Case Report: Intramedullary Cervical Spinal Cord Hemangioblastoma with an Evaluation of von Hippel-Lindau Disease

History of Present Illness MO is a 49 year old male with a history of multiple sclerosis who presents with a one year history of progressive numbness in his shoulders bilateral and upper back. The patient describes occasional sharp pains that radiate to his first three fingers on his right hand. He denies weakness, clumsiness, difficulty walking, or bladder/bowel dysfunction. He describes no problems with handwriting, or fine motor skills

An evaluation of neuroplasticity and behavior after deep brain stimulation of the nucleus accumbens in an animal model of depression.

BACKGROUND: Recent interest has demonstrated the nucleus accumbens (NAcc) as a potential target for the treatment of depression with deep brain stimulation (DBS). OBJECTIVE: To demonstrate that DBS of the NAcc is an effective treatment modality for depression and that chemical and structural changes associated with these behavioral changes are markers of neuroplasticity. METHODS: A deep brain stimulator was placed in the NAcc of male Wistar-Kyoto rats. Groups were divided into sham (no stimulation), intermittent (3 h/d for 2 weeks), or continuous (constant stimulation for 2 weeks). Exploratory and anxietylike behaviors were evaluated with the open-field test before and after stimulation. Tissue samples of the prefrontal cortex (PFC) were processed with Western blot analysis of markers of noradrenergic activity that included the noradrenergic synthesizing enzyme tyrosine hydroxylase. Analysis of tissue levels for catecholamines was achieved with high-performance liquid chromatography. Morphological properties of cortical pyramidal neurons were assessed with Golgi-Cox staining. RESULTS: Subjects undergoing intermittent and continuous stimulation of the NAcc exhibited an increase in exploratory behavior and reduced anxietylike behaviors. Tyrosine hydroxylase expression levels were decreased in the PFC after intermittent and continuous DBS, and dopamine and norepinephrine levels were decreased after continuous stimulation. Golgi-Cox staining indicated that DBS increased the length of apical and basilar dendrites in pyramidal neurons of the PFC. CONCLUSION: Deep brain stimulation induces behavioral improvement in and neurochemical and morphological alterations of the PFC that demonstrate changes within the circuitry of the brain different from the target area of stimulation. This observed dendritic plasticity may underlie the therapeutic efficacy of this treatment

Supplementary Material for: Corpus Callosotomy with the CO₂ Laser Suction Device: A Technical Note

<i>Introduction:</i> Patients with symptomatic generalized epilepsy who are not candidates for resections may be considered for corpus callosotomy. <i>Methods:</i> The two patients who were followed in this series underwent resection of the corpus callosum utilizing the OmniGuide CO₂ Laser System. <i>Surgical Technique:</i> The OmniGuide CO₂ Laser Systemcan be used in place of the bipolar electrocautery in a corpus callosotomy to improve midline dissection, decrease the likelihood of entering the ventricle, and improve visualization in the dissection. <i>Conclusion:</i> The OmniGuide CO₂ Laser System is a valuable option when performing a corpus callosotomy

Supplementary Material for: The Rate of Magnetic Resonance Imaging in Patients with Deep Brain Stimulation

<b><i>Background:</i></b> For Parkinson's disease (PD), essential tremor (ET), and dystonia patients with deep brain stimulation (DBS) implants, magnetic resonance imaging (MRI) requires additional safety considerations due to potentially hazardous interactions. <b><i>Objective:</i></b> A propensity-matched cohort of DBS-implanted patients was analyzed to determine the likelihood of needing MRI. <b><i>Methods:</i></b> Patients with new DBS full-system implants (n = 576) were identified in the Truven Health MarketScan® Commercial Claims and Medicare Supplemental Databases (2009-2012). Patients diagnosed with PD, ET, or dystonia and no DBS implant were identified (DBS-indicated patients: n = 11,216). The DBS-indicated patients were continuously enrolled for 4 years and matched for age, gender, and propensity score based on comorbid conditions to DBS-implanted patients (n = 4,878 and 543, respectively). A Kaplan-Meier survival curve of time to first MRI was extrapolated to 10 years. <b><i>Results:</i></b> An estimated 56-57% of DBS-indicated patients need an MRI within 5 years and 66-75% within 10 years after implantation. While 92% of DBS-implanted patients' MRI after implantation was of the head, for DBS-indicated patients, 62% of MRIs were of the body, potentially unrelated to the primary diagnosis. <b><i>Conclusions:</i></b> This analysis highlights the projected utilization of MRI in the DBS population for head and full-body images

A Systematic Literature Review of Dorsal Root Ganglion Neurostimulation for the Treatment of Pain

© 2020 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected]. OBJECTIVE: To conduct a systematic literature review of dorsal root ganglion (DRG) stimulation for pain. DESIGN: Grade the evidence for DRG stimulation. METHODS: An international, interdisciplinary work group conducted a literature search for DRG stimulation. Abstracts were reviewed to select studies for grading. General inclusion criteria were prospective trials (randomized controlled trials and observational studies) that were not part of a larger or previously reported group. Excluded studies were retrospective, too small, or existed only as abstracts. Studies were graded using the modified Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment, the Cochrane Collaborations Risk of Bias assessment, and the US Preventative Services Task Force level-of-evidence criteria. RESULTS: DRG stimulation has Level II evidence (moderate) based upon one high-quality pivotal randomized controlled trial and two lower-quality studies. CONCLUSIONS: Moderate-level evidence supports DRG stimulation for treating chronic focal neuropathic pain and complex regional pain syndrome