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Allam AK, Larkin MB, Sharma H, Viswanathan A. Trigeminal and Glossopharyngeal Neuralgia. Neurol Clin 2024; 42:585-598. [PMID: 38575268 DOI: 10.1016/j.ncl.2023.12.011] [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: 04/06/2024]
Abstract
Trigeminal neuralgia and glossopharyngeal neuralgia are craniofacial pain syndromes characterized by recurrent brief shock-like pains in the distributions of their respective cranial nerves. In this article, the authors aim to summarize each condition's characteristics, pathophysiology, and current pharmacotherapeutic and surgical interventions available for managing and treating these conditions.
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Affiliation(s)
- Anthony K Allam
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - M Benjamin Larkin
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Himanshu Sharma
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
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2
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Goldberg AR, Dovas A, Torres D, Sharma SD, Mela A, Merricks EM, Olabarria M, Shokooh LA, Zhao HT, Kotidis C, Calvaresi P, Viswanathan A, Banu MA, Razavilar A, Sudhakar TD, Saxena A, Chokran C, Humala N, Mahajan A, Xu W, Metz JB, Chen C, Bushong EA, Boassa D, Ellisman MH, Hillman EMC, McKhann GM, Gill BJA, Rosenfeld SS, Schevon CA, Bruce JN, Sims PA, Peterka DS, Canoll P. Glioma-Induced Alterations in Excitatory Neurons are Reversed by mTOR Inhibition. bioRxiv 2024:2024.01.10.575092. [PMID: 38293120 PMCID: PMC10827113 DOI: 10.1101/2024.01.10.575092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Gliomas are highly aggressive brain tumors characterized by poor prognosis and composed of diffusely infiltrating tumor cells that intermingle with non-neoplastic cells in the tumor microenvironment, including neurons. Neurons are increasingly appreciated as important reactive components of the glioma microenvironment, due to their role in causing hallmark glioma symptoms, such as cognitive deficits and seizures, as well as their potential ability to drive glioma progression. Separately, mTOR signaling has been shown to have pleiotropic effects in the brain tumor microenvironment, including regulation of neuronal hyperexcitability. However, the local cellular-level effects of mTOR inhibition on glioma-induced neuronal alterations are not well understood. Here we employed neuron-specific profiling of ribosome-bound mRNA via 'RiboTag,' morphometric analysis of dendritic spines, and in vivo calcium imaging, along with pharmacological mTOR inhibition to investigate the impact of glioma burden and mTOR inhibition on these neuronal alterations. The RiboTag analysis of tumor-associated excitatory neurons showed a downregulation of transcripts encoding excitatory and inhibitory postsynaptic proteins and dendritic spine development, and an upregulation of transcripts encoding cytoskeletal proteins involved in dendritic spine turnover. Light and electron microscopy of tumor-associated excitatory neurons demonstrated marked decreases in dendritic spine density. In vivo two-photon calcium imaging in tumor-associated excitatory neurons revealed progressive alterations in neuronal activity, both at the population and single-neuron level, throughout tumor growth. This in vivo calcium imaging also revealed altered stimulus-evoked somatic calcium events, with changes in event rate, size, and temporal alignment to stimulus, which was most pronounced in neurons with high-tumor burden. A single acute dose of AZD8055, a combined mTORC1/2 inhibitor, reversed the glioma-induced alterations on the excitatory neurons, including the alterations in ribosome-bound transcripts, dendritic spine density, and stimulus evoked responses seen by calcium imaging. These results point to mTOR-driven pathological plasticity in neurons at the infiltrative margin of glioma - manifested by alterations in ribosome-bound mRNA, dendritic spine density, and stimulus-evoked neuronal activity. Collectively, our work identifies the pathological changes that tumor-associated excitatory neurons experience as both hyperlocal and reversible under the influence of mTOR inhibition, providing a foundation for developing therapies targeting neuronal signaling in glioma.
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Affiliation(s)
- Alexander R Goldberg
- Department of Pathology and Cell Biology, Irving Cancer Research Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Athanassios Dovas
- Department of Pathology and Cell Biology, Irving Cancer Research Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Daniela Torres
- Department of Pathology and Cell Biology, Irving Cancer Research Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Sohani Das Sharma
- Department of Systems Biology, Columbia University Irving Medical Center, New York, NY 10032
| | - Angeliki Mela
- Department of Pathology and Cell Biology, Irving Cancer Research Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Edward M Merricks
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Markel Olabarria
- Department of Pathology and Cell Biology, Irving Cancer Research Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | | | - Hanzhi T Zhao
- Laboratory for Functional Optical Imaging, Zuckerman Mind Brain Behavior Institute, Departments of Biomedical Engineering and Radiology, Columbia University, New York, NY 10027, USA
| | - Corina Kotidis
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Peter Calvaresi
- Department of Pathology and Cell Biology, Irving Cancer Research Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Ashwin Viswanathan
- Department of Pathology and Cell Biology, Irving Cancer Research Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Matei A Banu
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Aida Razavilar
- Department of Pathology and Cell Biology, Irving Cancer Research Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Tejaswi D Sudhakar
- Department of Pathology and Cell Biology, Irving Cancer Research Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Ankita Saxena
- Department of Pathology and Cell Biology, Irving Cancer Research Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Cole Chokran
- Department of Pathology and Cell Biology, Irving Cancer Research Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Nelson Humala
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Aayushi Mahajan
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Weihao Xu
- Laboratory for Functional Optical Imaging, Zuckerman Mind Brain Behavior Institute, Departments of Biomedical Engineering and Radiology, Columbia University, New York, NY 10027, USA
| | - Jordan B Metz
- Department of Systems Biology, Columbia University Irving Medical Center, New York, NY 10032
| | - Cady Chen
- Department of Pathology and Cell Biology, Irving Cancer Research Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Eric A Bushong
- National Center for Microscopy and Imaging Research, University of California, San Diego, La Jolla, CA 92093, USA
| | - Daniela Boassa
- National Center for Microscopy and Imaging Research, University of California, San Diego, La Jolla, CA 92093, USA
| | - Mark H Ellisman
- National Center for Microscopy and Imaging Research, University of California, San Diego, La Jolla, CA 92093, USA
| | - Elizabeth M C Hillman
- Laboratory for Functional Optical Imaging, Zuckerman Mind Brain Behavior Institute, Departments of Biomedical Engineering and Radiology, Columbia University, New York, NY 10027, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Brian J A Gill
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | | | - Catherine A Schevon
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Jeffrey N Bruce
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Peter A Sims
- Department of Systems Biology, Columbia University Irving Medical Center, New York, NY 10032
- Sulzberger Columbia Genome Center, Columbia University Irving Medical Center, New York, NY, 10032
- Department of Biochemistry & Molecular Biophysics, Columbia University Irving Medical Center, New York, NY, 10032
| | - Darcy S Peterka
- Irving Institute for Cancer Dynamics, Columbia University, New York, NY 10027, USA
- Mortimer B. Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY 10027, USA
| | - Peter Canoll
- Department of Pathology and Cell Biology, Irving Cancer Research Center, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
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Ansil BR, George CE, Chandrasingh S, Viswanathan A, Thattai M, Raghu P, Devadiga S, Harikumar AG, Harsha PK, Nair I, Ramakrishnan U, Mayor S. Validating saliva as a biological sample for cost-effective, rapid and routine screening for SARS-CoV-2. Indian J Med Microbiol 2023; 45:100384. [PMID: 37573057 PMCID: PMC10231307 DOI: 10.1016/j.ijmmb.2023.100384] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 11/12/2022] [Accepted: 05/11/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Compared to nasopharyngeal/oropharyngeal swabs (N/OPS-VTM), non-invasive saliva samples have enormous potential for scalability and routine population screening of SARS-CoV-2. In this study, we investigate the efficacy of saliva samples relative to N/OPS-VTM for use as a direct source for RT-PCR based SARS-CoV-2 detection. METHODS We collected paired nasopharyngeal/oropharyngeal swabs and saliva samples from suspected positive SARS-CoV-2 patients and tested using RT-PCR. We used generalized linear models to investigate factors that explain result agreement. Further, we used simulations to evaluate the effectiveness of saliva-based screening in restricting the spread of infection in a large campus such as an educational institution. RESULTS We observed a 75.4% agreement between saliva and N/OPS-VTM, that increased drastically to 83% in samples stored for less than three days. Such samples processed within two days of collection showed 74.5% test sensitivity. Our simulations suggest that a test with 75% sensitivity, but high daily capacity can be very effective in limiting the size of infection clusters in a workspace. Guided by these results, we successfully implemented a saliva-based screening in the Bangalore Life Sciences Cluster (BLiSC) campus. CONCLUSION These results suggest that saliva may be a viable alternate source for SARS-CoV-2 surveillance if samples are processed immediately. Although saliva shows slightly lower sensitivity levels when compared to N/OPS-VTM, saliva collection is logistically advantageous. We strongly recommend the implementation of saliva-based screening strategies for large workplaces and in schools, as well as for population-level screening and routine surveillance as we learn to live with the SARS-CoV-2 virus.
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Affiliation(s)
- B R Ansil
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, Karnataka, 560065, India.
| | - Carolin Elizabeth George
- Community Health and Research Division, Bangalore Baptist Hospital, Bangalore, Karnataka, 560024, India.
| | - Sindhulina Chandrasingh
- Department of Microbiology, Bangalore Baptist Hospital, Bangalore, Karnataka, 560024, India.
| | | | - Mukund Thattai
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, Karnataka, 560065, India.
| | - Padinjat Raghu
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, Karnataka, 560065, India.
| | - Santhosha Devadiga
- COVID-19 Testing Laboratory, Institute for Stem Cell Science and Regenerative Medicine, Bangalore Life Science Cluster, Bangalore, Karnataka, 560065, India.
| | - Arun Geetha Harikumar
- COVID-19 Testing Laboratory, Institute for Stem Cell Science and Regenerative Medicine, Bangalore Life Science Cluster, Bangalore, Karnataka, 560065, India.
| | - Pulleri Kandi Harsha
- COVID-19 Testing Laboratory, Institute for Stem Cell Science and Regenerative Medicine, Bangalore Life Science Cluster, Bangalore, Karnataka, 560065, India.
| | - Indu Nair
- Department of Medicine and Infectious Diseases, Bangalore Baptist Hospital, Bangalore, Karnataka, 560024, India.
| | - Uma Ramakrishnan
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, Karnataka, 560065, India.
| | - Satyajit Mayor
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, Karnataka, 560065, India.
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Shofty B, Gadot R, Viswanathan A, Provenza NR, Storch EA, McKay SA, Meyers MS, Hertz AG, Avendano-Ortega M, Goodman WK, Sheth SA. Intraoperative valence testing to adjudicate between ventral capsule/ventral striatum and bed nucleus of the stria terminalis target selection in deep brain stimulation for obsessive-compulsive disorder. J Neurosurg 2023; 139:442-450. [PMID: 36681982 DOI: 10.3171/2022.10.jns221683] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/20/2022] [Accepted: 10/12/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is an accepted therapy for severe, treatment-refractory obsessive-compulsive disorder (trOCD). The optimal DBS target location within the anterior limb of the internal capsule, particularly along the anterior-posterior axis, remains elusive. Empirical evidence from several studies in the past decade has suggested that the ideal target lies in the vicinity of the anterior commissure (AC), either just anterior to the AC, above the ventral striatum (VS), or just posterior to the AC, above the bed nucleus of the stria terminalis (BNST). Various methods have been utilized to optimize target selection for trOCD DBS. The authors describe their practice of planning trajectories to both the VS and BNST and adjudicating between them with awake intraoperative valence testing to individualize permanent target selection. METHODS Eight patients with trOCD underwent awake DBS with trajectories planned for both VS and BNST targets bilaterally. The authors intraoperatively assessed the acute effects of stimulation on mood, energy, and anxiety and implanted the trajectory with the most reliable positive valence responses and least stimulation-induced side effects. The method of intraoperative target adjudication is described, and the OCD outcome at last follow-up is reported. RESULTS The mean patient age at surgery was 41.25 ± 15.1 years, and the mean disease duration was 22.75 ± 10.2 years. The median preoperative Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was 39 (range 34-40). Two patients had previously undergone capsulotomy, with insufficient response. Seven (44%) of 16 leads were moved to the second target based on intraoperative stimulation findings, 4 of them to avoid strong negative valence effects. Three patients had an asymmetric implant (1 lead in each target). All 8 patients (100%) met full response criteria, and the mean Y-BOCS score reduction across the full cohort was 51.2% ± 12.8%. CONCLUSIONS Planning and intraoperatively testing trajectories flanking the AC-superjacent to the VS anteriorly and to the BNST posteriorly-allowed identification of positive valence responses and acute adverse effects. Awake testing helped to select between possible trajectories and identify individually optimized targets in DBS for trOCD.
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Affiliation(s)
- Ben Shofty
- 1Department of Neurosurgery, University of Utah, Salt Lake City, Utah; and
| | | | | | | | - Eric A Storch
- 3Psychiatry, Baylor College of Medicine, Houston, Texas
| | - Sarah A McKay
- 3Psychiatry, Baylor College of Medicine, Houston, Texas
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Swamy CP, Besheli BF, Branco LRF, Provenza NR, Sheth SA, Goodman WK, Viswanathan A, Ince NF. Pulsation artifact removal from intra-operatively recorded local field potentials using sparse signal processing and data-specific dictionary . Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38082947 PMCID: PMC10746292 DOI: 10.1109/embc40787.2023.10340160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Neural recordings frequently get contaminated by ECG or pulsation artifacts. These large amplitude components can mask the neural patterns of interest and make the visual inspection process difficult. The current study describes a sparse signal representation strategy that targets to denoise pulsation artifacts in local field potentials (LFPs) recorded intraoperatively. To estimate the morphology of the artifact, we first detect the QRS-peaks from the simultaneously recorded ECG trace as an anchor point. After the LFP data has been epoched with respect to each beat, a pool of raw data segments of a specific length is generated. Using the K-singular value decomposition (K-SVD) algorithm, we constructed a data-specific dictionary to represent each contaminated LFP epoch in a sparse fashion. Since LFP is aligned to each QRS complex and the background neural activity is uncorrelated to the anchor points, we assumed that constructed dictionary will be formed to mainly represent the pulsation artifact. In this scheme, we performed an orthogonal matching pursuit to represent each LFP epoch as a linear combination of the dictionary atoms. The denoised LFP data is thus obtained by calculating the residual between the raw LFP and its approximation. We discuss and demonstrate the improvements in denoised data and compare the results with respect to principal component analysis (PCA). We noted that there is a comparable change in the signal for visual inspection to observe various oscillating patterns in the alpha and beta bands. We also see a noticeable compression of signal strength in the lower frequency band (<13 Hz), which was masked by the pulsation artifact, and a strong increase in the signal-to-noise ratio (SNR) in the denoised data.Clinical Relevance- Pulsation artifact can mask relevant neural activity patterns and make their visual inspection difficult. Using sparse signal representation, we established a new approach to reconstruct the quasiperiodic pulsation template and computed the residue signal to achieve noise-free neural activity.
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Branco LRF, Viswanathan A, Tarakad A, Ince NF. Construction of semi-supervised spatial projections to identify the source of beta- and high frequency oscillations in Parkinson's disease. Int IEEE EMBS Conf Neural Eng 2023; 2023:10.1109/ner52421.2023.10123890. [PMID: 37601420 PMCID: PMC10440159 DOI: 10.1109/ner52421.2023.10123890] [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] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Traditional deep brain stimulation (DBS) treatment for Parkinson's disease (PD) targets the placement of DBS leads into subthalamic nucleus (STN). Extraction of neurobiomarkers from STN local field potential activity can be used for the optimization of DBS. Beta (12-30 Hz) and high frequency oscillations (200-450 Hz, HFO) of STN and their phase-amplitude coupling have been previously correlated with symptom severity in PD. The typical approach is to take bipolar derivations of electrode contacts in order to enhance recordings of local brain activity and suppress noise levels. This approach can often cancel the signals in correlated neighboring contacts and create ambiguity in which monopolar contact to select for the identification of the main source of the oscillatory signal. To improve local specificity and help identify the source of beta and HFO in terms of electrode contact, we propose a semi supervised blind-source separation method. This approach presents a novel perspective to investigate electrophysiology by projecting the recorded channels into a subspace of virtual channels. We show the contribution of each channel to the identified source and correlate the spatial information with imaging and postoperative programming parameters. We anticipate such a source identification strategy can be used in the future to investigate the distribution of beta and HFO on individual contacts of the DBS lead and can improve the interpretation of these signals.
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Affiliation(s)
- Luciano R F Branco
- Department of Biomedical Engineering, University of Houston, Houston, TX, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Arjun Tarakad
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Nuri F Ince
- Department of Biomedical Engineering, University of Houston, Houston, TX, USA
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Allam AK, Viswanathan A, Schwalb JM, Patil PG, Larkin MB. Editorial: Surgical techniques for the management of pain. Front Pain Res (Lausanne) 2023; 4:1120174. [PMID: 36860332 PMCID: PMC9969155 DOI: 10.3389/fpain.2023.1120174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/17/2023] [Indexed: 02/17/2023] Open
Affiliation(s)
- Anthony K. Allam
- School of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States,Department of Neurosurgery, University of Texas, MD Anderson, Houston, TX, United States
| | - Jason M. Schwalb
- Department of Neurosurgery, Henry Ford Medical Group, West Bloomfield, MI, United States
| | - Parag G. Patil
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI, United States
| | - M. Benjamin Larkin
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States,Correspondence: M. Benjamin Larkin
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Allam AK, Sharma H, Larkin MB, Viswanathan A. Trigeminal Neuralgia. Neurol Clin 2023; 41:107-121. [DOI: 10.1016/j.ncl.2022.09.001] [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: 11/17/2022]
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Allam AK, Larkin MB, Katlowitz KA, Shofty B, Viswanathan A. Case report: MR-guided laser induced thermal therapy for palliative cingulotomy. Front Pain Res (Lausanne) 2022; 3:1028424. [PMID: 36387414 PMCID: PMC9663803 DOI: 10.3389/fpain.2022.1028424] [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] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/11/2022] [Indexed: 01/24/2023]
Abstract
In end-stage cancer, oncologic pain refractory to medical management significantly reduces patients' quality of life. In recent years, ablative surgery has seen a resurgence in treating diffuse and focal cancer pain in terminal patients. The anterior cingulate gyrus has been a key focus as it plays a role in the cognitive and emotional processing of pain. While radiofrequency ablation of the dorsal anterior cingulate is well described for treating cancer pain, MRI-guided laser-induced thermal therapy (LITT) is novel. Our paper describes a patient treated with an MRI-guided LITT therapy of the anterior cingulate gyrus for intractable debilitating pain secondary to terminal metastatic cancer.
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Affiliation(s)
- Anthony K. Allam
- School of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - M. Benjamin Larkin
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Kalman A. Katlowitz
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Ben Shofty
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States,Department of Neurosurgery, University of Texas, MD Anderson, Houston, TX, United States,Correspondence: Ashwin Viswanathan
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Allam AK, Larkin MB, McGinnis JP, Viswanathan A. Neuroablative central lateral thalamotomy for chronic neuropathic pain. Front Pain Res 2022; 3:999891. [PMID: 36176711 PMCID: PMC9513204 DOI: 10.3389/fpain.2022.999891] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic neuropathic pain refractory to medical management can be debilitating and can seriously affect one's quality of life. The interest of ablative surgery for the treatment or palliation of chronic neuropathic pain, cancer-related or chemotherapy-induced, has grown. Numerous regions along the nociceptive pathways have been prominent targets including the various nuclei of the thalamus. Traditional targets include the medial pulvinar, central median, and posterior complex thalamic nuclei. However, there has been little research regarding the role of the central lateral nucleus. In this paper, we aim to summarize the anatomy, pathophysiology, and patient experiences of the central lateral thalamotomy.
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Affiliation(s)
- Anthony K. Allam
- School of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - M. Benjamin Larkin
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - John P. McGinnis
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
- Department of Neurosurgery, University of Texas, MD Anderson, Houston, TX, United States
- Correspondence: Ashwin Viswanathan
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Shah DS, Sharma H, Patel P, Shetty A, English CW, Goodman JC, Viswanathan A, Patel AJ. Recurrent liponeurocytoma: A case report and systematic review of the literature. Surg Neurol Int 2022; 13:395. [PMID: 36128091 PMCID: PMC9479547 DOI: 10.25259/sni_513_2022] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/26/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Liponeurocytomas are rare neurocytic neoplasms that most often arise in the posterior fossa and affect individuals in the third and fifth decades of life. Most reported cases of this unique tumor in the literature have described a favorable clinical prognosis without recurrence. However, increasing reports of recurrent cases prompted the World Health Organization, in 2016, to recategorize the tumor from Grade I to the less favorable Grade II classification. We conducted a systematic review to identify recurrent cases of this unique tumor and to summarize differences between the primary and recurrent cases of liponeurocytoma. Methods: A systematic review exploring recurrent liponeurocytoma cases was conducted by searching the PubMed, Google Scholar, and Scopus databases for articles in English. Abstracts from articles were read and selected for full-text review according to a priori criteria. Relevant full-text articles were analyzed for symptoms, imaging, location, histological, pathological, treatment, and recurrence-free time between the primary and recurrent cases. Results: Of 4392 articles, 15 articles accounting for 18 patients were included (level of evidence: IV) in the study. Recurrence-free time decreased from an average of 82 months between the primary tumor resection to first recurrence to 31.3 months between the first and second recurrence. Recurrent tumors demonstrated increased pleomorphic neural cells, necrosis, vascular proliferation, and MIB-1 index when compared to the primary tumor. Several cases also demonstrated decreased lipidizing components when compared to the primary tumor, further indicating increased dedifferentiation. The primary treatment for this tumor was surgical resection with occasional adjunctive radiotherapy. Conclusion: Recurrent cases of liponeurocytoma have features of increased malignant proliferation compared to the primary cases. The standard treatment for these primary and recurrent tumors is gross total resection. The role of adjunctive radiotherapy remains a matter of debate.
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Affiliation(s)
- Darsh S. Shah
- Department of Neurosurgery, Dell Medical School, Austin,
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital,
- Department of Neurosurgery, Baylor College of Medicine, Houston,
| | - Himanshu Sharma
- Department of Neurosurgery, Baylor College of Medicine, Houston,
| | - Prem Patel
- Department of Neurosurgery, University of Texas Southwestern, Dallas,
| | - Arya Shetty
- Department of Neurosurgery, Baylor College of Medicine, Houston,
| | - Collin William English
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital,
- Department of Neurosurgery, Baylor College of Medicine, Houston,
| | | | | | - Akash J. Patel
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital,
- Department of Neurosurgery, Baylor College of Medicine, Houston,
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
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Giridharan N, Katlowitz KA, Anand A, Gadot R, Najera RA, Shofty B, Snyder R, Larrinaga C, Prablek M, Karas PJ, Viswanathan A, Sheth SA. Robot-Assisted Deep Brain Stimulation: High Accuracy and Streamlined Workflow. Oper Neurosurg (Hagerstown) 2022; 23:254-260. [PMID: 35972090 DOI: 10.1227/ons.0000000000000298] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/03/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A number of stereotactic platforms are available for performing deep brain stimulation (DBS) lead implantation. Robot-assisted stereotaxy has emerged more recently demonstrating comparable accuracy and shorter operating room times compared with conventional frame-based systems. OBJECTIVE To compare the accuracy of our streamlined robotic DBS workflow with data in the literature from frame-based and frameless systems. METHODS We retrospectively reviewed 126 consecutive DBS lead placement procedures using a robotic stereotactic platform. Indications included Parkinson disease (n = 94), essential tremor (n = 21), obsessive compulsive disorder (n = 7), and dystonia (n = 4). Procedures were performed using a stereotactic frame for fixation and the frame pins as skull fiducials for robot registration. We used intraoperative fluoroscopic computed tomography for registration and postplacement verification. RESULTS The mean radial error for the target point was 1.06 mm (SD: 0.55 mm, range 0.04-2.80 mm) on intraoperative fluoroscopic computed tomography. The mean operative time for an asleep, bilateral implant without implantable pulse generator placement was 238 minutes (SD: 52 minutes), and skin-to-skin procedure time was 116 minutes (SD: 42 minutes). CONCLUSION We describe a streamlined workflow for DBS lead placement using robot-assisted stereotaxy with a comparable accuracy profile. Obviating the need for checking and switching coordinates, as is standard for frame-based DBS, also reduces the chance for human error and facilitates training.
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Affiliation(s)
- Nisha Giridharan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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13
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Hassan AR, Zhao Z, Ferrero JJ, Cea C, Jastrzebska‐Perfect P, Myers J, Asman P, Ince NF, McKhann G, Viswanathan A, Sheth SA, Khodagholy D, Gelinas JN. Translational Organic Neural Interface Devices at Single Neuron Resolution. Adv Sci (Weinh) 2022; 9:e2202306. [PMID: 35908811 PMCID: PMC9507374 DOI: 10.1002/advs.202202306] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/10/2022] [Indexed: 06/15/2023]
Abstract
Recording from the human brain at the spatiotemporal resolution of action potentials provides critical insight into mechanisms of higher cognitive functions and neuropsychiatric disease that is challenging to derive from animal models. Here, organic materials and conformable electronics are employed to create an integrated neural interface device compatible with minimally invasive neurosurgical procedures and geared toward chronic implantation on the surface of the human brain. Data generated with these devices enable identification and characterization of individual, spatially distribute human cortical neurons in the absence of any tissue penetration (n = 229 single units). Putative single-units are effectively clustered, and found to possess features characteristic of pyramidal cells and interneurons, as well as identifiable microcircuit interactions. Human neurons exhibit consistent phase modulation by oscillatory activity and a variety of population coupling responses. The parameters are furthermore established to optimize the yield and quality of single-unit activity from the cortical surface, enhancing the ability to investigate human neural network mechanisms without breaching the tissue interface and increasing the information that can be safely derived from neurophysiological monitoring.
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Affiliation(s)
- Ahnaf Rashik Hassan
- Institute for Genomic MedicineColumbia University Irving Medical CenterNew YorkNY10032USA
- Department of Biomedical EngineeringColumbia UniversityNew YorkNY10027USA
| | - Zifang Zhao
- Department of Electrical EngineeringColumbia UniversityNew YorkNY10027USA
| | - Jose J. Ferrero
- Institute for Genomic MedicineColumbia University Irving Medical CenterNew YorkNY10032USA
| | - Claudia Cea
- Department of Electrical EngineeringColumbia UniversityNew YorkNY10027USA
| | | | - John Myers
- Department of NeurosurgeryBaylor College of MedicineHoustonTX77030USA
| | - Priscella Asman
- Department of Biomedical EngineeringUniversity of HoustonHoustonTX77004USA
| | - Nuri Firat Ince
- Department of Biomedical EngineeringUniversity of HoustonHoustonTX77004USA
| | - Guy McKhann
- Department of NeurosurgeryColumbia University Irving Medical Center and New York Presbyterian HospitalNew YorkNY10032USA
| | | | - Sameer A. Sheth
- Department of NeurosurgeryBaylor College of MedicineHoustonTX77030USA
| | - Dion Khodagholy
- Department of Electrical EngineeringColumbia UniversityNew YorkNY10027USA
| | - Jennifer N. Gelinas
- Institute for Genomic MedicineColumbia University Irving Medical CenterNew YorkNY10032USA
- Department of NeurologyColumbia University Irving Medical Center and New York Presbyterian HospitalNew YorkNY10032USA
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14
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Gadot R, Vanegas Arroyave N, Dang H, Anand A, Najera RA, Taneff LY, Bellows S, Tarakad A, Jankovic J, Horn A, Shofty B, Viswanathan A, Sheth SA. Association of clinical outcomes and connectivity in awake versus asleep deep brain stimulation for Parkinson disease. J Neurosurg 2022; 138:1016-1027. [PMID: 35932263 DOI: 10.3171/2022.6.jns212904] [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: 12/21/2021] [Accepted: 06/09/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) for Parkinson disease (PD) is traditionally performed with awake intraoperative testing and/or microelectrode recording. Recently, however, the procedure has been increasingly performed under general anesthesia with image-based verification. The authors sought to compare structural and functional networks engaged by awake and asleep PD-DBS of the subthalamic nucleus (STN) and correlate them with clinical outcomes. METHODS Levodopa equivalent daily dose (LEDD), pre- and postoperative motor scores on the Movement Disorders Society-Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS III), and total electrical energy delivered (TEED) at 6 months were retroactively assessed in patients with PD who received implants of bilateral DBS leads. In subset analysis, implanted electrodes were reconstructed using the Lead-DBS toolbox. Volumes of tissue activated (VTAs) were used as seed points in group volumetric and connectivity analysis. RESULTS The clinical courses of 122 patients (52 asleep, 70 awake) were reviewed. Operating room and procedure times were significantly shorter in asleep cases. LEDD reduction, MDS-UPDRS III score improvement, and TEED at the 6-month follow-up did not differ between groups. In subset analysis (n = 40), proximity of active contact, VTA overlap, and desired network fiber counts with motor STN correlated with lower DBS energy requirement and improved motor scores. Discriminative structural fiber tracts involving supplementary motor area, thalamus, and brainstem were associated with optimal clinical improvement. Areas of highest structural and functional connectivity with VTAs did not significantly differ between the two groups. CONCLUSIONS Compared to awake STN DBS, asleep procedures can achieve similarly optimal targeting-based on clinical outcomes, electrode placement, and connectivity estimates-in more efficient procedures and shorter operating room times.
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Affiliation(s)
- Ron Gadot
- 1Department of Neurosurgery, Baylor College of Medicine
| | - Nora Vanegas Arroyave
- 2Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas; and
| | - Huy Dang
- 1Department of Neurosurgery, Baylor College of Medicine
| | - Adrish Anand
- 1Department of Neurosurgery, Baylor College of Medicine
| | | | - Lisa Yutong Taneff
- 2Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas; and
| | - Steven Bellows
- 2Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas; and
| | - Arjun Tarakad
- 2Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas; and
| | - Joseph Jankovic
- 2Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas; and
| | - Andreas Horn
- 3Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité-Universitätsmedizin, Berlin, Germany
| | - Ben Shofty
- 1Department of Neurosurgery, Baylor College of Medicine
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15
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Provenza N, Sheth S, Rijn EDV, Mathura R, Ding Y, Vogt G, Avendano-Ortega M, Ramakrishnan N, Peled N, Fracassi Gelin LF, Xing D, Jeni L, Ertugrul IO, Barrios-Anderson A, Matteson E, Wiese A, Xu J, Viswanathan A, Harrison M, Bijanki K, Storch E, Cohn J, Goodman W, Borton D. ID:16509 Long-Term Ecological Assessment of Intracranial Electrophysiology Synchronized to Behavioral Markers in Obsessive-Compulsive Disorder. Neuromodulation 2022. [DOI: 10.1016/j.neurom.2022.02.118] [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: 10/17/2022]
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16
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Allam AK, Larkin Michael MB, Shofty B, Viswanathan A. Ablation Procedures. Neurosurg Clin N Am 2022; 33:339-344. [PMID: 35718404 DOI: 10.1016/j.nec.2022.02.014] [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: 11/24/2022]
Abstract
Although ablation has a limited role in the management of chronic noncancer pain, ablation continues to help patients with treatment of refractory cancer-related pain. Interdisciplinary treatment involving supportive care, pain medicine, oncology, and neurosurgery is critical to optimizing the timing and outcome of neurosurgical ablative options for pain management. In this review, 3 targets for ablative surgery-the spinothalamic tract, the dorsal column's visceral pain pathway, and the anterior cingulate cortex-are discussed with a focus on patient selection and key aspects of surgical technique.
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Affiliation(s)
- Anthony Kaspa Allam
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge Street, Suite 9A, Houston, TX 77030, USA
| | - M Benjamin Larkin Michael
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge Street, Suite 9A, Houston, TX 77030, USA
| | - Ben Shofty
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge Street, Suite 9A, Houston, TX 77030, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge Street, Suite 9A, Houston, TX 77030, USA.
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17
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Haider N, Viswanathan A, Lee A, Lee J, Rosenberg J, Hayek S, Desai M. ID:16068 IPG-Free PNS for the Treatment of CFNS: Interim Results* of a Prospective Randomized Controlled Trial. Neuromodulation 2022. [DOI: 10.1016/j.neurom.2022.02.185] [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: 11/24/2022]
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18
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Katlowitz K, Ince NF, Tarakad A, Sheth SA, Viswanathan A. 818 Association Between Intraoperative LFP, Lead Location, and Outcomes in Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_818] [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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19
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Praveen J, Nameer PO, Jha A, Aravind A, Dilip KG, Karuthedathu D, Tom G, Mavelikara H, Mannar H, Palot J, Johnson J, Jishnu R, Rodrigues KM, Mujeeb PM, Namassivayan L, Payyeri N, Nesrudheen PP, Narayanan SP, Prasanth SS, Krishna MCP, Praveen ES, Velayudhan P, Reghuvaran P, Kidoor R, Rathish RL, Roshnath R, Sashikumar C, Meppayur S, Sivakumar AK, Sreedevi AK, Sreekumar B, Sreekumar ER, Sumesh PB, Venugopal R, Venugopal V, Vishnudas CK, Kartha V, Puliyeri V, Quader S, Reddy A, Puthiyeri AR, Riyas KA, Abhijith RS, Surendran A, Sunil AM, Chandran A, Abhirami C, Jayakumar AM, Peter AS, Muhammed NVA, Katakath AF, Ajai P, Raju AK, Akhil PM, Akhil US, Amal US, Menon A, Ansari AI, Aneesh KS, Aneesh S, Hari CA, Anjitha R, Raj PNA, John A, Varma A, Anushreedha SS, Aravind CK, Ramachandran A, Arun B, George A, Gopi AP, Varghese A, Vinod A, Shaji A, Raj VMA, Viswanathan A, Mohammed A, Aswin A, Aswin KS, Ali AA, Balaji PB, Paul MB, Shree JC, Venkatraman C, Charutha K, Jose CT, Jose CP, Singh D, Sanghamithra D, Sikarwar DS, Murukesh D, Divin V, Arief F, Mandal J, Sarlin PJ, Nafar AA, Bachan KHA, Rejitha V, Dev RSV, Rowther BE, Raja F, Iyer G, George G, Gireesan TU, Mohan PKG, Dsouza GP, Govind G, Greeshma P, Prasad PMH, Hariharan TV, Harith A, Harith C, Hemanth B, Mohamed I, David JP, Jain PK, Jameela P, Jayakrishnan G, Jishnu K, Jismi MO, Johnson J, Soniya CJ, Babu JR, Roy J, Nelson J, Krishnan MJ, Bhandary KP, Jamaludheen KM, Ravi K, Thrikkadeeri K, Nair KK, Kiran BS, Kumar KS, Raj DK, Panaganti KK, Moorthy MK, Murthy RK, Krishnanunni MR, Prabhakaran L, Lathika KK, Abraham L, Narayanan GH, Panigrahi M, Manav S, Karingamadathil M, Manoj TR, Thomas M, Manuel PP, Varghese MG, Chandran PM, Sulaiman MM, Madathil MA, Hirash VKM, Ramees KM, Thirunnavaya MS, Niyas APM, Muhasin CT, Kizhakkemadham M, Azeez NA, Nikhil PV, Niranjana C, Mundekad N, Mohan N, Pavithra A, Viswanathan P, Pramod P, Prakash G, Prasath S, Prakash P, Preethi N, Rajeevan R, Rajaguru M, Rajarajan V, Sankaran R, Ratheesh K, Crasta RP, Mohan R, Renju A, Koshy RC, Rai R, Tom R, Chandran S, Sachinkrishna MV, Ali MVSA, Siril S, Bharadwaj DDS, George S, Morris S, Augustine S, Das SK, Morris S, Sandra PR, Sanuraj TK, Sawant S, Morris S, Selvaganesh K, Shahil K, Shahina NN, Valasy S, Siji PK, Joseph S, Sivashankar R, Karim SA, Mohan SK, Pillai SM, Sowmiya MS, Srinila KT, Subin KS, Sujith VG, Sukumaran S, Syamili MS, Menon T, Praveen T, Thilak SA, Antony T, Ullas UR, Sivaji VO, Narayanan V, Sreejith MV, Chandran AV, Sudhakaran V, Vridhi R, Humam WI, Uchummal YJ, Yathumon MA. Kerala Bird Atlas 2015–20: features, outcomes and implications of a citizen-science project. CURR SCI INDIA 2022. [DOI: 10.18520/cs/v122/i3/298-309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Khan A, Patel K, Shukla H, Viswanathan A, van der Valk T, Borthakur U, Nigam P, Zachariah A, Jhala YV, Kardos M, Ramakrishnan U. Genomic evidence for inbreeding depression and purging of deleterious genetic variation in Indian tigers. Proc Natl Acad Sci U S A 2021; 118:e2023018118. [PMID: 34848534 PMCID: PMC8670471 DOI: 10.1073/pnas.2023018118] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [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] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 01/03/2023] Open
Abstract
Increasing habitat fragmentation leads to wild populations becoming small, isolated, and threatened by inbreeding depression. However, small populations may be able to purge recessive deleterious alleles as they become expressed in homozygotes, thus reducing inbreeding depression and increasing population viability. We used whole-genome sequences from 57 tigers to estimate individual inbreeding and mutation load in a small-isolated and two large-connected populations in India. As expected, the small-isolated population had substantially higher average genomic inbreeding (FROH = 0.57) than the large-connected (FROH = 0.35 and FROH = 0.46) populations. The small-isolated population had the lowest loss-of-function mutation load, likely due to purging of highly deleterious recessive mutations. The large populations had lower missense mutation loads than the small-isolated population, but were not identical, possibly due to different demographic histories. While the number of the loss-of-function alleles in the small-isolated population was lower, these alleles were at higher frequencies and homozygosity than in the large populations. Together, our data and analyses provide evidence of 1) high mutation load, 2) purging, and 3) the highest predicted inbreeding depression, despite purging, in the small-isolated population. Frequency distributions of damaging and neutral alleles uncover genomic evidence that purifying selection has removed part of the mutation load across Indian tiger populations. These results provide genomic evidence for purifying selection in both small and large populations, but also suggest that the remaining deleterious alleles may have inbreeding-associated fitness costs. We suggest that genetic rescue from sources selected based on genome-wide differentiation could offset any possible impacts of inbreeding depression.
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Affiliation(s)
- Anubhab Khan
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India;
| | - Kaushalkumar Patel
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India
| | - Harsh Shukla
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India
| | - Ashwin Viswanathan
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India
- Nature Conservation Foundation, Mysore 570017, India
| | | | | | - Parag Nigam
- Wildlife Institute of India, Dehradun 248001, India
| | | | | | - Marty Kardos
- Northwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, Seattle, WA 98112;
| | - Uma Ramakrishnan
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India;
- Department of Biotechnology-Wellcome Trust India Alliance, Hyderabad 500034, India
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21
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Provenza NR, Sheth SA, Dastin-van Rijn EM, Mathura RK, Ding Y, Vogt GS, Avendano-Ortega M, Ramakrishnan N, Peled N, Gelin LFF, Xing D, Jeni LA, Ertugrul IO, Barrios-Anderson A, Matteson E, Wiese AD, Xu J, Viswanathan A, Harrison MT, Bijanki KR, Storch EA, Cohn JF, Goodman WK, Borton DA. Long-term ecological assessment of intracranial electrophysiology synchronized to behavioral markers in obsessive-compulsive disorder. Nat Med 2021; 27:2154-2164. [PMID: 34887577 PMCID: PMC8800455 DOI: 10.1038/s41591-021-01550-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/22/2021] [Indexed: 01/02/2023]
Abstract
Detection of neural signatures related to pathological behavioral states could enable adaptive deep brain stimulation (DBS), a potential strategy for improving efficacy of DBS for neurological and psychiatric disorders. This approach requires identifying neural biomarkers of relevant behavioral states, a task best performed in ecologically valid environments. Here, in human participants with obsessive-compulsive disorder (OCD) implanted with recording-capable DBS devices, we synchronized chronic ventral striatum local field potentials with relevant, disease-specific behaviors. We captured over 1,000 h of local field potentials in the clinic and at home during unstructured activity, as well as during DBS and exposure therapy. The wide range of symptom severity over which the data were captured allowed us to identify candidate neural biomarkers of OCD symptom intensity. This work demonstrates the feasibility and utility of capturing chronic intracranial electrophysiology during daily symptom fluctuations to enable neural biomarker identification, a prerequisite for future development of adaptive DBS for OCD and other psychiatric disorders.
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Affiliation(s)
- Nicole R Provenza
- Brown University School of Engineering, Providence, RI, USA
- Charles Stark Draper Laboratory, Cambridge, MA, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Raissa K Mathura
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Yaohan Ding
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gregory S Vogt
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Michelle Avendano-Ortega
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Nithya Ramakrishnan
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Noam Peled
- MGH/HST Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | | | - David Xing
- Brown University School of Engineering, Providence, RI, USA
| | - Laszlo A Jeni
- Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Itir Onal Ertugrul
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, the Netherlands
| | | | - Evan Matteson
- Brown University School of Engineering, Providence, RI, USA
| | - Andrew D Wiese
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Junqian Xu
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Kelly R Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey F Cohn
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - David A Borton
- Brown University School of Engineering, Providence, RI, USA.
- Carney Institute for Brain Science, Brown University, Providence, RI, USA.
- Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of Veterans Affairs, Providence, RI, USA.
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22
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Wong S, Hirani S, Forbes A, Kumar N, Hariharan R, O'Driscoll J, Viswanathan A, Harvey G, Sekhar R, Jamous A. Effect of lactobacillus casei shirota in preventing antibiotic associated diarrhoea including clostridium difficile infection in patients with spinal cord injuries: a multicentre randomised, double-blinded, placebo-controlled trial. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.025] [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: 10/19/2022]
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23
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Torrealba-Acosta G, Butt H, Edmondson EA, Willaert R, Viswanathan A, Goldman AM. A Neurostimulation-Triggered Trigeminal Neuralgia-like Pain: Risk Factors and Management. Neurol Clin Pract 2021; 11:e760-e762. [PMID: 34840901 DOI: 10.1212/cpj.0000000000001050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/14/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Gabriel Torrealba-Acosta
- Department of Neurology (GT-A, HB, EAE, AMG), Baylor College of Medicine, Houston, TX; GeneDx (RW); and Department of Neurosurgery (AV), Baylor College of Medicine, Houston, TX
| | - Haroon Butt
- Department of Neurology (GT-A, HB, EAE, AMG), Baylor College of Medicine, Houston, TX; GeneDx (RW); and Department of Neurosurgery (AV), Baylor College of Medicine, Houston, TX
| | - Everton A Edmondson
- Department of Neurology (GT-A, HB, EAE, AMG), Baylor College of Medicine, Houston, TX; GeneDx (RW); and Department of Neurosurgery (AV), Baylor College of Medicine, Houston, TX
| | - Rebecca Willaert
- Department of Neurology (GT-A, HB, EAE, AMG), Baylor College of Medicine, Houston, TX; GeneDx (RW); and Department of Neurosurgery (AV), Baylor College of Medicine, Houston, TX
| | - Ashwin Viswanathan
- Department of Neurology (GT-A, HB, EAE, AMG), Baylor College of Medicine, Houston, TX; GeneDx (RW); and Department of Neurosurgery (AV), Baylor College of Medicine, Houston, TX
| | - Alica M Goldman
- Department of Neurology (GT-A, HB, EAE, AMG), Baylor College of Medicine, Houston, TX; GeneDx (RW); and Department of Neurosurgery (AV), Baylor College of Medicine, Houston, TX
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24
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Allawala A, Bijanki KR, Goodman W, Cohn JF, Viswanathan A, Yoshor D, Borton DA, Pouratian N, Sheth SA. In Reply: A Novel Framework for Network-Targeted Neuropsychiatric Deep Brain Stimulation. Neurosurgery 2021; 89:E283. [PMID: 34383050 DOI: 10.1093/neuros/nyab308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/27/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anusha Allawala
- School of Engineering Brown University Providence, Rhode Island, USA
| | - Kelly R Bijanki
- Department of Neurosurgery Baylor College of Medicine Houston, Texas, USA
| | - Wayne Goodman
- Menninger Department of Psychiatry and Behavioral Sciences Baylor College of Medicine Houston, Texas, USA
| | - Jeffrey F Cohn
- Department of Psychology University of Pittsburgh Pittsburgh, Pennsylvania, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery Baylor College of Medicine Houston, Texas, USA
| | - Daniel Yoshor
- Department of Neurosurgery University of Pennsylvania Philadelphia, Pennsylvania, USA
| | - David A Borton
- School of Engineering Brown University Providence, Rhode Island, USA
| | - Nader Pouratian
- Department of Neurological Surgery University of Texas, Southwestern Dallas, Texas, USA
| | - Sameer A Sheth
- Department of Neurosurgery Baylor College of Medicine Houston, Texas, USA
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Raslan AM, Ben-Haim S, Falowski SM, Machado AG, Miller J, Pilitsis JG, Rosenberg WS, Rosenow JM, Sweet J, Viswanathan A, Winfree CJ, Schwalb JM. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Neuroablative Procedures for Patients With Cancer Pain. Neurosurgery 2021; 88:437-442. [PMID: 33355345 DOI: 10.1093/neuros/nyaa527] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Managing cancer pain once it is refractory to conventional treatment continues to challenge caregivers committed to serving those who are suffering from a malignancy. Although neuromodulation has a role in the treatment of cancer pain for some patients, these therapies may not be suitable for all patients. Therefore, neuroablative procedures, which were once a mainstay in treating intractable cancer pain, are again on the rise. This guideline serves as a systematic review of the literature of the outcomes following neuroablative procedures. OBJECTIVE To establish clinical practice guidelines for the use of neuroablative procedures to treat patients with cancer pain. METHODS A systematic review of neuroablative procedures used to treat patients with cancer pain from 1980 to April 2019 was performed using the United States National Library of Medicine PubMed database, EMBASE, and Cochrane CENTRAL. After inclusion criteria were established, full text articles that met the inclusion criteria were reviewed by 2 members of the task force and the quality of the evidence was graded. RESULTS In total, 14 646 relevant abstracts were identified by the literature search, from which 189 met initial screening criteria. After full text review, 58 of the 189 articles were included and subdivided into 4 different clinical scenarios. These include unilateral somatic nociceptive/neuropathic body cancer pain, craniofacial cancer pain, midline subdiaphragmatic visceral cancer pain, and disseminated cancer pain. Class II and III evidence was available for these 4 clinical scenarios. Level III recommendations were developed for the use of neuroablative procedures to treat patients with cancer pain. CONCLUSION Neuroablative procedures may be an option for treating patients with refractory cancer pain. Serious adverse events were reported in some studies, but were relatively uncommon. Improved imaging, refinements in technique and the availability of new lesioning modalities may minimize the risks of neuroablation even further.The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/guidelines-on-neuroablative-procedures-patients-wi.
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Affiliation(s)
- Ahmed M Raslan
- Department of Neurological Surgery, School of Medicine, Oregon Health & Science University Healthcare, Portland, Oregon
| | - Sharona Ben-Haim
- Department of Neurological Surgery, University of California San Diego, San Diego, California
| | | | - André G Machado
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jonathan Miller
- Department of Neurological Surgery, Case Western Reserve University, Cleveland, Ohio
| | - Julie G Pilitsis
- Department of Neurosurgery and Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, New York
| | | | - Joshua M Rosenow
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer Sweet
- Department of Stereotactic & Functional Neurosurgery, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Christopher J Winfree
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Medical Group, Detroit, Michigan
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Allawala A, Bijanki KR, Goodman W, Cohn JF, Viswanathan A, Yoshor D, Borton DA, Pouratian N, Sheth SA. A Novel Framework for Network-Targeted Neuropsychiatric Deep Brain Stimulation. Neurosurgery 2021; 89:E116-E121. [PMID: 33913499 PMCID: PMC8279838 DOI: 10.1093/neuros/nyab112] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 12/18/2020] [Accepted: 02/14/2021] [Indexed: 12/28/2022] Open
Abstract
Deep brain stimulation (DBS) has emerged as a promising therapy for neuropsychiatric illnesses, including depression and obsessive-compulsive disorder, but has shown inconsistent results in prior clinical trials. We propose a shift away from the empirical paradigm for developing new DBS applications, traditionally based on testing brain targets with conventional stimulation paradigms. Instead, we propose a multimodal approach centered on an individualized intracranial investigation adapted from the epilepsy monitoring experience, which integrates comprehensive behavioral assessment, such as the Research Domain Criteria proposed by the National Institutes of Mental Health. In this paradigm-shifting approach, we combine readouts obtained from neurophysiology, behavioral assessments, and self-report during broad exploration of stimulation parameters and behavioral tasks to inform the selection of ideal DBS parameters. Such an approach not only provides a foundational understanding of dysfunctional circuits underlying symptom domains in neuropsychiatric conditions but also aims to identify generalizable principles that can ultimately enable individualization and optimization of therapy without intracranial monitoring.
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Affiliation(s)
- Anusha Allawala
- School of Engineering, Brown University, Providence, Rhode Island, USA
| | - Kelly R Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Wayne Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Jeffrey F Cohn
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel Yoshor
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.,Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David A Borton
- School of Engineering, Brown University, Providence, Rhode Island, USA.,Carney Institute for Brain Science, Brown University, Providence, Rhode Island, USA.,Department of Veterans Affairs, Providence VA Medical Center for Neurorestoration and Neurotechnology, Providence, Rhode Island, USA
| | - Nader Pouratian
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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Ozturk M, Viswanathan A, Sheth SA, Ince NF. Electroceutically induced subthalamic high-frequency oscillations and evoked compound activity may explain the mechanism of therapeutic stimulation in Parkinson's disease. Commun Biol 2021; 4:393. [PMID: 33758361 PMCID: PMC7988171 DOI: 10.1038/s42003-021-01915-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/23/2021] [Indexed: 01/31/2023] Open
Abstract
Despite having remarkable utility in treating movement disorders, the lack of understanding of the underlying mechanisms of high-frequency deep brain stimulation (DBS) is a main challenge in choosing personalized stimulation parameters. Here we investigate the modulations in local field potentials induced by electrical stimulation of the subthalamic nucleus (STN) at therapeutic and non-therapeutic frequencies in Parkinson's disease patients undergoing DBS surgery. We find that therapeutic high-frequency stimulation (130-180 Hz) induces high-frequency oscillations (~300 Hz, HFO) similar to those observed with pharmacological treatment. Along with HFOs, we also observed evoked compound activity (ECA) after each stimulation pulse. While ECA was observed in both therapeutic and non-therapeutic (20 Hz) stimulation, the HFOs were induced only with therapeutic frequencies, and the associated ECA were significantly more resonant. The relative degree of enhancement in the HFO power was related to the interaction of stimulation pulse with the phase of ECA. We propose that high-frequency STN-DBS tunes the neural oscillations to their healthy/treated state, similar to pharmacological treatment, and the stimulation frequency to maximize these oscillations can be inferred from the phase of ECA waveforms of individual subjects. The induced HFOs can, therefore, be utilized as a marker of successful re-calibration of the dysfunctional circuit generating PD symptoms.
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Affiliation(s)
- Musa Ozturk
- Department of Biomedical Engineering, University of Houston, Houston, TX, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Nuri F Ince
- Department of Biomedical Engineering, University of Houston, Houston, TX, USA.
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Raposo N, Zanon Zotin MC, Schoemaker D, Xiong L, Fotiadis P, Charidimou A, Pasi M, Boulouis G, Schwab K, Schirmer MD, Etherton MR, Gurol ME, Greenberg SM, Duering M, Viswanathan A. Peak Width of Skeletonized Mean Diffusivity as Neuroimaging Biomarker in Cerebral Amyloid Angiopathy. AJNR Am J Neuroradiol 2021; 42:875-881. [PMID: 33664113 DOI: 10.3174/ajnr.a7042] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/20/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Whole-brain network connectivity has been shown to be a useful biomarker of cerebral amyloid angiopathy and related cognitive impairment. We evaluated an automated DTI-based method, peak width of skeletonized mean diffusivity, in cerebral amyloid angiopathy, together with its association with conventional MRI markers and cognitive functions. MATERIALS AND METHODS We included 24 subjects (mean age, 74.7 [SD, 6.0] years) with probable cerebral amyloid angiopathy and mild cognitive impairment and 62 patients with MCI not attributable to cerebral amyloid angiopathy (non-cerebral amyloid angiopathy-mild cognitive impairment). We compared peak width of skeletonized mean diffusivity between subjects with cerebral amyloid angiopathy-mild cognitive impairment and non-cerebral amyloid angiopathy-mild cognitive impairment and explored its associations with cognitive functions and conventional markers of cerebral small-vessel disease, using linear regression models. RESULTS Subjects with Cerebral amyloid angiopathy-mild cognitive impairment showed increased peak width of skeletonized mean diffusivity in comparison to those with non-cerebral amyloid angiopathy-mild cognitive impairment (P < .001). Peak width of skeletonized mean diffusivity values were correlated with the volume of white matter hyperintensities in both groups. Higher peak width of skeletonized mean diffusivity was associated with worse performance in processing speed among patients with cerebral amyloid angiopathy, after adjusting for other MRI markers of cerebral small vessel disease. The peak width of skeletonized mean diffusivity did not correlate with cognitive functions among those with non-cerebral amyloid angiopathy-mild cognitive impairment. CONCLUSIONS Peak width of skeletonized mean diffusivity is altered in cerebral amyloid angiopathy and is associated with performance in processing speed. This DTI-based method may reflect the degree of white matter structural disruption in cerebral amyloid angiopathy and could be a useful biomarker for cognition in this population.
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Affiliation(s)
- N Raposo
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts .,Department of Neurology (N.R.), Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center (N.R.), Université de Toulouse, Institut National de la Santé et de la Recherche Médicale, Toulouse, UPS, France
| | - M C Zanon Zotin
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Imaging Sciences and Medical Physics (M.C.Z.Z.). Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil;, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil
| | - D Schoemaker
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - L Xiong
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - P Fotiadis
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - A Charidimou
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Pasi
- Department of Neurology (M.P.), Centre Hospitalier Universitaire de Lille, Lille, France
| | - G Boulouis
- Department of Neuroradiology (G.B.), Centre Hospitalier Sainte-Anne, Université Paris-Descartes, Paris, France
| | - K Schwab
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M D Schirmer
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Computer Science and Artificial Intelligence Lab (M.D.S.), Massachusetts Institute of Technology, Boston, Massachusetts.,Department of Population Health Sciences (M.D.S.), German Center for Neurodegenerative Diseases, Bonn, Germany
| | - M R Etherton
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M E Gurol
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - S M Greenberg
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Duering
- Medical Image Analysis Center and Quantitative Biomedical Imaging Group (M.D.), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - A Viswanathan
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Yu AT, Regenhardt RW, Whitney C, Schwamm LH, Patel AB, Stapleton CJ, Viswanathan A, Hirsch JA, Lev M, Leslie-Mazwi TM. CTA Protocols in a Telestroke Network Improve Efficiency for Both Spoke and Hub Hospitals. AJNR Am J Neuroradiol 2021; 42:435-440. [PMID: 33541900 DOI: 10.3174/ajnr.a6950] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/03/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Telestroke networks support screening for patients with emergent large-vessel occlusions who are eligible for endovascular thrombectomy. Ideal triage processes within telestroke networks remain uncertain. We characterize the impact of implementing a routine spoke hospital CTA protocol in our integrated telestroke network on transfer and thrombectomy patterns. MATERIALS AND METHODS A protocol-driven CTA process was introduced at 22 spoke hospitals in November 2017. We retrospectively identified prospectively collected patients who presented to a spoke hospital with National Institutes of Health Stroke Scale scores ≥6 between March 1, 2016 and March 1, 2017 (pre-CTA), and March 1, 2018 and March 1, 2019 (post-CTA). We describe the demographics, CTA utilization, spoke hospital retention rates, emergent large-vessel occlusion identification, and rates of endovascular thrombectomy. RESULTS There were 167 patients pre-CTA and 207 post-CTA. The rate of CTA at spoke hospitals increased from 15% to 70% (P < .001). Despite increased endovascular thrombectomy screening in the extended window, the overall rates of transfer out of spoke hospitals remained similar (56% versus 54%; P = .83). There was a nonsignificant increase in transfers to our hub hospital for endovascular thrombectomy (26% versus 35%; P = .12), but patients transferred >4.5 hours from last known well increased nearly 5-fold (7% versus 34%; P < .001). The rate of endovascular thrombectomy performed on patients transferred for possible endovascular thrombectomy more than doubled (22% versus 47%; P = .011). CONCLUSIONS Implementation of CTA at spoke hospitals in our telestroke network was feasible and improved the efficiency of stroke triage. Rates of patients retained at spoke hospitals remained stable despite higher numbers of patients screened. Emergent large-vessel occlusion confirmation at the spoke hospital lead to a more than 2-fold increase in thrombectomy rates among transferred patients at the hub.
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Affiliation(s)
- A T Yu
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.)
| | - R W Regenhardt
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.)
| | - C Whitney
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.)
| | - L H Schwamm
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.)
| | - A B Patel
- Neurosurgery (R.W.R., A.B.P., C.J.S., T.M.L.-M.)
| | | | - A Viswanathan
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.)
| | - J A Hirsch
- Department of Radiology (J.A.H., M.L.), Massachusetts General Hospital, Boston, Massachusetts
| | - M Lev
- Department of Radiology (J.A.H., M.L.), Massachusetts General Hospital, Boston, Massachusetts
| | - T M Leslie-Mazwi
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.).,Neurosurgery (R.W.R., A.B.P., C.J.S., T.M.L.-M.)
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Viswanathan A, Vedantam A, Williams LA, Koyyalagunta D, Abdi S, Dougherty PM, Mendoza T, Bassett RL, Hou P, Bruera E. Percutaneous Cordotomy for Pain Palliation in Advanced Cancer: A Randomized Clinical Trial Study Protocol. Neurosurgery 2021; 87:394-402. [PMID: 32012217 DOI: 10.1093/neuros/nyz527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/28/2019] [Accepted: 10/09/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cancer pain, one of the most common symptoms for patients with advanced cancer, is often refractory to maximal medical therapy. A controlled clinical trial is needed to provide definitive evidence to support the use of ablative procedures such as cordotomy for patients with medically refractory cancer pain. OBJECTIVE To assess the efficacy of cordotomy for patients with unilateral advanced cancer pain using a controlled clinical trial study design. The secondary objectives are to define the patient experience of cordotomy for medically refractory cancer pain as well as to determine the utility of magnetic resonance imaging as a non-invasive biomarker for successful cordotomy. METHODS We will undertake a single-institution, double-blind, sham-controlled clinical trial of cordotomy in patients with refractory cancer pain. Patients in the cordotomy arm will undergo a percutaneous computed tomography-guided cordotomy at C1-C2, while patients in the control arm will undergo a similar procedure where the needle will not penetrate the thecal sac. The primary endpoint will be the reduction in pain intensity, as measured by the Edmonton Symptoms Assessment Scale. EXPECTED OUTCOMES We expect that patients randomized to cordotomy will have a significantly greater reduction in pain intensity than those patients randomized to the control surgical intervention. DISCUSSION This randomized clinical trial comparing cordotomy with a control intervention will provide the level of evidence necessary to determine whether cordotomy should be the standard of care intervention for patients with advanced cancer pain.
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Affiliation(s)
| | - Aditya Vedantam
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Loretta A Williams
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Salahadin Abdi
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patrick M Dougherty
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tito Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Patel N, Viswanathan A, Lee J, Barrow S, Cant A, Sanghvi R, Deseta M, Layton J, Bhujel N, Sheehy EC. Paediatric dental A&E service during the COVID-19 pandemic in the Greater London area. Eur Arch Paediatr Dent 2021; 22:507-513. [PMID: 33389688 PMCID: PMC7778697 DOI: 10.1007/s40368-020-00589-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 09/19/2020] [Accepted: 11/18/2020] [Indexed: 10/26/2022]
Abstract
PURPOSE The UK government introduced a nationwide lockdown on the 23rd March 2020 to prevent the spread of COVID-19. All elective hospital and dental practice assessments and procedures were mandated to stop. Key hospital dental workers were required to work, and Guy's and St Thomas' NHS Foundation Trust became a designated Urgent Dental Care Centre (UDC) for the greater London area. The paediatric dental emergency walk-in service was suspended and replaced with a telephone triage system and evaluation of digital images sent by parents/carers when needed. The aim of this paper is to describe the emergency service provided by staff in the department of Paediatric Dentistry at St Thomas' Hospital during the first lockdown. METHODS A prospective service evaluation of the modified paediatric dental emergency service was carried out between 25th March and 29th May 2020. RESULTS Four-hundred and sixty-four patients accessed the paediatric dental emergency service via telephone during the service evaluation period. Of these, 192 (41%) had dental pain, 121 (26%) had pain and swelling of dental origin, and 89 (19%) had trauma. CONCLUSIONS Remote telephone consultations and digital photographs were useful to screen emergency paediatric dental patients, but lack of face-to-face consultations with radiographic assessment and access to general anaesthetic services were major limiting factors.
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Affiliation(s)
- N Patel
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - A Viswanathan
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - J Lee
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - S Barrow
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - A Cant
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - R Sanghvi
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - M Deseta
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - J Layton
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - N Bhujel
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - E C Sheehy
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Mohanty A, Srinivasan VM, Burkhardt JK, Johnson J, Patel AJ, Sheth SA, Viswanathan A, Yoshor D, Kan P. Ambulatory neurosurgery in the COVID-19 era: patient and provider satisfaction with telemedicine. Neurosurg Focus 2020; 49:E13. [PMID: 33260126 DOI: 10.3171/2020.9.focus20596] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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: 06/30/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Telemedicine has rapidly expanded in the recent years as technologies have afforded healthcare practitioners the ability to diagnose and treat patients remotely. Due to the COVID-19 pandemic, nonessential clinical visits were greatly limited, and much of the outpatient neurosurgical practice at the authors' institution was shifted quickly to telehealth. Although there are prior data suggesting that the use of telemedicine is satisfactory in other surgical fields, data in neurosurgery are limited. This study aimed to investigate both patient and provider satisfaction with telemedicine and its strengths and limitations in outpatient neurosurgery visits. METHODS This quality improvement study was designed to analyze provider and patient satisfaction with telemedicine consultations in an outpatient neurosurgery clinic setting at a tertiary care, large-volume, academic center. The authors designed an 11-question survey for neurosurgical providers and a 13-question survey for patients using both closed 5-point Likert scale responses and multiple choice responses. The questionnaires were administered to patients and providers during the period when the clinic restricted in-person visits. At the conclusion of the study, the overall data were analyzed qualitatively and quantitatively. RESULTS During the study period, 607 surveys were sent out to patients seen by telehealth at the authors' academic center, and 122 responses were received. For the provider survey, 85 surveys were sent out to providers at the authors' center and other academic centers, and 40 surveys were received. Ninety-two percent of patients agreed or strongly agreed that they were satisfied with that particular telehealth visit. Eighty-eight percent of patients agreed that their telehealth visit was more convenient for them than an in-person visit, but only 36% of patients stated they would like their future visits to be telehealth. Sixty-three percent of providers agreed that telehealth visits were more convenient for them than in-person visits, and 85% of responding providers stated that they wished to incorporate telehealth into their future practice. CONCLUSIONS Although the authors' transition to telehealth was both rapid and unexpected, most providers and patients reported positive experiences with their telemedicine visits and found telemedicine to be an effective form of ambulatory neurosurgical care. Not all patients preferred telemedicine visits over in-person visits, but the high satisfaction with telemedicine by both providers and patients is promising to the future expansion of telehealth in ambulatory neurosurgery.
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Affiliation(s)
- Alina Mohanty
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | | | | | - Jeremiah Johnson
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | - Akash J Patel
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | - Sameer A Sheth
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | | | - Daniel Yoshor
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | - Peter Kan
- 2Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas
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Larkin MB, Karas PJ, McGinnis JP, McCutcheon IE, Viswanathan A. Stereotactic Radiosurgery Hypophysectomy for Palliative Treatment of Refractory Cancer Pain: A Historical Review and Update. Front Oncol 2020; 10:572557. [PMID: 33392075 PMCID: PMC7773820 DOI: 10.3389/fonc.2020.572557] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/21/2020] [Indexed: 11/21/2022] Open
Abstract
Medically refractory pain in those with advanced cancer significantly reduces one's quality of life. Therefore, palliative interventions to mitigate cancer pain and reduce opioid requirements are necessary to reduce patient suffering and opioid-induced side effects. Hypophysectomy, a largely forgotten pain procedure with several technical variations, has been repeatedly studied in small series with encouraging results, though historically has been fraught with complications. As a result, the minimally invasive and more tolerable stereotactic radiosurgery (SRS) hypophysectomy has resurfaced as a possible treatment for cancer-related pain. While the mechanism of pain relief is not entirely understood, the hypothalamohypophyseal axis appears to play an essential role in pain perception and transmission and involves C fiber signal processing and downstream modulation of the brainstem and spinal cord via the hypothalamus. This review highlights the role of hypophysectomy in alleviating advanced cancer pain, both in hormonal and nonhormonal malignancy and the current mechanistic understanding of pain relief for the three primary hypophysectomy modalities used historically: surgical and chemical adenolysis, as well as the more recent, SRS hypophysectomy. Given the lack of high-quality evidence for stereotactic radiosurgery hypophysectomy, there is a need for further rigorous and prospective clinical studies despite its ideal and noninvasive approach.
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Affiliation(s)
- M. Benjamin Larkin
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Patrick J. Karas
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - John P. McGinnis
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Ian E. McCutcheon
- Department of Neurosurgery, University of Texas, MD Anderson, Houston, TX, United States
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
- Department of Neurosurgery, University of Texas, MD Anderson, Houston, TX, United States
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Kostick K, Storch EA, Zuk P, Blumenthal-Barby JS, Torgerson L, Yoshor D, Sheth S, Viswanathan A, Tarakad A, Jimenez-Shahed J, Goodman W, Lázaro-Muñoz G. Strategies to mitigate impacts of the COVID-19 pandemic on patients treated with deep brain stimulation. Brain Stimul 2020; 13:1642-1643. [PMID: 33017673 PMCID: PMC7530624 DOI: 10.1016/j.brs.2020.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Kristin Kostick
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA.
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Peter Zuk
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - J S Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Laura Torgerson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Daniel Yoshor
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Sameer Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Arjun Tarakad
- Parkinson's Disease and Movement Disorders Center, Neurology, Movement Disorders, Baylor College of Medicine, Houston, TX, USA
| | - Joohi Jimenez-Shahed
- Movement Disorders Neuromodulation & Brain Circuit Therapeutics, Neurology, Icahn School of Medicine at Mount Sinai, Mount Sinai West, 1000 10th Avenue, Suite 10C, New York, NY, 10019, USA
| | - Wayne Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Gabriel Lázaro-Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
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Larkin MB, North RY, Viswanathan A. Percutaneous Computed Tomography-Guided Radiofrequency Ablation of Spinal Trigeminal Tract and Nucleus Caudalis for Refractory Trigeminal Neuropathic Pain: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E530-E531. [PMID: 32649751 DOI: 10.1093/ons/opaa188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/06/2020] [Accepted: 04/20/2020] [Indexed: 11/13/2022] Open
Abstract
This is a surgical video of a computed tomography (CT)-guided percutaneous radiofrequency ablation of the spinal trigeminal tract and nucleus caudalis for refractory trigeminal neuropathic pain.1,2 Many have contributed historically, among them, Sjoqvist3 in 1938 first described destruction of the descending medullary trigeminal tractus via open craniotomy.3-6 In 1967 and 1968, Crue7 and Hitchcock8 independently developed a percutaneous tractotomy technique. Although Kanpolat9,10 first described the use of CT imaging for percutaneous creation of a single tractotomy/nucleotomy lesion resulting in satisfactory pain relief for 85% of patients. The spinal trigeminal tract is a descending fiber pathway containing central processes of first-order afferent neurons from cranial nerves V, VII, IX, and X. The spinal trigeminal nucleus is the terminal projection of the spinal trigeminal tract comprised of 3 subnuclei: oralis, interpolaris, and caudalis. The nucleus caudalis is the most caudal of the 3 subdivisions of the spinal trigeminal nucleus and houses the cell bodies of second-order afferent neurons critical in nociception of the face. Lesioning of the spinal trigeminal tract and nucleus caudalis can provide pain relief without affecting facial sensation or trigeminal motor function.9,11-13 Percutaneous radiofrequency ablation is performed using anatomical landmarks, serial CT scans, impedance monitoring, and functional confirmation to ensure appropriate insertion of the probe to the target of interest prior to lesioning. This procedure remains uncommon in current practices even among functional neurosurgery pain specialists but offers a low-risk, minimally invasive treatment option for refractory facial pain.14 This procedure was done under Institutional Review Board guidance (H-41228: retrospective chart review of patients undergoing spine surgery for pain). The risks and benefits were explained, and the patient consented to videography/procedure. Images in the video used with permission from the following: Carter HV. Anatomy of the Human Body. Wikimedia Commons [Public Domain]. https://commons.wikimedia.org/wiki/File:Gray698.png. Published 1918. Accessed June 30, 2019; Carter HV. Anatomy of the Human Body. Wikimedia Commons [Public Domain]. https://commons.wikimedia.org/wiki/File:Gray784.png. Published 1918. Accessed June 30, 2019; Reprinted from Kanpolat Y, Kahilogullari G, Ugur HC, Elhan AH, CT-guided percutaneous trigeminal tractotomy-nucleotomy, Neurosurgery, 2008, 63(1 Suppl 1), ONS147-53; discussion ONS153-5, by permission of the Congress of Neurological Surgeons; Madhero88. Onion Distribution of Pain and Temperature Sense by Trigeminal Nerve. Wikimedia Commons [Creative Commons BY 3.0 license]. https://en.wikipedia.org/wiki/File:Onionskinddistribution.svg#/media/File:Onionskinddistribution.svg. Accessed June 30, 2019.
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Affiliation(s)
- M Benjamin Larkin
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Robert Y North
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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Larkin MB, North RY, Viswanathan A. Percutaneous CT-guided cordotomy for pain. Neurosurgical Focus: Video 2020; 3:V15. [PMID: 36285259 PMCID: PMC9542299 DOI: 10.3171/2020.5.focvid209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/27/2020] [Indexed: 11/25/2022]
Abstract
Cordotomy has evolved since the first open procedure by Spiller and the first percutaneous radiofrequency cordotomy by Mullan in 1965. Today, the minimally invasive, CT-guided percutaneous radiofrequency cordotomy is mostly used for the palliative management of medically intractable somatic pain related to malignancy in well-selected patients. The risk of adverse events is minimized with the use of intraoperative stimulation monitoring. This video highlights the spinal cord anatomy at the level of C1–2, the approach to patient selection, the associated risks and benefits, and, finally, the procedural setup and key steps involved in this unique neurosurgical procedure. The video can be found here: https://youtu.be/a-0ORqy0W2o
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Beavis A, Rositch A, Romero-Sackey A, Viswanathan A, Fader A, Stone R, Wethington S, Levinson K. The effect of multidisciplinary team integration on treatment completion disparities in women undergoing treatment for cervical cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.272] [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: 11/29/2022]
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Larkin MB, North RY, Vedantam A, Viswanathan A. Limited midline myelotomy for visceral pain. Neurosurgical Focus: Video 2020; 3:V16. [PMID: 36285262 PMCID: PMC9542228 DOI: 10.3171/2020.6.focvid2014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/30/2020] [Indexed: 11/24/2022]
Abstract
The traditional commissural myelotomy consists of a sagittal cut in the midline and was originally described by Greenfield and performed by Armour in 1926. Today, myelotomy refers to the selective disruption of the ascending visceral pain pathway. The success of the procedure is incumbent on the correct identification of the midline. Limited midline open myelotomy for the treatment of medically intractable abdominal or pelvic visceral cancer pain, with the aid of somatosensory evoked potentials to identify midline, offers patients superior pain relief over similar percutaneous techniques. Multicenter registries are needed to better elucidate the best surgical technique for this procedure. The video can be found here: https://youtu.be/0unlmwp08po
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Larkin MB, McGinnis JP, Snyder RI, Storch EA, Goodman WK, Viswanathan A, Sheth SA. Neurostimulation for treatment-resistant posttraumatic stress disorder: an update on neurocircuitry and therapeutic targets. J Neurosurg 2020; 134:1715-1723. [PMID: 32736358 DOI: 10.3171/2020.4.jns2061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/30/2020] [Accepted: 04/06/2020] [Indexed: 11/06/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a widespread and often devastating psychiatric condition. Core symptoms include intrusive and distressing thoughts, heightened reactivity, mood changes, cognitive impairments, and consequent avoidance of trauma-related stimuli. Symptoms of PTSD are often refractory to standard treatments, and neuromodulatory techniques have therefore drawn significant interest among the most treatment-resistant patients. Transcranial magnetic stimulation has demonstrated minimal efficacy, and deep brain stimulation trials are currently ongoing. PTSD is a disorder of neural circuitry; the current understanding includes involvement of the amygdala (basolateral and central nuclei), the prefrontal cortex (ventral medial and dorsolateral regions), and the hippocampus. Neuroimaging and optogenetic studies have improved the understanding of large-scale neural networks and the effects of microcircuitry manipulation, respectively. This review discusses the current PTSD literature and ongoing neurostimulation trials, and it highlights the current understanding of neuronal circuit dysfunction in PTSD. The authors emphasize the anatomical correlations of PTSD's hallmark symptoms, offer another potential deep brain stimulation target for PTSD, and note the need for continued research to identify useful biomarkers for the development of closed-loop therapies. Although there is hope that neuromodulation will become a viable treatment modality for PTSD, this concept remains theoretical, and further research should involve institutional review board-approved controlled prospective clinical studies.
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Affiliation(s)
| | | | | | - Eric A Storch
- 2Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Wayne K Goodman
- 2Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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Ozturk M, Telkes I, Jimenez-Shahed J, Viswanathan A, Tarakad A, Kumar S, Sheth SA, Ince NF. Randomized, Double-Blind Assessment of LFP Versus SUA Guidance in STN-DBS Lead Implantation: A Pilot Study. Front Neurosci 2020; 14:611. [PMID: 32655356 PMCID: PMC7325925 DOI: 10.3389/fnins.2020.00611] [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: 02/27/2020] [Accepted: 05/18/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The efficacy of deep brain stimulation (DBS) therapy in Parkinson's disease (PD) patients is highly dependent on the precise localization of the target structures such as subthalamic nucleus (STN). Most commonly, microelectrode single unit activity (SUA) recordings are performed to refine the target. This process is heavily experience based and can be technically challenging. Local field potentials (LFPs), representing the activity of a population of neurons, can be obtained from the same microelectrodes used for SUA recordings and allow flexible online processing with less computational complexity due to lower sampling rate requirements. Although LFPs have been shown to contain biomarkers capable of predicting patients' symptoms and differentiating various structures, their use in the localization of the STN in the clinical practice is not prevalent. Methods: Here we present, for the first time, a randomized and double-blinded pilot study with intraoperative online LFP processing in which we compare the clinical benefit from SUA- versus LFP-based implantation. Ten PD patients referred for bilateral STN-DBS were randomly implanted using either SUA or LFP guided targeting in each hemisphere. Although both SUA and LFP were recorded for each STN, the electrophysiologist was blinded to one at a time. Three months postoperatively, the patients were evaluated by a neurologist blinded to the intraoperative recordings to assess the performance of each modality. While SUA-based decisions relied on the visual and auditory inspection of the raw traces, LFP-based decisions were given through an online signal processing and machine learning pipeline. Results: We found a dramatic agreement between LFP- and SUA-based localization (16/20 STNs) providing adequate clinical improvement (51.8% decrease in 3-month contralateral motor assessment scores), with LFP-guided implantation resulting in greater average improvement in the discordant cases (74.9%, n = 3 STNs). The selected tracks were characterized by higher activity in beta (11-32 Hz) and high-frequency (200-400 Hz) bands (p < 0.01) of LFPs and stronger non-linear coupling between these bands (p < 0.05). Conclusion: Our pilot study shows equal or better clinical benefit with LFP-based targeting. Given the robustness of the electrode interface and lower computational cost, more centers can utilize LFP as a strategic feedback modality intraoperatively, in conjunction to the SUA-guided targeting.
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Affiliation(s)
- Musa Ozturk
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
| | - Ilknur Telkes
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Joohi Jimenez-Shahed
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Arjun Tarakad
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Suneel Kumar
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Nuri F. Ince
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
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Vedantam A, Hassan I, Kotrotsou A, Hassan A, Zinn PO, Viswanathan A, Colen RR. Magnetic Resonance-Based Radiomic Analysis of Radiofrequency Lesion Predicts Outcomes After Percutaneous Cordotomy: A Feasibility Study. Oper Neurosurg (Hagerstown) 2020; 18:721-727. [PMID: 31665446 DOI: 10.1093/ons/opz288] [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: 01/10/2019] [Accepted: 07/19/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To date, there is limited data on evaluation of the cordotomy lesion and predicting clinical outcome. OBJECTIVE To evaluate the utility of magnetic resonance (MR)-based radiomic analysis to quantify microstructural changes created by the cordotomy lesion and predict outcome in patients undergoing percutaneous cordotomy for medically refractory cancer pain. METHODS This is a retrospective interpretation of prospectively acquired data in 10 patients (5 males, age range 43-76 yr) who underwent percutaneous computed tomography-guided high cervical cordotomy for medically refractory cancer pain between 2015 and 2016. All patients underwent magnetic resonance imaging (MRI) of the cordotomy lesion on postoperative day 1. After segmentation of T2-weighted images, 310 radiomic features were extracted. Pain outcomes were recorded on postoperative day 1 and day 7 using the visual analog scale. R software was used to build statistical models based on MRI radiomic features for prediction of pain outcomes. RESULTS A total of 20 relevant radiomic features were identified using the maximum relevance minimum redundanc method. Radiomics predicted postoperative day 1 pain scores with an accuracy of 90% (P = .046), 100% sensitivity, 75% specificity, 85.7% positive predictive value, and 100% negative predictive value. The radiomics model also predicted if the postoperative day 1 pain score was sustained on postoperative day 7 with an accuracy of 100% (P = .028), 100% sensitivity, 100% specificity, and 100% positive and negative predictive value. CONCLUSION MR-based radiomic analysis of the cordotomy lesion was predictive of pain outcomes at 1 wk after percutaneous cordotomy for intractable cancer pain.
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Affiliation(s)
- Aditya Vedantam
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Islam Hassan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aikaterini Kotrotsou
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ahmed Hassan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pascal O Zinn
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.,Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Cancer Biology, Division of Basic Science Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Rivka R Colen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Javed S, Viswanathan A, Abdi S. Cordotomy for Intractable Cancer Pain: A Narrative Review. Pain Physician 2020; 23:283-292. [PMID: 32517394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Cordotomy is an invasive procedure for the management of intractable pain not controlled by conventional therapies, such as analgesics or nerve block. This procedure involves mechanical disruption of nociceptive pathways in the anterolateral column, specifically the spinothalamic and spinoreticular pathways to relieve pain while preserving fine touch and proprioceptive tracts. OBJECTIVES The purpose of this review article is to refresh our knowledge of cordotomy and support its continued use in managing intractable pain due to malignant disease. STUDY DESIGN This is a review article with the goal of reviewing and summarizing the pertinent case reports, case series, retrospective studies, prospective studies, and review articles published from 2010 onward on spinal cordotomy. SETTING The University of Texas, MD Anderson Cancer Center. METHODS PubMed search of keywords "spinal cordotomy," "percutaneous cordotomy," or "open cordotomy" was undertaken. Search results were organized by year of publication. RESULTS Cordotomy can be performed via percutaneous, open, endoscopic, or transdiscal approach. Percutaneous image-guided approach is the most well-studied and reported technique compared with others, with relatively good pain improvement both in the postoperative and short-term period. The use of open cordotomy has diminished significantly in recent years because of the advent of other less invasive approaches. Cordotomy in children, although rare, has been described in some case reports and case series with reported pain improvement postprocedure. Although complications can vary broadly, some reported side effects include ataxia and paresis due to lesion in the spinocerebellar/corticospinal tract; respiratory failure due to lesion in the reticulospinal tract; or sympathetic dysfunction, bladder dysfunctions, or Horner syndrome due to unintentional lesions in the spinothalamic tract. LIMITATIONS Review article included literature published only in English. For the studies reviewed, the sample size was relatively small and the patient population was heterogeneous (in terms of underlying disease process, duration of symptoms, previous treatment attempted and length of follow-up). CONCLUSIONS Cordotomy results in selective loss of pain and temperature perception on the contralateral side, up to several segments below the level of the disruption. The plethora of analgesics available and advanced technologies have reduced the demand for cordotomy in the management of intractable pain. However, some patients with pain unresponsive to medical and procedural management, particularly malignant pain, may benefit from this procedure, and it is a viable treatment option especially for patients with a limited life expectancy whose severe, unilateral pain is unresponsive to analgesic medications. KEY WORDS Cancer pain, cordotomy complications, cordotomy indications, intractable pain, open cordotomy, percutaneous cordotomy.
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Affiliation(s)
- Saba Javed
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Salahadin Abdi
- University of Texas, MD Anderson Cancer Center, Houston, TX
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LoPresti MA, McDeavitt JT, Wade K, Jahn LK, Viswanathan A, Fordis M, Yoshor D. Letter: Telemedicine in Neurosurgery—A Timely Review. Neurosurgery 2020; 87:E208-E210. [DOI: 10.1093/neuros/nyaa175] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Kristin Wade
- Administrative Departments Baylor Medicine Houston, Texas
| | - Laura K Jahn
- Administrative Departments Baylor Medicine Houston, Texas
| | | | - Michael Fordis
- Administrative Departments Baylor Medicine Houston, Texas
| | - Daniel Yoshor
- Department of Neurosurgery Baylor College of Medicine Houston, Texas
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Ozturk M, Kaku H, Jimenez-Shahed J, Viswanathan A, Sheth SA, Kumar S, Ince NF. Subthalamic Single Cell and Oscillatory Neural Dynamics of a Dyskinetic Medicated Patient With Parkinson's Disease. Front Neurosci 2020; 14:391. [PMID: 32390796 PMCID: PMC7193777 DOI: 10.3389/fnins.2020.00391] [Citation(s) in RCA: 5] [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: 12/18/2019] [Accepted: 03/30/2020] [Indexed: 02/01/2023] Open
Abstract
Single cell neuronal activity (SUA) and local field potentials (LFP) in the subthalamic nucleus (STN) of unmedicated Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS) surgery have been well-characterized during microelectrode recordings (MER). However, there is limited knowledge about the changes in the firing patterns and oscillations above and within the territories of STN after the intake of dopaminergic medication. Here, for the first time, we report the STN single cell and oscillatory neural dynamics in a medicated patient with idiopathic PD using intraoperative MER. We recorded LFP and SUA with microelectrodes at various depths during bilateral STN-DBS electrode implantation. We isolated 26 neurons in total and observed that tonic and irregular firing patterns of individual neurons predominated throughout the territories of STN. While burst-type firings have been well-characterized in the dorsal territories of STN in unmedicated patients, interestingly, this activity was not observed in our medicated subject. LFP recordings lacked the excessive beta (8-30 Hz) activity, characteristic of the unmedicated state and signal energy was mainly dominated by slow oscillations below 8 Hz. We observed sharp gamma oscillations between 70 and 90 Hz within and above the STN. Despite the presence of a broadband high frequency activity in 200-400 Hz range, no cross-frequency interaction in the form of phase-amplitude coupling was noted between low and high frequency oscillations of LFPs. While our results are in agreement with the previously reported LFP recordings from the DBS lead in medicated PD patients, the sharp gamma peak present throughout the depth recordings and the lack of bursting firings after levodopa intake have not been reported before. The lack of bursting in SUA, the lack of excessive beta activity and cross frequency coupling between HFOs and lower rhythms further validate the link between bursting firing regime of neurons and pathological oscillatory neural activity in PD-STN. Overall, these observations not only validate the existing literature on the PD electrophysiology in healthy/medicated animal models but also provide insights regarding the underlying electro-pathophysiology of levodopa-induced dyskinesias in PD patients through demonstration of multiscale relationships between single cell firings and field potentials.
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Affiliation(s)
- Musa Ozturk
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
| | - Heet Kaku
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
| | - Joohi Jimenez-Shahed
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Suneel Kumar
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Nuri F. Ince
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
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Jastrzebska-Perfect P, Spyropoulos GD, Cea C, Zhao Z, Rauhala OJ, Viswanathan A, Sheth SA, Gelinas JN, Khodagholy D. Mixed-conducting particulate composites for soft electronics. Sci Adv 2020; 6:eaaz6767. [PMID: 32494646 PMCID: PMC7182411 DOI: 10.1126/sciadv.aaz6767] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/27/2020] [Indexed: 05/29/2023]
Abstract
Bioelectronic devices should optimally merge a soft, biocompatible tissue interface with capacity for local, advanced signal processing. Here, we introduce an organic mixed-conducting particulate composite material (MCP) that can form functional electronic components by varying particle size and density. We created MCP-based high-performance anisotropic films, independently addressable transistors, resistors, and diodes that are pattern free, scalable, and biocompatible. MCP enabled facile and effective electronic bonding between soft and rigid electronics, permitting recording of neurophysiological data at the resolution of individual neurons from freely moving rodents and from the surface of the human brain through a small opening in the skull. We also noninvasively acquired high-spatiotemporal resolution electrophysiological signals by directly interfacing MCP with human skin. MCP provides a single-material solution to facilitate development of bioelectronic devices that can safely acquire, transmit, and process complex biological signals.
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Affiliation(s)
| | | | - Claudia Cea
- Department of Electrical Engineering, Columbia University, New York, NY 10027, USA
| | - Zifang Zhao
- Department of Electrical Engineering, Columbia University, New York, NY 10027, USA
| | - Onni J. Rauhala
- Department of Electrical Engineering, Columbia University, New York, NY 10027, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jennifer N. Gelinas
- Department of Neurology, Columbia University Medical Center, New York, NY 10032, USA
- Institute for Genomic Medicine, Columbia University Medical Center, New York, NY 10032, USA
| | - Dion Khodagholy
- Department of Electrical Engineering, Columbia University, New York, NY 10027, USA
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Vedantam A, Bruera E, Hess KR, Dougherty PM, Viswanathan A. Somatotopy and Organization of Spinothalamic Tracts in the Human Cervical Spinal Cord. Neurosurgery 2020; 84:E311-E317. [PMID: 30011044 DOI: 10.1093/neuros/nyy330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 12/01/2017] [Accepted: 06/20/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Understanding spinothalamic tract anatomy may improve lesioning and outcomes in patients undergoing percutaneous cordotomy. OBJECTIVE To investigate somatotopy and anatomical organization of spinothalamic tracts in the human cervical spinal cord. METHODS Patients with intractable cancer pain undergoing cordotomy underwent preoperative and postoperative quantitative sensory testing for sharp pain and heat pain on day 1 and 7 after cordotomy. Intraoperative sensory stimulation was performed with computed tomography (CT) imaging to confirm the location of the radiofrequency electrode during cordotomy. Postoperative magnetic resonance (MR) imaging was performed to define the location of the lesion. RESULTS Twelve patients were studied, and intraoperative sensory stimulation combined with CT imaging revealed a somatotopy where fibers from the legs were posterolateral to fibers from the hand. Sharpness detection thresholds were significantly elevated in the area of maximum pain on postoperative day 1 (P = .01). Heat pain thresholds for all areas were not elevated significantly on postoperative day 1, or postoperative day 7. MR imaging confirmed that the cordotomy lesion was in the anterolateral quadrant, and in this location the lesion had a sustained effect on sharp pain but a transient impact on heat pain. CONCLUSION In the high cervical spinal cord, spinothalamic fibers mediating sharp pain for the arms are located ventromedial to fibers for the legs, and these fibers are spatially distinct from fibers that mediate heat pain.
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Affiliation(s)
- Aditya Vedantam
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kenneth R Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patrick M Dougherty
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Kaku H, Ozturk M, Viswanathan A, Jimenez-Shahed J, Sheth S, Ince NF. Grouping Neuronal Spiking Patterns in the Subthalamic Nucleus of Parkinsonian Patients. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:4221-4224. [PMID: 31946800 DOI: 10.1109/embc.2019.8857418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The subthalamic nucleus (STN) is a commonly used target in deep brain stimulation (DBS) to control the motor symptoms of Parkinson's Disease (PD). Identification of the spiking patterns in the STN is important in order to understand the neuropathophysiology of PD and can also assist in electrophysiological mapping of the structure. This study aims to provide a tool for grouping these firing patterns based on several extracted features from the spiking data. Single neuronal activity from the STN of PD subjects was detected and sorted to compute the binary spike trains. Several features including loca variation, bursting index and the prominence of the peak frequency of the power spectrum were extracted. Clustering of spike train segments was performed based on combination of features in 3D space to scrutinize how well they describe different firing regimes. The results show that this approach could be used to automate the grouping of stereotypic firing patterns in STN.
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Hunt PJ, Zhang X, Storch EA, Christian CC, Viswanathan A, Goodman WK, Sheth SA. Obsessive-Compulsive Disorder: Deep Brain Stimulation. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_29] [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: 10/24/2022]
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Sankaran S, Majumder S, Viswanathan A, Guttal V. Clustering and correlations: Inferring resilience from spatial patterns in ecosystems. Methods Ecol Evol 2019. [DOI: 10.1111/2041-210x.13304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sumithra Sankaran
- Centre for Ecological Sciences Indian Institute of Science Bengaluru India
| | - Sabiha Majumder
- Centre for Ecological Sciences Indian Institute of Science Bengaluru India
- Institut für Integrative Biologie ETH Zurich Zürich Switzerland
| | - Ashwin Viswanathan
- Centre for Ecological Sciences Indian Institute of Science Bengaluru India
- Nature Conservation Foundation Bengaluru India
| | - Vishwesha Guttal
- Centre for Ecological Sciences Indian Institute of Science Bengaluru India
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Vedantam A, Koyyalagunta D, Bruel BM, Dougherty PM, Viswanathan A. Limited Midline Myelotomy for Intractable Visceral Pain: Surgical Techniques and Outcomes. Neurosurgery 2019; 83:783-789. [PMID: 29165656 DOI: 10.1093/neuros/nyx549] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 10/02/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Limited midline myelotomy targets the midline nociceptive pathway for intractable visceral pain. Multiple techniques are available for limited midline myelotomy; however, outcome data for each technique are sparse. OBJECTIVE To review our experience with open and percutaneous approaches for limited midline myelotomy for intractable visceral pain. METHODS Patients who underwent limited midline myelotomy for intractable visceral pain were reviewed. Myelotomy was performed using 3 techniques: open limited myelotomy, percutaneous radiofrequency myelotomy, and percutaneous mechanical myelotomy. Demographic and perioperative clinical data were recorded. In addition to the visual analog scale and Karnofsy performance score, outcomes were categorized as excellent (no pain), good (considerable reduction in pain, not requiring opioids stronger than codeine), fair (minimal reduction in pain, but no change in opioid medication requirement), and poor (no reduction in pain). RESULTS Eight patients (median age 56.5 yr, 6 females) underwent limited myelotomy. Four patients underwent open limited thoracic myelotomy with excellent pain outcomes. Three patients underwent percutaneous radiofrequency lesioning with fair (n = 1) and poor outcomes (n = 2). One patient underwent percutaneous mechanical lesioning with a good outcome (n = 1). The median duration of follow-up was 11 wk (2-54 wk). Two patients reported minor sensory complications after the procedure. CONCLUSION In our preliminary experience, outcomes for open limited thoracic myelotomy were superior to percutaneous approaches. Given the limited utilization of this technique, multicenter registries are needed to further evaluate the best surgical technique for limited midline myelotomy.
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Affiliation(s)
- Aditya Vedantam
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Brian Mendoza Bruel
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Patrick M Dougherty
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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