Neurology Commons^™

Computer-Assisted Planning For Minimally Invasive Anterior Two-Thirds Laser Corpus Callosotomy: A Feasibility Study With Probabilistic Tractography Validation., Vejay N. Vakharia, Rachel E. Sparks, Sjoerd B. Vos, Yarema Bezchlibnyk, Ashesh D. Mehta, Jon T. Willie, Chengyuan Wu, Ashwini Sharan, Sebastien Ourselin, John S Duncan

Department of Neurosurgery Faculty Papers

BACKGROUND: Anterior two-thirds corpus callosotomy is an effective palliative neurosurgical procedure for drug-refractory epilepsy that is most commonly used to treat drop-attacks. Laser interstitial thermal therapy is a novel stereotactic ablative technique that has been utilised as a minimally invasive alternative to resective and disconnective open neurosurgery. Case series have reported success in performing laser anterior two-thirds corpus callosotomy. Computer-assisted planning algorithms may help to automate and optimise multi-trajectory planning for this procedure.

OBJECTIVE: To undertake a simulation-based feasibility study of computer-assisted corpus callostomy planning in comparison with expert manual plans in the same patients.

METHODS: Ten patients were selected …

Musical Expertise Generalizes To Superior Temporal Scaling In A Morse Code Tapping Task, Matthew A. Slayton, Juan L. Romero-Sosa, Katrina Shore, Dean V. Buonomano, Indre Viskontas

Psychology

A key feature of the brain’s ability to tell time and generate complex temporal patterns is its capacity to produce similar temporal patterns at different speeds. For example, humans can tie a shoe, type, or play an instrument at different speeds or tempi—a phenomenon referred to as temporal scaling. While it is well established that training improves timing precision and accuracy, it is not known whether expertise improves temporal scaling, and if so, whether it generalizes across skill domains. We quantified temporal scaling and timing precision in musicians and non-musicians as they learned to tap a Morse code sequence. We …

A Phantom Of The Past: Withdrawal From Meprobamate Presenting With Focal Seizures., Thomas M. Zink, John E. Erickson

Journal of Maine Medical Center

Introduction: Meprobamate (Miltown, Equinil) is a sedative-hypnotic medication that first gained popularity as an anxiolytic and later as a muscle relaxant. It is a major metabolite of the more commonly used muscle relaxant carisoprodol (Soma). In vitro and electroencephalogram studies demonstrated that meprobamate modulates gama-aminobutyric acid (GABA) receptors, similar to barbiturates. Withdrawal from meprobamate manifests in symptoms ranging from mild anxiety to severe autonomic instability and death. Meprobamate is rarely prescribed, but is still given to a small subset of elderly patients.

Clinical findings: In this case of meprobamate withdrawal, the patient initially displayed altered mental status and recurrent seizures …

Toxic Leukoencephalopathy Presenting As Agitation And Social Withdrawal In A Patient With Substance Use Disorder: A Case Report, Andrew R. Beauchesne, Brian F. King

Journal of Maine Medical Center

Introduction: Toxic leukoencephalopathy (TLE) is characterized by damage to myelin of cerebral white matter and is caused by a number of offending agents, including drugs of abuse. The clinical presentation of TLE is variable and not fully understood.

Clinical Findings: A 51-year-old male presented with pneumonia, parapneumonic effusion, and acute kidney injury. His medical course was complicated by neurobehavioral changes, including aggression and social withdrawal.

Diagnoses, interventions, and outcomes: The patient was diagnosed with acute toxic leukoencephalopathy based on diffuse subcortical T2-weighted-fluid-attenuated inversion recovery (T2/FLAIR) on brain MRI, bilateral frontal arrhythmic delta waves on encephalogram, and a …

Small Cell Lung Cancer Presenting With Personality Change, Brian F. King, Heidi Horstman, Katherine Rizzolo

Journal of Maine Medical Center

Introduction: Paraneoplastic limbic encephalitis is a syndrome characterized by autoimmune inflammation of the limbic system in the setting of underlying malignancy. The syndrome presents with acute to subacute neuropsychiatric clinical findings, often before the cancer diagnosis is known.

Clinical Findings: A 57-year-old woman with a 30 pack-year smoking history presented to Maine Medical Center after multiple generalized tonic-clonic seizures. Her family reported periodic odd behavior including confusion, disinhibition, and paranoia--all of which preceded her first seizure by two weeks.

Diagnoses, interventions, and outcomes: MRI brain showed T2/FLAIR signal hyperintensity of the right amygdala and hippocampus with sparing of the right …

Telemedicine For Outpatient Neurosurgical Oncology Care: Lessons Learned For The Future During The Covid-19 Pandemic., Lc Daggubati, Dg Eichberg, Me Ivan, S Hanft, A Mansouri, Rj Komotar, Rs D'Amico, Be Zacharia

Journal Articles

No abstract provided.

The Influence Of Migraine On Driving: Current Understanding, Future Directions, And Potential Implications Of Findings, S. J. Tepper, S. D. Silberstein, N. L. Rosen, R. B. Lipton, E. B. Dennehy, S. A. Dowsett, E. Doty

Journal Articles

© 2019 Eli Lilly and Company. Headache: The Journal of Head and Face Pain published by Wiley Periodicals, Inc. on behalf of American Headache Society Objective: To review the published findings relevant to migraine and driving performance, with an intent to encourage discussion on research which may broaden understanding in this area and help educate healthcare providers and their patients. Background: Motor vehicle crashes result in more than 35,000 deaths and more than 2 million injuries annually in the United States. Migraine is one of the most prevalent diseases in the world, and many symptoms associated with migraine attacks have …

Incorporating Remote Electrical Neuromodulation (Ren) Into Usual Care Reduces Acute Migraine Medication Use: An Open-Label Extension Study, M. J. Marmura, T. Lin, D. Harris, A. Ironi, N. L. Rosen

Journal Articles

© Copyright © 2020 Marmura, Lin, Harris, Ironi and Rosen. Background: A recent randomized controlled study showed that 66.7% (66/99) and 37.4% (37/99) of people undergoing remote electrical neuromodulation (REN), a novel non-pharmacological migraine treatment, achieve pain relief and pain freedom, respectively, at 2 h post-treatment. The participants who completed the 6-weeks double-blind phase of this study were offered to participate in an open-label extension (OLE) with an active REN device. Objective: This study investigated the clinical use of REN, focusing on its potential in reducing the use of acute migraine medications. Methods: The parent study for this open-label extension …

Significance Of Blood And Cerebrospinal Fluid Biomarkers For Alzheimer's Disease: Sensitivity, Specificity And Potential For Clinical Use, C. D'Abramo, L. D'Adamio, L. Giliberto

Journal Articles

No abstract provided.

Mesial Temporal Resection Following Long-Term Ambulatory Intracranial Eeg Monitoring With A Direct Brain-Responsive Neurostimulation System, L. J. Hirsch, E. A. Mirro, V. Salanova, T. C. Witt, C. N. Drees, M. Brown, R. W. Lee, N. Sotudeh, R. I. Kuzniecky, M. J. Morrell, +21 Additional Authors

Journal Articles

No abstract provided.

A Closer Look At The Psychiatric Effects Of Deep Brain Stimulation To Further Guide Treatment Of Refractory Epilepsy: A Focused Review, Latangela Smith

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction: Effective treatment of medically-refractory epilepsy remains a formidable challenge in many patients. The SANTE trial (2010) led to the FDA approval of deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) for the treatment of medically-refractory epilepsy. However, ANT DBS also raised significant mental health concerns. This review will take another look at the psychiatric effects of DBS to more definitively outline the mental health risks and identify additional targets to guide future treatment.

Methods: A search of the clinical literature published between January 1, 1990 and December 31, 2019 was completed. The most relevant papers …

Age And Functional Outcomes Post-Neurologic Insult In Patients Attending Inpatient Rehabilitation, Jonathan Bowman Spt, Elena Crooks Pt, Dpt, Phd, Doug Weeks Phd, Kimberly Honn Phd

2020 Symposium Posters

Introduction

Neurologic insults such as strokes and traumatic brain injuries (TBI) affect over 1 million Americans every year. The lack of current knowledge informing accurate prognoses causes victims and their loved ones distress, and is a focus of much research. The purpose of this study was to determine whether patient age at time of insult could predict change in functional outcomes during inpatient rehabilitation.

Methods

Subjects were patients of an inpatient rehabilitation facility (IRF) post-stroke or TBI. The Functional Independence Measure (FIM) assessed functional independence and cognitive status at admission and discharge from the IRF. The Montebello Rehabilitation Factor Score …

Effect Of Sleep Deprivation And Sleep Recovery On Heart Rate And Heart Rate Variability In Males Versus Females, Abrianna Lochner Spt, Elena Crooks Pt, Dpt, Phd, Myles Gordon Finlay Ba, Julie A. Erwin Ms, Kimberly Honn Phd

2020 Symposium Posters

Introduction

Elevated heart rate (HR) and low HR variability (HRV) are indicators of increased sympathetic tone and cardiovascular risk. Here, we assess the effect of one night of sleep deprivation and a subsequent night of recovery sleep on HR and HRV in healthy males versus females.

Methods

Fifty-nine subjects (29.5±8.5y, n=35 female) completed a 4-day/3-night laboratory study. Subjects had a baseline sleep opportunity (22:00–08:00), followed by 38h of sleep deprivation, and a recovery sleep opportunity (22:00–08:00). EKG was monitored via Holter monitors to measure HR and the pNN50 and rMMSD variables of HRV. Time points used for analyses included 09:00–09:20 …

Letter: Surgical Management Of Brain Tumor Patients In The Covid-19 Era, Be Zacharia, Dg Eichberg, Me Ivan, S Hanft, Ja Boockvar, H Isildak, A Mansouri, Rj Komotar, Rs D'Amico

Journal Articles

No abstract provided.

Negative Sars-Cov-2 Antibody Testing Following Covid-19 Infection In Two Ms Patients Treated With Ocrelizumab, Jr Thornton, A Harel

Journal Articles

No abstract provided.

Central Nervous System Complications Associated With Sars-Cov-2 Infection: Integrative Concepts Of Pathophysiology And Case Reports, S. Najjar, A. Najjar, D. J. Chong, B. K. Pramanik, C. Kirsch, R. Kuzniecky, S. Pacia, S. Azhar

Journal Articles

No abstract provided.

Cerebrovascular Complications Of Covid-19, J. M. Katz, R. B. Libman, J. J. Wang, P. Sanelli, C. G. Filippi, M. Gribko, S. V. Pacia, R. I. Kuzniecky, S. Najjar, S. Azhar

Journal Articles

No abstract provided.

Elevated Matrix Metalloproteinase-9 Levels In Neuronal Extracellular Vesicles In Alzheimer's Disease, D. Gu, F. Liu, M. Meng, L. Zhang, M. L. Gordon, Y. Wang, L. Cai, N. Zhang

Journal Articles

No abstract provided.

Oscillatory Bursting As A Mechanism For Temporal Coupling And Information Coding, I. Tal, S. Neymotin, S. Bickel, P. Lakatos, C. E. Schroeder

Journal Articles

© Copyright © 2020 Tal, Neymotin, Bickel, Lakatos and Schroeder. Even the simplest cognitive processes involve interactions between cortical regions. To study these processes, we usually rely on averaging across several repetitions of a task or across long segments of data to reach a statistically valid conclusion. Neuronal oscillations reflect synchronized excitability fluctuations in ensembles of neurons and can be observed in electrophysiological recordings in the presence or absence of an external stimulus. Oscillatory brain activity has been viewed as sustained increase in power at specific frequency bands. However, this perspective has been challenged in recent years by the notion …

Are We Responding Effectively To Bone Mineral Density Loss And Fracture Risks In People With Epilepsy?, A. S. Miller, V. Ferastraoaru, V. Tabatabaie, T. R. Gitlevich, R. Spiegel, S. R. Haut

Journal Articles

© 2020 The Authors. Epilepsia Open published by Wiley Periodicals Inc. on behalf of International League Against Epilepsy. Objective: A 2007 study performed at Montefiore Medical Center (Bronx, NY) identified high prevalence of reduced bone density in an urban population of patients with epilepsy and suggested that bone mineralization screenings should be regularly performed for these patients. We conducted a long-term follow-up study to determine whether bone mineral density (BMD) loss, osteoporosis, and fractures have been successfully treated or prevented. Methods: In the current study, patients from the 2007 study who had two dual-energy absorptiometry (DXA) scans performed at least …

Fetal Loss And Malformations In The Monead Study Of Pregnant Women With Epilepsy, K. J. Meador, P. B. Pennell, R. C. May, L. Van Marter, T. F. Mcelrath, C. Brown, E. E. Gerard, L. Kalayjian, S. Hwang, R. H. Finnell, +7 Additional Authors

Journal Articles

No abstract provided.

Diagnostic Value Of Electroencephalography With Ten Electrodes In Critically Ill Patients, M. B. Westover, K. Gururangan, M. S. Markert, B. N. Blond, S. Lai, S. Benard, S. Bickel, L. J. Hirsch, J. Parvizi

Journal Articles

No abstract provided.

Neurological Manifestations Of Covid-19 (Sars-Cov-2): A Review, Mu Ahmed, M Hanif, Mj Ali, Ma Haider, D Kherani, Gm Memon, Ah Karim, A Sattar

Journal Articles

No abstract provided.

Acute Seizures Occurring In Association With Sars-Cov-2, S. T. Hwang, A. A. Ballout, U. Mirza, A. N. Sonti, A. Husain, C. Kirsch, R. Kuzniecky, S. Najjar

Journal Articles

© Copyright © 2020 Hwang, Ballout, Mirza, Sonti, Husain, Kirsch, Kuzniecky and Najjar. Seizures are an infrequent and serious neurological complication of SARS-CoV-2 infection, with limited data describing the etiology and the clinical context in which these occur or the associated electrographic and imaging findings. This series details four cases of seizures occurring in patients with COVID-19 with distinct time points, underlying pathology, and proposed physiological mechanisms. An enhanced understanding of seizure manifestations in COVID-19 and their clinical course may allow for earlier detection and improved patient management.

Deep Brain Stimulation For Refractory Obsessive-Compulsive Disorder (Ocd): Emerging Or Established Therapy?, H. Wu, M. Hariz, V. Visser-Vandewalle, L. Zrinzo, V. A. Coenen, S. A. Sheth, C. Bervoets, M. Naesstrom, M. Schulder, B. Nuttin, +45 Additional Authors

Journal Articles

No abstract provided.

Fusiform Superior Cerebellar Artery Aneurysm Treated With Flow Diversion: A Case Report, Y. Serulle, D. Khatri, J. Fletcher, A. Pappas, A. Heidbreder, D. Langer, R. A. Ortiz

Journal Articles

© 2020 Published by Scientific Scholar on behalf of Surgical Neurology International. Background: Fusiform aneurysms of the distal superior cerebellar artery are rare and challenging to treat. Due to the rarity of these lesions, there is little consensus regarding their management. Treatment options have traditionally included parent artery sacrifice with either an endovascular approach or microsurgical clipping. Given the small diameter of the superior cerebellar artery, flow diversion has not been typically considered as a viable treatment option for these aneurysms. Case Description: A 67-year-old female presented complaining of severe sudden onset headache. Noncontrast head CT demonstrated no intracranial hemorrhage. …

Tdp-43 Is Elevated In Plasma Neuronal-Derived Exosomes Of Patients With Alzheimer’S Disease, N. Zhang, D. Gu, M. Meng, M. L. Gordon

Journal Articles

© Copyright © 2020 Zhang, Gu, Meng and Gordon. Background: Recently, TDP-43 has been recognized as a common proteinopathy in the “oldest old” and a neuropathological comorbidity in patients with Alzheimer’s disease (AD). However, since it has a low concentration in cerebrospinal fluid, the presence of TDP-43 in AD is rarely investigated in vivo. Methods: Twenty-four patients with amyloid PET confirmed AD and 15 healthy controls (HCs) were included in this study. TDP-43 level in plasma neuronal-derived exosomes (NDEs) was measured by enzyme-linked immunosorbent assay. Results: TDP-43 level was elevated in patients with AD compared with HCs (median 1.08 ng/ml, …

Simulation Of Status Epilepticus Is Effective Teaching For Junior Neurology Residents, Pankhuri Jha, Navya George, Jeffrey Ratliff

Phase 1

Purpose: Status Epilepticus (SE) represents a potentially fatal neurologic emergency. At Jefferson, acute management of SE falls to the inpatient neurologist, requiring early competency.

Methods: During a 2 week educational “bootcamp”, 9 PGY2 residents participated in a 2 hour simulation of acute SE with two clinical scenarios. Scenarios included a patient with SE requiring adequate benzodiazepine dosing and another with seizures requiring IV anticonvulsant therapy. Prior to and following the simulation, residents took a survey to gauge their knowledge and confidence in managing SE.

Results and Conclusions: There was an increase in the number of residents expressing confidence in their …

Machine Learning Prediction Of Glioblastoma Patient One-Year Survival, Andrew Du '20, Warren Mcgee, Jane Y. Wu

Student Publications & Research

Glioblastoma (GBM) is a grade IV astrocytoma formed primarily from cancerous astrocytes and sustained by intense angiogenesis. GBM often causes non-specific symptoms, creating difficulty for diagnosis. This study aimed to utilize machine learning techniques to provide an accurate one-year survival prognosis for GBM patients using clinical and genomic data from the Chinese Glioma Genome Atlas. Logistic regression (LR), support vector machines (SVM), random forest (RF), and ensemble models were used to identify and select predictors for GBM survival and to classify patients into those with an overall survival (OS) of less than one year and one year or greater. With …

Investigating Aggression In Huntington Disease, Chloe E. Larochelle

Honors Undergraduate Theses

Huntington Disease (HD) is a neurodegenerative disorder that is caused by a CAG trinucleotide repeat expansion in the huntingtin gene. The onset of the disease is defined by the presence of motor deficits, such as chorea. However, cognitive and psychiatric symptoms often develop before motor onset and typically have a larger impact on patient quality of life. Psychiatric symptoms include depression, anxiety, and OCD, but also aggression and irritability, which have been comparatively understudied due to stigma. Currently, treatments to modify these behaviors in premanifest HD patients are not consistently effective and often have side effects, creating a need for …