• Title/Summary/Keyword: deep brain stimulation

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Epilepsy Surgery in 2019 : A Time to Change

  • Phi, Ji Hoon;Cho, Byung-Kyu
    • Journal of Korean Neurosurgical Society
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    • v.62 no.3
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    • pp.361-365
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    • 2019
  • Epilepsy has been known to humankind since antiquity. The surgical treatment of epilepsy began in the early days of neurosurgery and has developed greatly. Many surgical procedures have stood the test of time. However, clinicians treating epilepsy patients are now witnessing a huge tide of change. In 2017, the classification system for seizure and epilepsy types was revised nearly 36 years after the previous scheme was released. The actual difference between these systems may not be large, but there have been many conceptual changes, and clinicians must bid farewell to old terminology. Paradigms in drug discovery are changing, and novel anti-seizure drugs have been introduced for clinical use. In particular, drugs that target genetic changes harbor greater therapeutic potential than previous screening-based compounds. The concept of focal epilepsy has been challenged, and now epilepsy is regarded as a network disorder. With this novel concept, stereotactic electroencephalography (SEEG) is becoming increasingly popular for the evaluation of dysfunctioning neuronal networks. Minimally invasive ablative therapies using SEEG electrodes and neuromodulatory therapies such as deep brain stimulation and vagus nerve stimulation are widely applied to remedy dysfunctional epilepsy networks. The use of responsive neurostimulation is currently off-label in children with intractable epilepsy.

Pathogenesis of Enuresis: Brain, Sleep Dysfunction and Psychological Effects (야뇨증의 병태생리: 뇌, 수면장애 그리고 정신적 효과)

  • Park, Kwan-Jin
    • Childhood Kidney Diseases
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    • v.16 no.1
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    • pp.9-14
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    • 2012
  • The relationship between central nervous system (CNS) and enuresis has not been sufficiently elucidated despite the presence of several circumstantial evidences. Contrary to common belief, polysomnographic sleep analysis revealed that the disturbance of arousal rather than deep sleep was responsible for enuresis. Subsequent studies confirmed depressed sympathetic tone and retarded brainstem reflex indicating abnormal arousal threshold in enuretics. In accordance with the bladder-brain dialogue, chronic stimulation of bladder may modify the brainstem function elevating arousal threshold. Epidemiological studies have suggested the association between enuresis and various psychosomatic disorders like attention deficit hyperactivity disorder (ADHD), which has shown the abnormal brainstem reflex similar to enuresis. Taken together, CNS is assumed to play a crucial role in the pathogenesis of enuresis. Psychological assessment is vital to understand the psychodynamic effect of enuresis. Studies have shown that the prevalence of psychological problems was higher in enuretic children and externalization of the symptoms was usually found. Several explanations have been brought up regarding the development of enuresis and psychological problems. Enuresis may cause psychological problems and vice versa. Otherwise, both may be associated with other variables, such as socioeconomic status (SES).

Neuromodulation for Trigeminal Neuralgia

  • Chung, Moonyoung;Huh, Ryoong
    • Journal of Korean Neurosurgical Society
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    • v.65 no.5
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    • pp.640-651
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    • 2022
  • Clinical studies on neuromodulation intervention for trigeminal neuralgia have not yet shown promising results. This might be due to the fact that the pathophysiology of chronic trigeminal neuropathy is not yet fully understood. Chronic trigeminal neuropathy includes trigeminal autonomic neuropathy, painful trigeminal neuropathy, and persistent idiopathic facial pain. This disorder is caused by complex abnormalities in the pain processing system, which is comprised of the affective, emotional, and sensory components, rather than mere abnormal sensation. Therefore, integrative understanding of the pain system is necessary for appropriate neuromodulation of chronic trigeminal neuropathy. The possible neuromodulation targets that participate in complex pain processing are as follows : the ventral posterior medial nucleus, periaqueductal gray, motor cortex, nucleus accumbens, subthalamic nucleus, globus pallidus internus, anterior cingulate cortex, hypothalamus, sphenopalatine ganglion, and occipital nerve. In conclusion, neuromodulation interventions for trigeminal neuralgia is yet to be elucidated; future advancements in this area are required.

Lesch-Nyhan syndrome: a case report

  • Han Ick Park;Gu-Hwan Kim;Kang-Min Ahn
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.49 no.4
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    • pp.228-232
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    • 2023
  • Lesch-Nyhan syndrome (LNS) is a rare X-linked recessive disorder caused by a mutation in the hypoxanthine phosphoribosyltransferase 1 (HPRT1) gene. This syndrome is characterized by excessive production of uric acid, mental retardation, self-mutilation, choreoathetosis, and spasticity. The most distinctive symptom is compulsive self-mutilation. For patients with LNS, different methods have been tried to reduce self-biting behaviors including restraints, behavioral treatment, medications, deep brain stimulation, tooth extraction and botulinum toxin A injection. In this report, we present a case of LNS undergoing cheiloplasty due to self-mutilation and tooth extraction of the left deciduous maxillary canine.

The potentiality of color preference analysis by EEG (뇌파분석 통한 색상의 선호도 분석 가능성)

  • Kim, Min-Kyung;Ryu, Hee-Wook
    • Science of Emotion and Sensibility
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    • v.14 no.2
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    • pp.311-320
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    • 2011
  • To quantitatively analyze the effects of color stimulation which is one of the major affecting factors on human emotion, we studied the relationship between color preference and the Electroencephalography (EEG) to 3 color stimuli; bright yellow red (BYR), deep green yellow (DGY), and vivid blue (VB). Physiological signal measured by EEG on the color stimulation was closely related with their well-known colorful images. The brain become more activated with decreasing the color temperature (BYR${\geq}$DGY>VB), and the right brain is more sensitive than the left. On the whole, the EEG values of the frequency bands are in order to beta ${\geq}$ theta and alpha > gamma. As decreasing the color temperature, beta wave increased (BYR${\geq}$DGY>VB), and alpha, beta and gamma waves increased with increasing the color temperature (BYR${\geq}$DGY>VB). The relationship between the color preference and EEG values showed EEG gets more activated at some frequency bands when the color preference becomes higher. In conclusion, the specific frequency band could be activating by a color stimuli which had showed higher the preference. It means that these color stimuli can apply for various industries such as beauty industry, interior design, fashion design, color therapy, and etc.

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Inter-Racial, Gender and Aging Influences in the Length of Anterior Commissure-Posterior Commissure Line

  • Lee, Tae-One;Hwang, Hyung-Sik;Salles, Antonio De;Mattozo, Carios;Pedroso, Alessandra G;Behnke, Eric
    • Journal of Korean Neurosurgical Society
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    • v.43 no.2
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    • pp.79-84
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    • 2008
  • Objective: The length of anterior-posterior commissure (AC-PC) in racial groups, age, gender of patients with deep brain stimulation (DBS) and pallidotomy were investigated. Methods: From January 1996 to December 2003, 211 patients were treated with DBS and pallidotomy. There were 160 (76%) Caucasians, 35 (17%) Hispanics, 12 (5%) Asians and 4 Blacks (2%). There were 88 males and 52 females in DBS-surgery group and 44 males, 27 females in pallidotomy group. Mean age was 58 year-old. There were 19 males and 19 females and mean age was 54.7 years in the control group. Measurements were made on MRI and @Target software. Results: The average AC-PC distance was 24.89 mm (range 32 to 19), which increased with aging until 75 years old in Caucasian and also increased with aging in Hispanic, but the AC-PC distance peaked at 45 years old in Hispanic. The order of AC-PC distance were $24.6{\pm}2$ mm in Caucasian, $24.6{\pm}2.24$ mm in Asian, 24.53 mm in Black, $23.6{\pm}1.98$ mm in Hispanic. The average AC-PC distance in all groups was 24.22 mm in female who was mean age of 56.35, 25.28 mm in male who was mean age of 60.19 and $24.5{\pm}2$ mm in control group that was excluded because of the difference of thickness of slice. According to multiple regression analysis, the AC-PC distance was significantly correlated with age, race, and gender. Conclusion: The AC-PC distance is significantly correlated with age, gender, and race. The atlas of functional stereotaxis would be depended on the Variation of indivisual brain that can influenced by aging, gender, and race.

Changes of c-Fos Immunoreactivity in Midbrain by Deep Pain and Effects of Aspirin (심부통증이 흰쥐 중뇌에 미치는 c-Fos 면역반응성의 변화와 아스피린의 효과)

  • Jung, Jin A;Yoo, Ki Soo;Hwang, Kyu Keun
    • Clinical and Experimental Pediatrics
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    • v.46 no.7
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    • pp.695-701
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    • 2003
  • Purpose : It had been suggested that pain arising from deep somatic body regions influences neural activity within periaqueductal gray(PAG) of midbrain via distinct spinal pathways. Aspirin is one of the popular non-steroidal anti-inflammatory drugs used in the management of pain. Fos expression was used as a marker for neuronal activity throughout central neurons following painful peripheral stimulation. This study was prepared to investigate changes of c-Fos immunoreactivity in midbrain by deep pain and effects of aspirin. Methods : Male Sprague-Dawley rats were injected with 0.1 mL of 5% formalin in the plantar muscle of the right hindpaw. For experimental group II, aspirin was injected intravenously before injection of formalin. An aspirin-untreated group was utilized as group I. Rats were sacrificed at 0.5, 1, 2, 6 and 24 hours after formalin injection. Rat's brains were removed and sliced in rat brain matrix. Brain slices were coronally sectioned at interaural 1.00-1.36 mm. Serial sections were immunohistochemically reacted with polyclonal c-Fos antibody. The numbers of c-Fos protein immunoreactive neurons in ventrolateral periaqueductal gray(VLPAG) and dorsomedial periaqueductal gray(DMPAG) were counted and analyzed statistically with Mann-Whitney U tests. Results : Higher numbers of c-Fos protein immunoreactive neurons were found in VLPAG. In both VLPAG and DMPAG of formalin-treated group, the numbers of c-Fos protein immunoreactive neurons were significantly higher at all time points than the formalin-untreated group, which peaked at two hours. The numbers of c-Fos immunoreactive neuron of the aspirin-treated group were less compared to the aspirin-untreated group at each time point. Conclusion : These results provide some basic knowledge in understanding the mechanism of formalin-induced deep somatic pain and the effects of aspirin.

A 4×32-Channel Neural Recording System for Deep Brain Stimulation Systems

  • Kim, Susie;Na, Seung-In;Yang, Youngtae;Kim, Hyunjong;Kim, Taehoon;Cho, Jun Soo;Kim, Jinhyung;Chang, Jin Woo;Kim, Suhwan
    • JSTS:Journal of Semiconductor Technology and Science
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    • v.17 no.1
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    • pp.129-140
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    • 2017
  • In this paper, a $4{\times}32$-channel neural recording system capable of acquiring neural signals is introduced. Four 32-channel neural recording ICs, complex programmable logic devices (CPLDs), a micro controller unit (MCU) with USB interface, and a PC are used. Each neural recording IC, implemented in $0.18{\mu}m$ CMOS technology, includes 32 channels of analog front-ends (AFEs), a 32-to-1 analog multiplexer, and an analog-to-digital converter (ADC). The mid-band gain of the AFE is adjustable in four steps, and have a tunable bandwidth. The AFE has a mid-band gain of 54.5 dB to 65.7 dB and a bandwidth of 35.3 Hz to 5.8 kHz. The high-pass cutoff frequency of the AFE varies from 18.6 Hz to 154.7 Hz. The input-referred noise (IRN) of the AFE is $10.2{\mu}V_{rms}$. A high-resolution, low-power ADC with a high conversion speed achieves a signal-to-noise and distortion ratio (SNDR) of 50.63 dB and a spurious-free dynamic range (SFDR) of 63.88 dB, at a sampling-rate of 2.5 MS/s. The effectiveness of our neural recording system is validated in in-vivo recording of the primary somatosensory cortex of a rat.

Investigation of Leksell GammaPlan's ability for target localizations in Gamma Knife Subthalamotomy (감마나이프 시상하핵파괴술에서 목표물 위치측정을 위한 렉셀 감마플랜 능력의 조사)

  • Hur, Beong Ik
    • Journal of the Korean Society of Radiology
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    • v.13 no.7
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    • pp.901-907
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    • 2019
  • The aim of this study is to evaluate the ability of target localizations of Leksell GammaPlan(LGP) in Gamma Knife Subthalamotomy(or Pallidotomy, Thalamotomy) of functional diseases. To evaluate the accuracy of LGP's location settings, the difference Δr of the target coordinates calculated by LGP (or LSP) and author's algorithm was reviewed for 10 patients who underwent Deep Brain Stimulation(DBS) surgery. Δr ranged from 0.0244663 mm to 0.107961 mm. The average of Δr was 0.054398 mm. Transformation matrix between stereotactic space and brain atlas space was calculated using PseudoInverse or Singular Value Decomposition of Mathematica to determine the positional relationship between two coordinate systems. Despite the precise frame positioning, the misalignment of yaw from -3.44739 degree to 1.82243 degree, pitch from -4.57212 degree to 0.692063 degree, and rolls from -6.38239 degree to 7.21426 degree appeared. In conclusion, a simple in-house algorithm was used to test the accuracy for location settings of LGP(or LSP) in Gamma Knife platform and the possibility for Gamma Knife Subthalamotomy. The functional diseases can be treated with Gamma Knife Radiosurgery with safety and efficacy. In the future, the proposed algorithm for target localizations' QA will be a great contributor to movement disorders' treatment of several Gamma Knife Centers.

A Study on Transcranial Magnetic Electrode Simulation Using Maxwell 3D (Maxwell 3D를 이용한 경두개 자기 전극 시뮬레이션에 관한 연구)

  • Lee, Geun-Yong;Yoon, Se-Jin;Jeong, Jin-hyoung;Kim, Jun-Tae;Lee, Sang-sik
    • The Journal of Korea Institute of Information, Electronics, and Communication Technology
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    • v.12 no.6
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    • pp.657-665
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    • 2019
  • In this study, we conducted a study on the transcranial magnetic electrode, a method for the study of dementia and muscle pain, a neurodegenerative disease caused by an aging society, which is becoming a problem worldwide. In particular, transcranial magnetic electrodes have been studied to improve their ability to be deteriorated by dementia symptoms such as speech, cognitive ability, and memory by outputting magnetism deep into the brain using coils on the head epidermis. In this study, simulation was performed using Maxwell 3D program for the design of coil, the core of transcranial magnetic electrode. As a result of the simulation comparison between the coil designed by the previous research and the coil through the research and development, the output was found to be superior to the conventional designed coil. The graphs of the coil outputs of B-Field and H-Field are found to be symmetrical, but the symmetry between each coil is pseudo-symmetrical and not accurate. Based on these results, an experiment was conducted to confirm whether the output of the head epidermis through both coils is possible. In the magnitude field of the reverse-coil 2-coil analysis, the maximum output was 3.3920e + 004 H [A_per_meter], and the vector field showed the strongest magnetic field around 35 to 165 degrees. It was confirmed that the magnetic output canceled due to the magnetic output. In the case of the forward 2-coil, a maximum of 3.2348e + 004H [A_per_meter] similar to the reverse coil was observed, but in the case of the vector field, the magnetic output regarding the forward output and the head skin output was confirmed. However, when the height change in the output coil, the magnetic output was reduced.