407 research outputs found
Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease
Background: Although the short-term benefits of bilateral stimulation of the subthalamic nucleus in patients with advanced Parkinson's disease have been well documented, the long-term outcomes of the procedure are unknown.
Methods: We conducted a five-year prospective study of the first 49 consecutive patients whom we treated with bilateral stimulation of the subthalamic nucleus. Patients were assessed at one, three, and five years with levodopa (on medication) and without levodopa (off medication), with use of the Unified Parkinson's Disease Rating Scale. Seven patients did not complete the study: three died, and four were lost to follow-up.
Results: As compared with base line, the patients' scores at five years for motor function while off medication improved by 54 percent (P<0.001) and those for activities of daily living improved by 49 percent (P<0.001). Speech was the only motor function for which off-medication scores did not improve. The scores for motor function on medication did not improve one year after surgery, except for the dyskinesia scores. On-medication akinesia, speech, postural stability, and freezing of gait worsened between year 1 and year 5 (P<0.001 for all comparisons). At five years, the dose of dopaminergic treatment and the duration and severity of levodopa-induced dyskinesia were reduced, as compared with base line (P<0.001 for each comparison). The average scores for cognitive performance remained unchanged, but dementia developed in three patients after three years. Mean depression scores remained unchanged. Severe adverse events included a large intracerebral hemorrhage in one patient. One patient committed suicide.
Conclusions: Patients with advanced Parkinson's disease who were treated with bilateral stimulation of the subthalamic nucleus had marked improvements over five years in motor function while off medication and in dyskinesia while on medication. There was no control group, but worsening of akinesia, speech, postural stability, freezing of gait, and cognitive function between the first and the fifth year is consistent with the natural history of Parkinson's disease
Hollow-Core Fiber-Based Biosensor: A Platform for Lab-in-Fiber Optical Biosensors for DNA Detection
In this paper, a novel platform for lab-in-fiber-based biosensors is studied. Hollow-core tube lattice fibers (HC-TLFs) are proposed as a label-free biosensor for the detection of DNA molecules. The particular light-guiding mechanism makes them a highly sensitive tool. Their transmission spectrum is featured by alternations of high and low transmittance at wavelength regions whose values depend on the thickness of the microstructured web composing the cladding around the hollow core. In order to achieve DNA detection by using these fibers, an internal chemical functionalization process of the fiber has been performed in five steps in order to link specific peptide nucleic acid (PNA) probes, then the functionalized fiber was used for a three-step assay. When a solution containing a particular DNA sequence is made to flow through the HC of the TLF in an ‘optofluidic’ format, a bio-layer is formed on the cladding surfaces causing a red-shift of the fiber transmission spectrum. By comparing the fiber transmission spectra before and after the flowing it is possible to identify the eventual formation of the layer and, therefore, the presence or not of a particular DNA sequence in the solution
Integrated liquid-core optical fibers --- ultra-efficient nonlinear liquid photonics
We have developed a novel integrated platform for liquid photonics based on
liquid core optical fiber (LCOF). The platform is created by fusion splicing
liquid core optical fiber to standard single-mode optical fiber making it fully
integrated and practical - a major challenge that has greatly hindered progress
in liquid-photonic applications. As an example, we report here the realization
of ultralow threshold Raman generation using an integrated CS2 filled LCOF
pumped with sub-nanosecond pulses at 1064nm and 532nm. The measured energy
threshold for the Stokes generation is ~ 1nJ, about three orders of magnitude
lower than previously reported values in the literature for hydrogen gas. The
integrated LCOF platform opens up new possibilities for ultralow power
nonlinear optics such as efficient white light generation for displays, mid-IR
generation, slow light generation, parametric amplification, all-optical
switching and wavelength conversion using liquids that have orders of magnitude
larger optical nonlinearities compared with silica glass.Comment: 4 pages, 3 figure
Desynchronizing effect of high-frequency stimulation in a generic cortical network model
Transcranial Electrical Stimulation (TCES) and Deep Brain Stimulation (DBS)
are two different applications of electrical current to the brain used in
different areas of medicine. Both have a similar frequency dependence of their
efficiency, with the most pronounced effects around 100Hz. We apply
superthreshold electrical stimulation, specifically depolarizing DC current,
interrupted at different frequencies, to a simple model of a population of
cortical neurons which uses phenomenological descriptions of neurons by
Izhikevich and synaptic connections on a similar level of sophistication. With
this model, we are able to reproduce the optimal desynchronization around
100Hz, as well as to predict the full frequency dependence of the efficiency of
desynchronization, and thereby to give a possible explanation for the action
mechanism of TCES.Comment: 9 pages, figs included. Accepted for publication in Cognitive
Neurodynamic
All-fiber broadband spectral acousto-optic modulation of a tubular-lattice hollow-core optical fiber
We demonstrate a broadband acousto-optic notch filter based on a
tubular-lattice hollow-core fiber for the first time. The guided optical modes
are modulated by acoustically induced dynamic long-period gratings along the
fiber. The device is fabricated employing a short interaction length (7.7 cm)
and low drive voltages (10 V). Modulated spectral bands with 20 nm half-width
and maximum depths greater than 60 % are achieved. The resonant notch
wavelength is tuned from 743 to 1355 nm (612 nm span) by changing the frequency
of the electrical signal. The results indicate a broader tuning range compared
to previous studies using standard and hollow-core fibers. It further reveals
unique properties for reconfigurable spectral filters and fiber lasers,
pointing to the fast switching and highly efficient modulation of all-fiber
photonic devices
Aggravated stuttering following subthalamic deep brain stimulation in Parkinson's disease - two cases
Stuttering is a speech disorder with disruption of verbal fluency which is occasionally present in patients with Parkinson's disease (PD). Long-term medical management of PD is frequently complicated by fluctuating motor functions and dyskinesias. High-frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment of motor fluctuations and is the most common surgical procedure in PD. Here we report the re-occurrence and aggravation of stuttering following STN-DBS in two male patients treated for advanced PD. In both patients the speech fluency improved considerably when the neurostimulator was turned off, indicating that stuttering aggravation was related to neurostimulation of the STN itself, its afferent or efferent projections and/or to structures localized in the immediate proximity. This report supports previous studies demonstrating that lesions of the basal ganglia-thalamocortical motor circuit, including the STN, is involved in the development of stuttering. In advanced PD STN-DBS is generally an effective and safe treatment. However, patients with PD and stuttering should be informed about the risk of aggravated symptoms following surgical therapy
Subthalamic nucleus deep brain stimulation in elderly patients – analysis of outcome and complications
BACKGROUND: There is an ongoing discussion about age limits for deep brain stimulation (DBS). Current indications for DBS are tremor-dominant disorders, Parkinson's disease, and dystonia. Electrode implantation for DBS with analgesia and sedation makes surgery more comfortable, especially for elderly patients. However, the value of DBS in terms of benefit-risk ratio in this patient population is still uncertain. METHODS: Bilateral electrode implantation into the subthalamic nucleus (STN) was performed in a total of 73 patients suffering from Parkinson's disease. Patients were analyzed retrospectively. For this study they were divided into two age groups: group I (age <65 years, n = 37) and group II (age ≥ 65 years, n = 36). Examinations were performed preoperatively and at 6-month follow-up intervals for 24 months postoperatively. Age, UPDRS motor score (part III) on/off, Hoehn & Yahr score, Activity of Daily Living (ADL), L-dopa medication, and complications were determined. RESULTS: Significant differences were found in overall performance determined as ADL scores (group I: 48/71 points, group II: 41/62 points [preoperatively/6-month postoperatively]) and in the rate of complications (group I: 4 transient psychosis, 4 infections in a total of 8 patients, group II: 2 deaths [unrelated to surgery], 1 intracerebral hemorrhage, 7 transient psychosis, 3 infections, 2 pneumonia in a total of 13 patients), (p < 0.05). Interestingly, changes in UPDRS scores, Hoehn & Yahr scores, and L-dopa medication were not statistically different between the two groups. CONCLUSION: DBS of the STN is clinically as effective in elderly patients as it is in younger ones. However, a more careful selection and follow-up of the elderly patients are required because elderly patients have a higher risk of surgery-related complications and a higher morbidity rate
Evanescent light-matter Interactions in Atomic Cladding Wave Guides
Alkali vapors, and in particular rubidium, are being used extensively in
several important fields of research such as slow and stored light non-linear
optics3 and quantum computation. Additionally, the technology of alkali vapors
plays a major role in realizing myriad industrial applications including for
example atomic clocks magentometers8 and optical frequency stabilization.
Lately, there is a growing effort towards miniaturizing traditional
centimeter-size alkali vapor cells. Owing to the significant reduction in
device dimensions, light matter interactions are greatly enhanced, enabling new
functionalities due to the low power threshold needed for non-linear
interactions. Here, taking advantage of the mature Complimentary
Metal-Oxide-Semiconductor (CMOS) compatible platform of silicon photonics, we
construct an efficient and flexible platform for tailored light vapor
interactions on a chip. Specifically, we demonstrate light matter interactions
in an atomic cladding wave guide (ACWG), consisting of CMOS compatible silicon
nitride nano wave-guide core with a Rubidium (Rb) vapor cladding. We observe
the highly efficient interaction of the electromagnetic guided mode with the
thermal Rb cladding. The nature of such interactions is explained by a model
which predicts the transmission spectrum of the system taking into account
Doppler and transit time broadening. We show, that due to the high confinement
of the optical mode (with a mode area of 0.3{\lambda}2), the Rb absorption
saturates at powers in the nW regime.Comment: 10 Pages 4 Figures. 1 Supplementar
Deep Brain Stimulation in Anorexia Nervosa: Hope for the Hopeless or Exploitation of the Vulnerable? The Oxford Neuroethics Gold Standard Framework
Neurosurgical interventions for psychiatric disorders have a long and troubled history (1, 2) but have become much more refined in the last few decades due to the rapid development of neuroimaging and robotic technologies (2). These advances have enabled the design of less invasive techniques, which are more focused, such as deep brain stimulation (DBS) (3). DBS involves electrode insertion into specific neural targets implicated in pathological behavior, which are then repeatedly stimulated at adjustable frequencies. DBS has been used for Parkinson's disease and movement disorders since the 1960s (4-6) and over the last decade has been applied to treatment-refractory psychiatric disorders, with some evidence of benefit in obsessive-compulsive disorder (OCD), major depressive disorder, and addictions (7). Recent consensus guidelines on best practice in psychiatric neurosurgery (8) stress, however, that DBS for psychiatric disorders remains at an experimental and exploratory stage. The ethics of DBS-in particular for psychiatric conditions-is debated (1, 8-10). Much of this discourse surrounds the philosophical implications of competence, authenticity, personality, or identity change following neurosurgical interventions, but there is a paucity of applied guidance on neuroethical best practice in psychiatric DBS, and health-care professionals have expressed that they require more (11). This paper aims to redress this balance by providing a practical, applied neuroethical gold standard framework to guide research ethics committees, researchers, and institutional sponsors. We will describe this as applied to our protocol for a particular research trial of DBS in severe and enduring anorexia nervosa (SE-AN) (https://clinicaltrials.gov/ct2/show/NCT01924598, unique identifier NCT01924598), but believe it may have wider application to DBS in other psychiatric disorders
A torque-based method demonstrates increased rigidity in Parkinson’s disease during low-frequency stimulation
Low-frequency oscillations in the basal ganglia are prominent in patients with Parkinson’s disease off medication. Correlative and more recent interventional studies potentially implicate these rhythms in the pathophysiology of Parkinson’s disease. However, effect sizes have generally been small and limited to bradykinesia. In this study, we investigate whether these effects extend to rigidity and are maintained in the on-medication state. We studied 24 sides in 12 patients on levodopa during bilateral stimulation of the STN at 5, 10, 20, 50, 130 Hz and in the off-stimulation state. Passive rigidity at the wrist was assessed clinically and with a torque-based mechanical device. Low-frequency stimulation at ≤20 Hz increased rigidity by 24 % overall (p = 0.035), whereas high-frequency stimulation (130 Hz) reduced rigidity by 18 % (p = 0.033). The effects of low-frequency stimulation (5, 10 and 20 Hz) were well correlated with each other for both flexion and extension (r = 0.725 ± SEM 0.016 and 0.568 ± 0.009, respectively). Clinical assessments were unable to show an effect of low-frequency stimulation but did show a significant effect at 130 Hz (p = 0.002). This study provides evidence consistent with a mechanistic link between oscillatory activity at low frequency and Parkinsonian rigidity and, in addition, validates a new method for rigidity quantification at the wrist
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