 patients with 962 head CT scans who had received diagnoses of either cSDH, dementia, or no known dementia condition. Volumetric analyses of brains in 45 patients with dementia (dementia group) and 73 patients without dementia (nondementia group), in whom 262 and 519 head CT scans were obtained, respectively, were compared with 11 patients in whom 81 CT scans were obtained a mean of 4.21 years before a cSDH diagnosis and 17 patients in whom 100 scans were obtained a mean of 4.24 years after SDH. Longitudinal measures were then related to disease status and the time since first scan by using hierarchical models, and atrophy rates between the groups were compared.RESULTSHead CT scans from patients were obtained for an average time period of 4.21 years (SD 1.69) starting at a mean patient age of 74 years. Absolute brain volume loss for the 17 patients in the post-SDH group (13 were treated surgically) was significantly greater, at 16.32 ml/year, compared with 6.61 ml/year in patients with dementia, 5.33 ml/year in patients without dementia, and 3.57 ml/year in pre-SDH patients. The atrophy rate for these individuals prior to enrollment in the study was 2.32 ml/year (p = 0.001). In terms of brain volume normalized to cranial cavity size, the post-SDH group had an atrophy rate of 0.7801%/year, compared with 0.4467%/year in patients with dementia, 0.3474%/year in patients without dementia, and 0.2135%/year in the pre-SDH group.CONCLUSIONSPrior to development of a cSDH, the atrophy rates in patients who ultimately develop cSDH are similar to those of patients without dementia. After development of a cSDH, the atrophy rates increase to more than twice those of patients with dementia. Chronic subdural hematoma is thus associated with a significant increase in brain atrophy rate. These findings suggest the neurotoxic consequences of cSDH and may have implications for better understanding of the pathophysiology of cerebral atrophy and dementia.
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Affiliation(s)
- Abdullah Bin Zahid
- 1Department of Surgery, Minneapolis VA Health Care System
- 2Department of Neurosurgery, University of Minnesota; and
- 3Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota
| | - David Balser
- 1Department of Surgery, Minneapolis VA Health Care System
- 2Department of Neurosurgery, University of Minnesota; and
- 3Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Rebekah Thomas
- 3Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Margaret Y. Mahan
- 2Department of Neurosurgery, University of Minnesota; and
- 3Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Molly E. Hubbard
- 1Department of Surgery, Minneapolis VA Health Care System
- 2Department of Neurosurgery, University of Minnesota; and
- 3Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Uzma Samadani
- 1Department of Surgery, Minneapolis VA Health Care System
- 2Department of Neurosurgery, University of Minnesota; and
- 3Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota
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Samadani U, Qian X, Costa RH. Identification of a transthyretin enhancer site that selectively binds the hepatocyte nuclear factor-3 beta isoform. Gene Expr 2018; 6:23-33. [PMID: 8931989 PMCID: PMC6148260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The upstream proximal region of the transthyretin (TTR) promoter and a distal enhancer are sufficient to drive liver-specific expression of the TTR gene, as demonstrated by experiments in transgenic mice. Previous analyses have characterized the binding of a number of liver-enriched transcription factors of the TTR promoter including hepatocyte nuclear factors one (HNF-1), HNF-4, and three distinct HNF-3 proteins (alpha, beta, and gamma), which are members of the winged helix (fork head) family. The TTR enhancer was shown to bind members of the CCAAT/enhancer binding protein (C/EBP) family at two distinct sites (TTR-2 and TTR-3), and an oligonucleotide containing the activation protein one (AP-1) binding sequence competed for recognition to a third enhancer site (TTR-1). In this study, we have carried out a detailed analysis of the transcription factors that recognize the TTR enhancer elements (TTR-1, TTR-2, and TTR-3 oligonucleotide sequences). Analysis of the TTR-1 site demonstrates that the putative AP-1 site in the TTR enhancer binds a ubiquitously expressed factor that is distinct from the AP-1 family of proteins. Next we demonstrate, via gel shift analysis, that the TTR-3 site is recognized by the C/EBP family in liver nuclear extracts. We also show that whereas the TTR-2 enhancer site is capable of binding recombinant C/EBP proteins, it does not bind C/EBP proteins from liver nuclear extracts. The TTR-2 site does, however, contain a variant HNF-3 recognition sequence that exclusively binds the HNF-3 beta isoform. Mutation of this HNF-3 beta-specific recognition sequence caused reductions in TTR enhancer activity. We had previously observed a 95% decrease in HNF-3 alpha expression and a 20% reduction in HNF-3 beta expression in acute phase livers, which correlated with a 60% decrease in TTR gene transcription. We propose that the HNF-3 beta-specific binding site in the TTR enhancer may play a role in maintaining TTR gene expression during the acute phase response in spite of the dramatic reduction in HNF-3 alpha protein levels.
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Affiliation(s)
- U Samadani
- Department of Biochemistry, College of Medicine, University of Illinois at Chicago 60612-7334, USA
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Rafter DJ, Samadani U. 333 Thoracoabdominal Crush Injury Causes Increased Intracranial Pressure Resulting in Traumatic Brain Injury Detectable With Eye Tracking Technology and Blood-Based Biomarkers. Neurosurgery 2018. [DOI: 10.1093/neuros/nyy303.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Toninato J, Casey H, Uppal M, Abdallah T, Bergman T, Eckner J, Samadani U. Traumatic brain injury reduction in athletes by neck strengthening (TRAIN). Contemp Clin Trials Commun 2018; 11:102-106. [PMID: 29998204 PMCID: PMC6037875 DOI: 10.1016/j.conctc.2018.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/13/2018] [Accepted: 06/20/2018] [Indexed: 11/29/2022] Open
Abstract
Reporting of sports-related concussions (SRCs) has risen dramatically over the last decade, increasing awareness of the need for treatment and prevention of SRCs. To date most prevention studies have focused on equipment and rule changes to sports in order to reduce the risk of injury. However, increased neck strength has been shown to be a predictor of concussion rate. In the TRAIN study, student-athletes will follow a simple neck strengthening program over the course of three years in order to better understand the relationship between neck strength and SRCs. Neck strength of all subjects will be measured at baseline and biannually over the course of the study using a novel protocol. Concussion severity and duration in any subject who incurs an SRC will be evaluated using the Sports Concussion Assessment Tool 5th edition, a questionnaire based tool utilizing several tests that are commonly affected by concussion, and an automated eye tracking algorithm. Neck strength, and improvement of neck strength, will be compared between concussed and non-concussed athletes to determine if neck strength can indeed reduce risk of concussion. Neck strength will also be analyzed taking into account concussion severity and duration to find if a strengthening program can provide a protective factor to athletes. The study population will consist of student-athletes, ages 12-23, from local high schools and colleges. These athletes are involved in a range of both contact and non-contact sports.
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Key Words
- ANOVA, Analysis of variance
- Athlete
- BAT-L, Boston Assessment of Traumatic Brain Injury Lifetime
- Brain injury
- CISG, Concussion in Sports Group
- Concussion
- Football
- Head injuries
- ICC, Intraclasss coefficient
- IRB, Institutional Review Board
- MMRF, Minneapolis Medical Research Foundation
- Neck strength
- Prevention
- SAC, Standardized Assessment of Concussion
- SCAT5, Sports Concussion Assessment Tool
- SRC, Sports-related concussion
- Sports
- Student
- TBI, Traumatic Brain Injury
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Affiliation(s)
- Joseph Toninato
- Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, MN 55415, USA
- University of Minnesota, 100 Church St. SE, Minneapolis MN 55455, USA
| | - Hannah Casey
- Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, MN 55415, USA
- University of Minnesota, 100 Church St. SE, Minneapolis MN 55455, USA
| | - Mohit Uppal
- Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, MN 55415, USA
- University of Minnesota, 100 Church St. SE, Minneapolis MN 55455, USA
| | - Tessneem Abdallah
- Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, MN 55415, USA
- University of Minnesota, 100 Church St. SE, Minneapolis MN 55455, USA
| | - Thomas Bergman
- Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, MN 55415, USA
- University of Minnesota, 100 Church St. SE, Minneapolis MN 55455, USA
| | - JamesT. Eckner
- University of Michigan, 1301 Catherine St., Ann Arbor, MI 48109, USA
| | - Uzma Samadani
- Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, MN 55415, USA
- University of Minnesota, 100 Church St. SE, Minneapolis MN 55455, USA
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Sone JY, Courtney-Kay Lamb S, Techar K, Dammavalam V, Uppal M, Williams C, Bergman T, Tupper D, Ort P, Samadani U. High prevalence of prior contact sports play and concussion among orthopedic and neurosurgical department chairs. J Neurosurg Pediatr 2018; 22:1-8. [PMID: 29701560 DOI: 10.3171/2018.1.peds17640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Increased understanding of the consequences of traumatic brain injury has heightened concerns about youth participation in contact sports. This study investigated the prevalence of high school and collegiate contact sports play and concussion history among surgical department chairs. METHODS A cross-sectional survey was administered to 107 orthopedic and 74 neurosurgery chairs. Responses were compared to published historical population norms for contact sports (high school 27.74%, collegiate 1.44%), football (high school 10.91%, collegiate 0.76%), and concussion prevalence (12%). One-proportion Z-tests, chi-square tests, and binary logistic regression were used to analyze differences. RESULTS High school contact sports participation was 2.35-fold higher (65.3%, p < 0.001) for orthopedic chairs and 1.73-fold higher (47.9%, p = 0.0018) for neurosurgery chairs than for their high school peers. Collegiate contact sports play was 31.0-fold higher (44.7%, p < 0.001) for orthopedic chairs and 15.1-fold higher (21.7%, p < 0.001) for neurosurgery chairs than for their college peers. Orthopedic chairs had a 4.30-fold higher rate of high school football participation (46.9%, p < 0.001) while neurosurgery chairs reported a 3.05-fold higher rate (33.3%, p < 0.001) than their high school peers. Orthopedic chairs reported a 28.1-fold higher rate of collegiate football participation (21.3%, p < 0.001) and neurosurgery chairs reported an 8.58-fold higher rate (6.5%, p < 0.001) compared to their college peers. The rate at which orthopedic (42.6%, p < 0.001) and neurosurgical (42.4%, p < 0.001) chairs reported having at least 1 concussion in their lifetime was significantly higher than the reported prevalence in the general population. After correction for worst possible ascertainment bias, all results except high school contact sports participation remained significant. CONCLUSIONS The high prevalence of youth contact sports play and concussion among surgical specialty chairs affirms that individuals in careers requiring high motor and cognitive function frequently played contact sports. The association highlights the need to further examine the relationships between contact sports and potential long-term benefits as well as risks of sport-related injury.
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Affiliation(s)
- Je Yeong Sone
- 1Department of Chemistry, New York University College of Arts and Science
| | | | - Kristina Techar
- 3Department of Surgery and.,4Neurosurgery, University of Minnesota
| | | | - Mohit Uppal
- 3Department of Surgery and.,4Neurosurgery, University of Minnesota
| | - Cedric Williams
- 3Department of Surgery and.,4Neurosurgery, University of Minnesota
| | - Thomas Bergman
- 3Department of Surgery and.,4Neurosurgery, University of Minnesota
| | - David Tupper
- 5Section of Neuropsychology, Hennepin County Medical Center; and
| | - Paul Ort
- 6Department of Orthopedics, VA NY Harbor Healthcare, NYU School of Medicine, New York, New York
| | - Uzma Samadani
- 3Department of Surgery and.,4Neurosurgery, University of Minnesota.,7Surgery, Minneapolis VA Medical Center, Minneapolis, Minnesota
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Daly S, Thorpe M, Rockswold S, Hubbard M, Bergman T, Samadani U, Rockswold G. Hyperbaric Oxygen Therapy in the Treatment of Acute Severe Traumatic Brain Injury: A Systematic Review. J Neurotrauma 2018; 35:623-629. [PMID: 29132229 DOI: 10.1089/neu.2017.5225] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
There has been no major advancement in a quarter of a century for the treatment of acute severe traumatic brain injury (TBI). This review summarizes 40 years of clinical and pre-clinical research on the treatment of acute TBI with hyperbaric oxygen therapy (HBO2) in the context of an impending National Institute of Neurologic Disorders and Stroke-funded, multi-center, randomized, adaptive Phase II clinical trial -the Hyperbaric Oxygen Brain Injury Treatment (HOBIT) trial. Thirty studies (eight clinical and 22 pre-clinical) that administered HBO2 within 30 days of a TBI were identified from PubMed searches. The pre-clinical studies consistently reported positive treatment effects across a variety of outcome measures with almost no safety concerns, thus providing strong proof-of-concept evidence for treating severe TBI in the acute setting. Of the eight clinical studies reviewed, four were based on the senior author's (GR) investigation of HBO2 as a treatment for acute severe TBI. These studies provided evidence that HBO2 significantly improves physiologic measures without causing cerebral or pulmonary toxicity and can potentially improve clinical outcome. These results were consistent across the other four reviewed clinical studies, thus providing preliminary clinical data supporting the HOBIT trial. This comprehensive review demonstrates that HBO2 has the potential to be the first significant treatment in the acute phase of severe TBI.
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Affiliation(s)
- Samuel Daly
- 1 Department of Surgery, Hennepin County Medical Center , Minneapolis, Minnesota.,2 University of Minnesota Medical School , Minneapolis, Minnesota
| | - Maxwell Thorpe
- 1 Department of Surgery, Hennepin County Medical Center , Minneapolis, Minnesota
| | - Sarah Rockswold
- 3 Department of Physical Medicine and Rehabilitation, University of Minnesota , Minneapolis, Minnesota
| | - Molly Hubbard
- 1 Department of Surgery, Hennepin County Medical Center , Minneapolis, Minnesota.,4 Department of Neurosurgery, University of Minnesota , Minneapolis, Minnesota
| | - Thomas Bergman
- 1 Department of Surgery, Hennepin County Medical Center , Minneapolis, Minnesota.,4 Department of Neurosurgery, University of Minnesota , Minneapolis, Minnesota
| | - Uzma Samadani
- 1 Department of Surgery, Hennepin County Medical Center , Minneapolis, Minnesota.,4 Department of Neurosurgery, University of Minnesota , Minneapolis, Minnesota
| | - Gaylan Rockswold
- 1 Department of Surgery, Hennepin County Medical Center , Minneapolis, Minnesota.,4 Department of Neurosurgery, University of Minnesota , Minneapolis, Minnesota
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Hubbard ME, Zahid AB, Meyer G, Vonderhaar K, Balser DY, Darrow D, Kleeberger A, Burri D, Dammavalam V, Venkatesh S, Tupper D, Rockswold SB, Bergman TA, Rockswold GL, Samadani U. 306 GCS Does Not Predict Cognitive Outcome 30 Years After Severe Traumatic Brain Injury. Neurosurgery 2017. [DOI: 10.1093/neuros/nyx417.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Meyer G, Hubbard ME, Vonderhaar K, Rockswold GL, Samadani U. Poster 75: Headache Prevalence 30 Years After Severe Traumatic Brain Injury (TBI): Results From a Comparative Cohort Study. PM R 2017. [DOI: 10.1016/j.pmrj.2017.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Gabrielle Meyer
- University of Minnesota, Saint Paul, Minnesota, United States
| | | | | | | | - Uzma Samadani
- University of Minnesota, Saint Paul, Minnesota, United States
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Vonderhaar K, Hubbard ME, Meyer G, Rockswold GL, Samadani U. Poster 136: 30 Year Outcomes After Severe Traumatic Brain Injury in a Pediatric Population. PM R 2017. [DOI: 10.1016/j.pmrj.2017.08.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kolecki R, Dammavalam V, Bin Zahid A, Hubbard M, Choudhry O, Reyes M, Han B, Wang T, Papas PV, Adem A, North E, Gilbertson DT, Kondziolka D, Huang JH, Huang PP, Samadani U. Elevated intracranial pressure and reversible eye-tracking changes detected while viewing a film clip. J Neurosurg 2017; 128:811-818. [PMID: 28574312 DOI: 10.3171/2016.12.jns161265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The precise threshold differentiating normal and elevated intracranial pressure (ICP) is variable among individuals. In the context of several pathophysiological conditions, elevated ICP leads to abnormalities in global cerebral functioning and impacts the function of cranial nerves (CNs), either or both of which may contribute to ocular dysmotility. The purpose of this study was to assess the impact of elevated ICP on eye-tracking performed while patients were watching a short film clip. METHODS Awake patients requiring placement of an ICP monitor for clinical purposes underwent eye tracking while watching a 220-second continuously playing video moving around the perimeter of a viewing monitor. Pupil position was recorded at 500 Hz and metrics associated with each eye individually and both eyes together were calculated. Linear regression with generalized estimating equations was performed to test the association of eye-tracking metrics with changes in ICP. RESULTS Eye tracking was performed at ICP levels ranging from -3 to 30 mm Hg in 23 patients (12 women, 11 men, mean age 46.8 years) on 55 separate occasions. Eye-tracking measures correlating with CN function linearly decreased with increasing ICP (p < 0.001). Measures for CN VI were most prominently affected. The area under the curve (AUC) for eye-tracking metrics to discriminate between ICP < 12 and ≥ 12 mm Hg was 0.798. To discriminate an ICP < 15 from ≥ 15 mm Hg the AUC was 0.833, and to discriminate ICP < 20 from ≥ 20 mm Hg the AUC was 0.889. CONCLUSIONS Increasingly elevated ICP was associated with increasingly abnormal eye tracking detected while patients were watching a short film clip. These results suggest that eye tracking may be used as a noninvasive, automatable means to quantitate the physiological impact of elevated ICP, which has clinical application for assessment of shunt malfunction, pseudotumor cerebri, concussion, and prevention of second-impact syndrome.
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Affiliation(s)
- Radek Kolecki
- 1Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Vikalpa Dammavalam
- 2Department of Neurosurgery, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota; and
| | - Abdullah Bin Zahid
- 2Department of Neurosurgery, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota; and
| | - Molly Hubbard
- 2Department of Neurosurgery, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota; and
| | - Osamah Choudhry
- 1Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Marleen Reyes
- 1Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - ByoungJun Han
- 1Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Tom Wang
- 1Department of Neurosurgery, New York University School of Medicine, New York, New York
| | | | - Aylin Adem
- 1Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Emily North
- 1Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - David T Gilbertson
- 2Department of Neurosurgery, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota; and
| | - Douglas Kondziolka
- 1Department of Neurosurgery, New York University School of Medicine, New York, New York
| | | | - Paul P Huang
- 1Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Uzma Samadani
- 2Department of Neurosurgery, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota; and
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Samadani U, Zahid AB, Lockyer J, Dammavalam V, Grady M, Nance M, Scheiman M, Master CL. Eye tracking a biomarker for concussion in the paediatricpediatric population. Br J Sports Med 2017. [DOI: 10.1136/bjsports-2016-097270.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Helmets are one of the earliest and most enduring methods of personal protection in human civilization. Although primarily developed for combat purposes in ancient times, modern helmets have become highly diversified to sports, recreation, and transportation. History and the scientific literature exhibit that helmets continue to be the primary and most effective prevention method against traumatic brain injury (TBI), which presents high mortality and morbidity rates in the US. The neurosurgical and neurotrauma literature on helmets and TBI indicate that helmets provide effectual protection against moderate to severe head trauma resulting in severe disability or death. However, there is a dearth of scientific data on helmet efficacy against concussion in both civilian and military aspects. The objective of this literature review was to explore the historical evolution of helmets, consider the effectiveness of helmets in protecting against severe intracranial injuries, and examine recent evidence on helmet efficacy against concussion. It was also the goal of this report to emphasize the need for more research on helmet efficacy with improved experimental design and quantitative standardization of assessments for concussion and TBI, and to promote expanded involvement of neurosurgery in studying the quantitative diagnostics of concussion and TBI. Recent evidence summarized by this literature review suggests that helmeted patients do not have better relative clinical outcome and protection against concussion than unhelmeted patients.
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Affiliation(s)
- Je Yeong Sone
- 1Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Douglas Kondziolka
- 1Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Jason H. Huang
- 2Department of Neurosurgery, Baylor Scott & White Central Division, Temple, Texas; and
| | - Uzma Samadani
- 3Department of Neurosurgery, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota
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Bin Zahid A, Hubbard ME, Dammavalam VM, Balser DY, Pierre G, Kim A, Kolecki R, Mehmood T, Wall SP, Frangos SG, Huang PP, Tupper DE, Barr W, Samadani U. Assessment of acute head injury in an emergency department population using sport concussion assessment tool - 3rd edition. Appl Neuropsychol Adult 2016; 25:110-119. [PMID: 27854143 DOI: 10.1080/23279095.2016.1248765] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Sport Concussion Assessment Tool version 3 (SCAT-3) is one of the most widely researched concussion assessment tools in athletes. Here normative data for SCAT3 in nonathletes are presented. The SCAT3 was administered to 98 nonathlete healthy controls, as well as 118 participants with head-injury and 46 participants with other body trauma (OI) presenting to the ED. Reference values were derived and classifier functions were built to assess the accuracy of SCAT3. The control population had a mean of 2.30 (SD = 3.62) symptoms, 4.38 (SD = 8.73) symptom severity score (SSS), and 26.02 (SD = 2.52) standardized assessment of concussion score (SAC). Participants were more likely to be diagnosed with a concussion (from among healthy controls) if the SSS > 7; or SSS ≤ 7 and SAC ≤22 (sensitivity = 96%, specificity = 77%). Identification of head injury patients from among both, healthy controls and body trauma was possible using rule SSS > 7 and headache or pressure in head present, or SSS ≤ 7 and SAC ≤ 22 (sensitivity = 87%, specificity = 80%). In this current study, the SCAT-3 provided high sensitivity to discriminate acute symptoms of TBI in the ED setting. Individuals with a SSS > 7 and headache or pressure in head, or SSS ≤ 7 but with a SAC ≤ 22 within 48-hours of an injury should undergo further testing.
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Affiliation(s)
- Abdullah Bin Zahid
- a Division of Neurosurgery , Hennepin County Medical Center , Minneapolis , Minnesota , USA.,b Division of Neurosurgery , Minneapolis VA Health Care System , Minneapolis , Minnesota , USA.,c Department of Neurosurgery , University of Minnesota , Minneapolis , Minnesota , USA
| | - Molly E Hubbard
- a Division of Neurosurgery , Hennepin County Medical Center , Minneapolis , Minnesota , USA.,c Department of Neurosurgery , University of Minnesota , Minneapolis , Minnesota , USA
| | - Vikalpa M Dammavalam
- a Division of Neurosurgery , Hennepin County Medical Center , Minneapolis , Minnesota , USA.,b Division of Neurosurgery , Minneapolis VA Health Care System , Minneapolis , Minnesota , USA
| | - David Y Balser
- a Division of Neurosurgery , Hennepin County Medical Center , Minneapolis , Minnesota , USA.,b Division of Neurosurgery , Minneapolis VA Health Care System , Minneapolis , Minnesota , USA
| | - Gritz Pierre
- d Department of Neurosurgery , New York University School of Medicine , New York , New York , USA
| | - Amie Kim
- e Department of Surgery , Westchester Medical Center , Valhallah , New York , USA
| | | | - Talha Mehmood
- e Department of Surgery , Westchester Medical Center , Valhallah , New York , USA
| | - Stephen P Wall
- g Ronald O. Perelman Department of Emergency Medicine , New York University School of Medicine , New York , New York , USA
| | - Spiros G Frangos
- h Department of Surgery , New York University School of Medicine , New York , New York , USA
| | - Paul P Huang
- d Department of Neurosurgery , New York University School of Medicine , New York , New York , USA.,i Department of Neurosurgery , Bellevue Hospital Center , New York , New York , USA
| | - David E Tupper
- j Neuropsychology Section (G8) , Hennepin County Medical Center , Minneapolis , Minnesota , USA
| | - William Barr
- k Departments of Neurology & Psychiatry , New York University School of Medicine , New York , New York , USA
| | - Uzma Samadani
- a Division of Neurosurgery , Hennepin County Medical Center , Minneapolis , Minnesota , USA.,b Division of Neurosurgery , Minneapolis VA Health Care System , Minneapolis , Minnesota , USA.,c Department of Neurosurgery , University of Minnesota , Minneapolis , Minnesota , USA
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Samadani U, Hubbard M. Diagnosing Traumatic Encephalopathy Syndrome. JAMA Neurol 2016; 73:1373-1374. [PMID: 27654818 DOI: 10.1001/jamaneurol.2016.2802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Uzma Samadani
- Neurosurgery, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Molly Hubbard
- Neurosurgery, Hennepin County Medical Center, Minneapolis, Minnesota
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Master CL, Zahid AB, Lockyer J, Houseknecht E, Dammavalam V, Grady M, Nance M, Samadani U. Eye Tracking as a Biomarker for Concussion in Pediatric Patients. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000486524.94354.7e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Samadani U. A new tool for monitoring brain function: eye tracking goes beyond assessing attention to measuring central nervous system physiology. Neural Regen Res 2015; 10:1231-3. [PMID: 26487847 PMCID: PMC4590232 DOI: 10.4103/1673-5374.162752] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Uzma Samadani
- Steven and Alexandra Cohen Veterans Center for Post-Traumatic Stress and Traumatic Brain Injury at NYU Langone Medical Center; Departments of Neurosurgery, Psychiatry, Physiology and Neuroscience, New York University School of Medicine, New York; New York Harbor Health Care System, USA
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Renfrow JJ, Rodriguez A, Liu A, Pilitsis JG, Samadani U, Ganju A, Germano IM, Benzil DL, Wolfe SQ. Positive trends in neurosurgery enrollment and attrition: analysis of the 2000-2009 female neurosurgery resident cohort. J Neurosurg 2015; 124:834-9. [PMID: 26452119 DOI: 10.3171/2015.3.jns142313] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Women compose a minority of neurosurgery residents, averaging just over 10% of matched applicants per year during this decade. A recent review by Lynch et al. raises the concern that women may be at a higher risk than men for attrition, based on analysis of a cohort matched between 1990 and 1999. This manuscript aims to characterize the trends in enrollment, attrition, and postattrition careers for women who matched in neurosurgery between 2000 and 2009. METHODS Databases from the American Association of Neurological Surgeons (AANS) and the American Board of Neurological Surgery (ABNS) were analyzed for all residents who matched into neurosurgery during the years 2000-2009. Residents were sorted by female gender, matched against graduation records, and if graduation was not reported from neurosurgery residency programs, an Internet search was used to determine the residents' alternative path. The primary outcome was to determine the number of women residents who did not complete neurosurgery training programs during 2000-2009. Secondary outcomes included the total number of women who matched into neurosurgery per year, year in training in which attrition occurred, and alternative career paths that these women chose to pursue. RESULTS Women comprised 240 of 1992 (12%) matched neurosurgery residents during 2000-2009. Among female residents there was a 17% attrition rate, compared with a 5.3% male attrition rate, with an overall attrition rate of 6.7%. The majority who left the field did so within the first 3 years of neurosurgical training and stayed in medicine--pursuing anesthesia, neurology, and radiology. CONCLUSIONS Although the percentage of women entering neurosurgical residency has continued to increase, this number is still disproportionate to the overall number of women in medicine. The female attrition rate in neurosurgery in the 2000-2009 cohort is comparable to that of the other surgical specialties, but for neurosurgery, there is disparity between the male and female attrition rates. Women who left the field tended to stay within medicine and usually pursued a neuroscience-related career. Given the need for talented women to pursue neurosurgery and the increasing numbers of women matching annually, the recruitment and retention of women in neurosurgery should be benchmarked and assessed.
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Affiliation(s)
- Jaclyn J Renfrow
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Analiz Rodriguez
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ann Liu
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Uzma Samadani
- Department of Neurosurgery, New York University School of Medicine, New York
| | - Aruna Ganju
- Department of Neurosurgery, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | | | - Deborah L Benzil
- Department of Neurosurgery, Columbia University, New York, New York; and
| | - Stacey Quintero Wolfe
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Samadani U. Will eye tracking change the way we diagnose and classify concussion and structural brain injury? Concussion 2015; 1:CNC2. [PMID: 30202547 PMCID: PMC6114020 DOI: 10.2217/cnc.15.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 11/21/2022] Open
Affiliation(s)
- Uzma Samadani
- New York Harbor HealthCare System, NY, USA.,Cohen Veterans Center for Post-Traumatic Stress & Traumatic Brain Injury.,Department of Neurosurgery, Psychiatry, Physiology & Neuroscience, New York University School of Medicine, 423 E, 23rd St, MC 112, Rm 4168N, New York, NY 10010, USA.,New York Harbor HealthCare System, NY, USA.,Cohen Veterans Center for Post-Traumatic Stress & Traumatic Brain Injury.,Department of Neurosurgery, Psychiatry, Physiology & Neuroscience, New York University School of Medicine, 423 E, 23rd St, MC 112, Rm 4168N, New York, NY 10010, USA
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Samadani U, Li M, Qian M, Laska E, Ritlop R, Kolecki R, Reyes M, Altomare L, Sone JY, Adem A, Huang P, Kondziolka D, Wall S, Frangos S, Marmar C. Sensitivity and specificity of an eye movement tracking-based biomarker for concussion. Concussion 2015; 1:CNC3. [PMID: 30202548 PMCID: PMC6114025 DOI: 10.2217/cnc.15.3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/05/2015] [Indexed: 12/05/2022] Open
Abstract
Object: The purpose of the current study is to determine the sensitivity and specificity of an eye tracking method as a classifier for identifying concussion. Methods: Brain injured and control subjects prospectively underwent both eye tracking and Sport Concussion Assessment Tool 3. The results of eye tracking biomarker based classifier models were then validated against a dataset of individuals not used in building a model. The area under the curve (AUC) of receiver operating characteristics was examined. Results: An optimal classifier based on best subset had an AUC of 0.878, and a cross-validated AUC of 0.852 in CT- subjects and an AUC of 0.831 in a validation dataset. The optimal misclassification rate in an external dataset (n = 254) was 13%. Conclusion: If one defines concussion based on history, examination, radiographic and Sport Concussion Assessment Tool 3 criteria, it is possible to generate an eye tracking based biomarker that enables detection of concussion with reasonably high sensitivity and specificity.
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Affiliation(s)
- Uzma Samadani
- Department of Neurosurgery, New York Harbor Health Care System, NY, USA.,Department of Neurosurgery, New York University, School of Medicine, NY, USA.,Steven & Alexandra Cohen Veterans Center for Post-Traumatic Stress & Traumatic Brain Injury, New York University Langone Medical Center, NY, USA.,Department of Neurosurgery, New York Harbor Health Care System, NY, USA.,Department of Neurosurgery, New York University, School of Medicine, NY, USA.,Steven & Alexandra Cohen Veterans Center for Post-Traumatic Stress & Traumatic Brain Injury, New York University Langone Medical Center, NY, USA
| | - Meng Li
- Steven & Alexandra Cohen Veterans Center for Post-Traumatic Stress & Traumatic Brain Injury, New York University Langone Medical Center, NY, USA.,Steven & Alexandra Cohen Veterans Center for Post-Traumatic Stress & Traumatic Brain Injury, New York University Langone Medical Center, NY, USA
| | - Meng Qian
- Steven & Alexandra Cohen Veterans Center for Post-Traumatic Stress & Traumatic Brain Injury, New York University Langone Medical Center, NY, USA.,Steven & Alexandra Cohen Veterans Center for Post-Traumatic Stress & Traumatic Brain Injury, New York University Langone Medical Center, NY, USA
| | - Eugene Laska
- Steven & Alexandra Cohen Veterans Center for Post-Traumatic Stress & Traumatic Brain Injury, New York University Langone Medical Center, NY, USA.,Nathan Kline Institute for Psychiatric Research, Orangeburg, NJ, USA.,Steven & Alexandra Cohen Veterans Center for Post-Traumatic Stress & Traumatic Brain Injury, New York University Langone Medical Center, NY, USA.,Nathan Kline Institute for Psychiatric Research, Orangeburg, NJ, USA
| | | | - Radek Kolecki
- Department of Neurosurgery, New York University, School of Medicine, NY, USA.,Department of Neurosurgery, New York University, School of Medicine, NY, USA
| | - Marleen Reyes
- Department of Neurosurgery, New York Harbor Health Care System, NY, USA.,Department of Neurosurgery, New York University, School of Medicine, NY, USA.,Department of Neurosurgery, New York Harbor Health Care System, NY, USA.,Department of Neurosurgery, New York University, School of Medicine, NY, USA
| | - Lindsey Altomare
- Department of Neurosurgery, New York University, School of Medicine, NY, USA.,Department of Neurosurgery, New York University, School of Medicine, NY, USA
| | - Je Yeong Sone
- Department of Neurosurgery, New York University, School of Medicine, NY, USA.,Department of Neurosurgery, New York University, School of Medicine, NY, USA
| | - Aylin Adem
- Department of Neurosurgery, New York University, School of Medicine, NY, USA.,Department of Neurosurgery, New York University, School of Medicine, NY, USA
| | - Paul Huang
- Department of Neurosurgery, New York University, School of Medicine, NY, USA.,Department of Neurosurgery, New York University, School of Medicine, NY, USA
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University, School of Medicine, NY, USA.,Department of Neurosurgery, New York University, School of Medicine, NY, USA
| | - Stephen Wall
- Department of Emergency Medicine, New York University School of Medicine, NY, USA.,Department of Emergency Medicine, New York University School of Medicine, NY, USA
| | - Spiros Frangos
- Department of Trauma Surgery, New York University School of Medicine, NY, USA.,Department of Trauma Surgery, New York University School of Medicine, NY, USA
| | - Charles Marmar
- Steven & Alexandra Cohen Veterans Center for Post-Traumatic Stress & Traumatic Brain Injury, New York University Langone Medical Center, NY, USA.,Steven & Alexandra Cohen Veterans Center for Post-Traumatic Stress & Traumatic Brain Injury, New York University Langone Medical Center, NY, USA
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Balser D, Farooq S, Mehmood T, Reyes M, Samadani U. Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations. J Neurosurg 2015; 123:1209-15. [PMID: 25794342 DOI: 10.3171/2014.9.jns141550] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Chronic subdural hematomas (SDHs) are more common among veterans and elderly persons than among members of the general population; however, precise incidence rates are unknown. The purposes of this study were 1) to determine the current incidence of chronic SDH in a US Veterans Administration (VA) population and 2) to create a mathematical model for determining the current and future incidence of chronic SDH as a function of population age, sex, and comorbidity in the United States VA and civilian populations. METHODS To determine the actual number of veterans who received a radiographic diagnosis and surgical treatment for SDH during 2000-2012, the authors used the VISN03 VA database. On the basis of this result and data from outside the United States, they then created a mathematical model accounting for age, sex, and alcohol consumption to predict the incidence of SDH in the VA and civilian populations during 2012-2040. RESULTS Of 875,842 unique (different patient) visits to a VA hospital during the study period, 695 new SDHs were identified on CT images. Of these 695 SDHs, 203 (29%) required surgical drainage. The incidence rate was 79.4 SDHs per 100,000 persons, and the age-standardized rate was 39.1±4.74 SDHs per 100,000 persons. The authors' model predicts that incidence rates of chronic SDH in aging United States VA and civilian populations will reach 121.4 and 17.4 cases per 100,000 persons, respectively, by 2030, at which time, approximately 60,000 cases of chronic SDH will occur each year in the United States. CONCLUSIONS The incidence of chronic SDH is rising; SDH is projected to become the most common cranial neurosurgical condition among adults by the year 2030.
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Affiliation(s)
- David Balser
- New York Harbor Healthcare System, Manhattan Veterans Administration, New York;,Department of Neurosurgery, New York University School of Medicine; and
| | - Sameer Farooq
- New York Harbor Healthcare System, Manhattan Veterans Administration, New York;,Department of Neurosurgery, New York University School of Medicine; and
| | - Talha Mehmood
- Department of Neurosurgery, New York University School of Medicine; and
| | - Marleen Reyes
- Department of Neurosurgery, New York University School of Medicine; and
| | - Uzma Samadani
- New York Harbor Healthcare System, Manhattan Veterans Administration, New York;,Department of Neurosurgery, New York University School of Medicine; and.,Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, NYU Langone Medical Center, New York, New York
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Samadani U, Ritlop R, Reyes M, Nehrbass E, Li M, Lamm E, Schneider J, Shimunov D, Sava M, Kolecki R, Burris P, Altomare L, Mehmood T, Smith T, Huang JH, McStay C, Todd SR, Qian M, Kondziolka D, Wall S, Huang P. Eye tracking detects disconjugate eye movements associated with structural traumatic brain injury and concussion. J Neurotrauma 2015; 32:548-56. [PMID: 25582436 PMCID: PMC4394159 DOI: 10.1089/neu.2014.3687] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Disconjugate eye movements have been associated with traumatic brain injury since ancient times. Ocular motility dysfunction may be present in up to 90% of patients with concussion or blast injury. We developed an algorithm for eye tracking in which the Cartesian coordinates of the right and left pupils are tracked over 200 sec and compared to each other as a subject watches a short film clip moving inside an aperture on a computer screen. We prospectively eye tracked 64 normal healthy noninjured control subjects and compared findings to 75 trauma subjects with either a positive head computed tomography (CT) scan (n=13), negative head CT (n=39), or nonhead injury (n=23) to determine whether eye tracking would reveal the disconjugate gaze associated with both structural brain injury and concussion. Tracking metrics were then correlated to the clinical concussion measure Sport Concussion Assessment Tool 3 (SCAT3) in trauma patients. Five out of five measures of horizontal disconjugacy were increased in positive and negative head CT patients relative to noninjured control subjects. Only one of five vertical disconjugacy measures was significantly increased in brain-injured patients relative to controls. Linear regression analysis of all 75 trauma patients demonstrated that three metrics for horizontal disconjugacy negatively correlated with SCAT3 symptom severity score and positively correlated with total Standardized Assessment of Concussion score. Abnormal eye-tracking metrics improved over time toward baseline in brain-injured subjects observed in follow-up. Eye tracking may help quantify the severity of ocular motility disruption associated with concussion and structural brain injury.
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Affiliation(s)
- Uzma Samadani
- 1 Steven and Alexandra Cohen Veterans Center for Post-Traumatic Stress and Traumatic Brain Injury at NYU Langone Medical Center, New York University School of Medicine , New York, New York
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