Multimodales physiologisches Monitoring während einer Motor Imagery-Aufgabe mit BCI-gesteuertem haptischem Feedback

Aufgrund der durch erworbene Hirnschädigungen hervorgerufenen, zunehmenden Zahl an Patienten mit schweren motorischen Einschränkungen nehmen die Erwartungen an die Rehabilitation zu. Hierbei wird seit einigen Jahren ein experimentelles Therapiekonzept aus Motor Imagery (MI), Brain Computer Interfaces (BCI) und Neurofeedback (NFB) evaluiert. Da die bisherigen funktionellen Ergebnisse die Erwartungen noch nicht erfüllen, ist es nötig, die physiologischen Vorgänge während des Trainings mittels geeigneter objektivierbarer Messparameter möglichst genau zu erfassen, um dieses Behandlungskonzept verbessern zu können. Das wesentliche Anliegen dieser Arbeit war es dabei, objektivierbare, physiologische Parameter bzw. kortikale Aktivitäts-Muster bei diesem neuartigen Therapieverfahren aus MI, BCI und NFB zu untersuchen. Dabei sollte auch untersucht werden, inwieweit diese Parameter Aufschluss über die Klassifizierungsgenauigkeit (Classification Accuracy, CA) während der Aufgabendurchführung geben können. Zur Beantwortung der Fragestellung stellten sich 30 gesunde Probanden eine Fingerextension ihrer linken Hand vor und erhielten BCI-vermittelt über eine robotische Handorthese ein haptisches Feedback dieser Bewegungsvorstellung. Währenddessen wurden Hirnsignale (EEG), Herzaktivität (EKG), Blinzelrate (EOG) und Hautleitwiderstand (EDA) als physiologische Marker erhoben. Die Auswertung dieser ergab, dass v.a. die Hirnaktivität den anderen Parametern überlegen war und besonderen Aufschluss über die versuchsbegleitende Physiologie liefern konnte. So konnten einerseits eine fronto-occipital lokalisierte Aufmerksamkeitskomponente (P300- und MRCP-Peak) und andererseits eine parietal-prämotorisch lokalisierte, sensorimotorische Feedbackkomponente nachgewiesen werden. Das Motor-related cortical potential (MRCP) korrelierte darüber hinaus mit der CA und kann damit als Indikator für die Anforderung und Anstrengung, die der jeweilige Proband bei dieser Trainingsaufgabe aufbringen muss, dienen. Schlussfolgernd kann die Erfassung bestimmter EEG-Parametern als geeignete Methode zur Anpassung der Aufgabenschwierigkeit eines Trainings aus MI, BCI und NFB angesehen werden und so ggf. zur Verbesserung der Rehabilitation nach Hirnschädigung beitragen

Trading mental and physical health in vestibular schwannoma treatment decision

ObjectiveObservation, radiotherapy and surgery are treatment options in vestibular schwannomas (VS). Decision making differs between centers and is usually based on tumor characteristics (e.g., size) and the expected physical health (PH) outcome (i.e., hearing and facial function). However, mental health (MH) is often under-reported. The objective of the present study was to ascertain the impact of VS treatment on PH and MH.MethodsPH and MH were assessed in a prospective cross-sectional study including 226 patients with unilateral sporadic VS before and after surgical removal (SURG). Quality-of-life (QoL) was estimated by self-rating questionnaires: general Short-Form Health Survey (SF-36), Penn Acoustic Neuroma Quality-of-Life Scale (PANQOL), Dizziness Handicap Inventory (DHI), Hearing Handicap Inventory (HHI), Tinnitus Handicap Inventory (THI), and Facial Disability Index (FDI). QoL changes over time as well as predictive factors were accessed by multivariate analyses of covariance (MANCOVA).ResultsIn total, 173 preoperative and 80 postoperative questionnaires were analyzed. There was a significant PH deterioration related to facial function (FDI, PANQOL-face) after surgery. In line with facial rehabilitation, however, FDI improved within the first five years after surgery and did not differ compared to the preoperative patient cohort, eventually. In contrast, MH (i.e., PANQOL-anxiety) and general health (i.e., PANQOL-GH) improved with surgery and correlated with the extent-of-resection.ConclusionPhysical and mental health is significantly influenced by VS surgery. While PH might decrease after surgery, MH potentially increases when patient is cured. Practitioners should take MH into account before advising an incompletely VS treatment (e.g., subtotal resection, observation or radiosurgery)

Association of extent of resection on recurrence-free survival and functional outcome in vestibular schwannoma of the elderly

BackgroundDespite the ongoing debate on the risk–benefit ratio of vestibular schwannoma (VS) treatment options, watchful observation and radiation are usually favored in the elderly (>65 years). If surgery is inevitable, a multimodal approach after deliberate subtotal resection has been described as a valid option. The relationship between the extent of resection (EOR) of surgical and functional outcomes and recurrence-free survival (RFS) remains unclear. This present study aims to evaluate the functional outcome and RFS of the elderly in relation to the EOR.MethodsThis matched cohort study analyzed all consecutive elderly VS patients treated at a tertiary referral center since 2005. A separate cohort (<65 years) served as a matched control group (young). Clinical status was assessed by the Charlson Comorbidity Index (CCI), the Karnofsky Performance (KPS), and the Gardner and Robertson (GR) and House & Brackmann (H&B) scales. RFS was evaluated by Kaplan–Meier analysis using contrast-enhanced magnetic resonance imaging to identify tumor recurrence.ResultsAmong 2,191 patients, 296 (14%) patients were classified as elderly, of whom 133 (41%) were treated surgically. The elderly were characterized by a higher preoperative morbidity and worse gait uncertainty. Postoperative mortality (0.8% and 1%), morbidity (13% and 14%), and the functional outcome (G&R, H&B, and KPS) did not differ between the elderly and the young. There was a significant benefit in regard to the preoperative imbalance. Gross total resection (GTR) was accomplished in 74% of all cases. Lower grades of the EOR (subtotal and decompressive surgery) raised the incidence of recurrence significantly. Mean time to recurrence in the surgELDERLY was 67.33 ± 42.02 months and 63.2 ± 70.98 months in the surgCONTROL.ConclusionsSurgical VS treatment aiming for complete tumor resection is feasible and safe, even in advanced age. A higher EOR is not associated with cranial nerve deterioration in the elderly compared to the young. In contrast, the EOR determines RFS and the incidence of recurrence/progression in both study cohorts. If surgery is indicated in the elderly, GTR can be intended safely, and if only subtotal resection is achieved, further adjuvant therapy, e.g., radiotherapy, should be discussed in the elderly, as the incidence of recurrence is not significantly lower compared to the young