Burst spinal cord stimulation for the treatment of cervical dystonia with intractable pain: A pilot study

Shimizu, T.; Maruo, T.; Miura, S.; Kimoto, Y.; Ushio, Y.; Goto, S.; Kishima, H. Burst Spinal Cord Stimulation for the Treatment of Cervical Dystonia with Intractable Pain: A Pilot Study. Brain Sci. 2020, 10, 827

Masked diabetes insipidus in pituitary metastasis from breast cancer after thalamic biopsy: a case report

Hashimoto H., Maruo T., Nakamura M., et al. Masked diabetes insipidus in pituitary metastasis from breast cancer after thalamic biopsy: a case report. Journal of Medical Case Reports 16, 12 (2022); https://doi.org/10.1186/s13256-021-03229-y.Background: Symptomatic pituitary metastasis is rare; furthermore, it can result in diabetes insipidus and panhypopituitarism. Since diabetes insipidus is masked by concurrent panhypopituitarism, it can impede the diagnosis of pituitary dysfunction. Case presentation: A 68-year-old Japanese female suffering from pituitary and thalamic metastases caused by untreated breast cancer, underwent a biopsy targeting the thalamus, not the pituitary. She lacked prebiopsy pituitary dysfunction symptoms; however, these symptoms unexpectedly occurred after biopsy. Diabetes insipidus was masked by corticosteroid insufficiency, and she showed normal urinary output and plasma sodium levels. Upon commencement of glucocorticoid replacement therapy, the symptoms of diabetes insipidus appeared. Conclusions: In this case, thalamic biopsy, as opposed to pituitary biopsy, was performed to preserve pituitary function. However, pituitary dysfunction could not be avoided. Caution is necessary for asymptomatic patients with pituitary metastases as invasive interventions, such as surgery, may induce pituitary dysfunction. Moreover, with respect to masked diabetes insipidus, there is a need to carefully consider pituitary dysfunction to avoid misdiagnosis and delayed treatment

Phase-amplitude coupling between infraslow and high-frequency activities well discriminates between the preictal and interictal states

Hashimoto H., Khoo H.M., Yanagisawa T., et al. Phase-amplitude coupling between infraslow and high-frequency activities well discriminates between the preictal and interictal states. Scientific Reports 11, 17405 (2021); https://doi.org/10.1038/s41598-021-96479-1.Infraslow activity (ISA) and high-frequency activity (HFA) are key biomarkers for studying epileptic seizures. We aimed to elucidate the relationship between ISA and HFA around seizure onset. We enrolled seven patients with drug-resistant focal epilepsy who underwent intracranial electrode placement. We comparatively analyzed the ISA, HFA, and ISA-HFA phase-amplitude coupling (PAC) in the seizure onset zone (SOZ) or non-SOZ (nSOZ) in the interictal, preictal, and ictal states. We recorded 15 seizures. HFA and ISA were larger in the ictal states than in the interictal or preictal state. During seizures, the HFA and ISA of the SOZ were larger and occurred earlier than those of nSOZ. In the preictal state, the ISA-HFA PAC of the SOZ was larger than that of the interictal state, and it began increasing at approximately 87 s before the seizure onset. The receiver-operating characteristic curve revealed that the ISA-HFA PAC of the SOZ showed the highest discrimination performance in the preictal and interictal states, with an area under the curve of 0.926. This study demonstrated the novel insight that ISA-HFA PAC increases before the onset of seizures. Our findings indicate that ISA-HFA PAC could be a useful biomarker for discriminating between the preictal and interictal states

Phase-amplitude coupling of ripple activities during seizure evolution with theta phase

Hashimoto H., Khoo H.M., Yanagisawa T., et al. Phase-amplitude coupling of ripple activities during seizure evolution with theta phase. Clinical Neurophysiology 132, 1243 (2021); https://doi.org/10.1016/j.clinph.2021.03.007.Objective: High-frequency activities (HFAs) and phase-amplitude coupling (PAC) are key neurophysiological biomarkers for studying human epilepsy. We aimed to clarify and visualize how HFAs are modulated by the phase of low-frequency bands during seizures. Methods: We used intracranial electrodes to record seizures of focal epilepsy (12 focal-to-bilateral tonic-clonic seizures and three focal-aware seizures in seven patients). The synchronization index, representing PAC, was used to analyze the coupling between the amplitude of ripples (80–250 Hz) and the phase of lower frequencies. We created a video in which the intracranial electrode contacts were scaled linearly to the power changes of ripple. Results: The main low frequency band modulating ictal-ripple activities was the θ band (4–8 Hz), and after completion of ictal-ripple burst, δ (1–4 Hz)-ripple PAC occurred. The ripple power increased simultaneously with rhythmic fluctuations from the seizure onset zone, and spread to other regions. Conclusions: Ripple activities during seizure evolution were modulated by the θ phase. The PAC phenomenon was visualized as rhythmic fluctuations. Significance: Ripple power associated with seizure evolution increased and spread with fluctuations. The θ oscillations related to the fluctuations might represent the common neurophysiological processing involved in seizure generation

Silicate Microfiber Scaffolds Support the Formation and Expansion of the Cortical Neuronal Layer of Cerebral Organoids With a Sheet-Like Configuration

Terada Eisaku, Bamba Yohei, Takagaki Masatoshi, et al. Silicate Microfiber Scaffolds Support the Formation and Expansion of the Cortical Neuronal Layer of Cerebral Organoids With a Sheet-Like Configuration. Stem Cells Translational Medicine 9, 519 (2023); https://doi.org/10.1093/stcltm/szad066.Cerebral organoids (COs) are derived from human-induced pluripotent stem cells in vitro and mimic the features of the human fetal brain. The development of COs is largely dependent on “self-organization” mechanisms, in which differentiating cells committed to cortical cells autonomously organize into the cerebral cortex-like tissue. However, extrinsic manipulation of their morphology, including size and thickness, remains challenging. In this study, we discovered that silicate microfiber scaffolds could support the formation of cortical neuronal layers and successfully generated cortical neuronal layers, which are 9 times thicker than conventional COs, in 70 days. These cortical neurons in the silicate microfiber layer were differentiated in a fetal brain-like lamination pattern. While these cellular characteristics such as cortical neurons and neural stem/progenitor cells were like those of conventional COs, the cortical neuronal layers were greatly thickened in sheet-like configuration. Moreover, the cortical neurons in the scaffolds showed spontaneous electrical activity. We concluded that silicate microfiber scaffolds support the formation of the cortical neuronal layers of COs without disturbing self-organization-driven corticogenesis. The extrinsic manipulation of the formation of the cortical neuronal layers of COs may be useful for the research of developmental mechanisms or pathogenesis of the human cerebral cortex, particularly for the development of regenerative therapy and bioengineering

Coupling between infraslow activities and high-frequency oscillations precedes seizure onset

Hashimoto H., Khoo H.M., Yanagisawa T., et al. Coupling between infraslow activities and high-frequency oscillations precedes seizure onset. Epilepsia Open 5, 501 (2020); https://doi.org/10.1002/epi4.12425.Infraslow activities and high-frequency oscillations (HFOs) are observed in seizure-onset zones. However, the relation between them remains unclear. In this study, we investigated phase-amplitude coupling between infraslow phase (0.016-1 Hz) and HFOs' amplitude of focal impaired awareness seizures followed by focal to bilateral tonic-clonic seizures, in a 28-year-old right-handed man with a dysembryoplastic neuroepithelial tumor. We recorded five habitual seizures. After the time of seizure onset, a significant increase in the power of HFOs was observed, and the power was significantly coupled with θ (4-8 Hz) phase. In contrast, coupling of infraslow activities and HFOs surged a few minutes before the seizure-onset time, and ictal HFOs discharged after that. Collectively, our results show that coupling of infraslow activities and HFOs precedes the seizure-onset time. We infer that such coupling may be a potential biomarker for seizure prediction

Frequency band coupling with high-frequency activities in tonic-clonic seizures shifts from θ to δ band

Hashimoto H., Khoo H.M., Yanagisawa T., et al. Frequency band coupling with high-frequency activities in tonic-clonic seizures shifts from θ to δ band. Clinical Neurophysiology 137, 122 (2022); https://doi.org/10.1016/j.clinph.2022.02.015.Objective: To clarify variations in the relationship between high-frequency activities (HFAs) and low-frequency bands from the tonic to the clonic phase in focal to bilateral tonic-clonic seizures (FBTCS), using phase-amplitude coupling. Methods: This retrospective study enrolled six patients with drug-resistant focal epilepsy who underwent intracranial electrode placement at Osaka University Hospital (July 2018–July 2019). We recorded 11 FBTCS. The synchronization index (SI) and receiver-operating characteristic (ROC) analysis were used to analyze the coupling between HFA amplitude (80–250 Hz) and lower frequencies phase. Results: In the tonic phase, the θ (4–8 Hz)-HFA coupling peaked, and the HFA power occurred at baseline (0 μV) of θ oscillations. In contrast, in the clonic phase, the δ (2–4 Hz)-HFA coupling peaked, and the HFA power occurred at the trough of δ oscillations. ROC analysis indicated that the δ-HFA SI discriminated well the clonic from the tonic phase. Conclusions: The main low-frequency band modulating the HFA shifted from the θ band in the tonic phase to the δ band in the clonic phase. Significance: Neurophysiological key frequency bands were implied to be the θ band and δ band in tonic and clonic seizures, respectively, which improves our understanding of FBTCS

BCI training to move a virtual hand reduces phantom limb pain: A randomized crossover trial

Objective: To determine whether training with a brain–computer interface (BCI) to control an image of a phantom hand, which moves based on cortical currents estimated from magnetoencephalographic signals, reduces phantom limb pain. Methods: Twelve patients with chronic phantom limb pain of the upper limb due to amputation or brachial plexus root avulsion participated in a randomized single-blinded crossover trial. Patients were trained to move the virtual hand image controlled by the BCI with a real decoder, which was constructed to classify intact hand movements from motor cortical currents, by moving their phantom hands for 3 days (“real training”). Pain was evaluated using a visual analogue scale (VAS) before and after training, and at follow-up for an additional 16 days. As a control, patients engaged in the training with the same hand image controlled by randomly changing values (“random training”). The 2 trainings were randomly assigned to the patients. This trial is registered at UMIN-CTR (UMIN000013608). Results: VAS at day 4 was significantly reduced from the baseline after real training (mean [SD], 45.3 [24.2]–30.9 [20.6], 1/100 mm; p = 0.009 0.025). Compared to VAS at day 1, VAS at days 4 and 8 was significantly reduced by 32% and 36%, respectively, after real training and was significantly lower than VAS after random training (p < 0.01). Conclusion: Three-day training to move the hand images controlled by BCI significantly reduced pain for 1 week. Classification of evidence: This study provides Class III evidence that BCI reduces phantom limb pain

Appearance of fluid content in Rathke’s cleft cyst is associated with clinical features and postoperative recurrence rates

The version of record of this article, first published in Pituitary, is available online at Publisher’s website: https://doi.org/10.1007/s11102-024-01395-y.Purpose: The contents of Rathke’s cleft cysts (RCCs) vary from clear and slightly viscous to purulent. Surgical treatment of symptomatic RCCs involves removing the cyst contents, whereas additional cyst-wall opening to prevent reaccumulation is at the surgeon’s discretion. The macroscopic findings of the cyst content can reflect the nature of RCCs and would aid in surgical method selection. Methods: We retrospectively reviewed the records of 42 patients with symptomatic RCCs who underwent transsphenoidal surgery at our institute between January 2010 and March 2022. According to the intraoperative findings, cyst contents were classified into type A (purulent), type B (turbid white with mixed semisolids), or type C (clear and slightly viscous). Clinical and imaging findings and early recurrence rate (within two years) were compared according to the cyst content type. Results: There were 42 patients classified into three types. Patients with type C were the oldest (65.4 ± 10.4 years), and type A included more females (92.9%). For magnetic resonance imaging, type-A patients showed contrast-enhanced cyst wall (92.9%), type-B patients had intracystic nodules (57.1%), and all type-C patients showed low T1 and high T2 intensities with larger cyst volumes. Fewer asymptomatic patients had type C. Preoperative pituitary dysfunction was most common in type A (71.4%). Early recurrence was observed in types A and C, which were considered candidates for cyst-wall opening. Conclusion: The clinical characteristics and surgical prognosis of RCCs depend on the nature of their contents

A Swallowing Decoder Based on Deep Transfer Learning: AlexNet Classification of the Intracranial Electrocorticogram

Electronic version of an article published as International Journal of Neural Systems, 31(11), 2021, 2050056. https://doi.org/10.1142/S0129065720500562 © 2021 World Scientific Publishing Company. https://www.worldscientific.com/worldscinet/ijnsTo realize a brain-machine interface to assist swallowing, neural signal decoding is indispensable. Eight participants with temporal-lobe intracranial electrode implants for epilepsy were asked to swallow during electrocorticogram (ECoG) recording. Raw ECoG signals or certain frequency bands of the ECoG power were converted into images whose vertical axis was electrode number and whose horizontal axis was time in milliseconds, which were used as training data. These data were classified with four labels (Rest, Mouth open, Water injection, and Swallowing). Deep transfer learning was carried out using AlexNet, and power in the high-γ band (75-150Hz) was the training set. Accuracy reached 74.01%, sensitivity reached 82.51%, and specificity reached 95.38%. However, using the raw ECoG signals, the accuracy obtained was 76.95%, comparable to that of the high-γ power. We demonstrated that a version of AlexNet pre-trained with visually meaningful images can be used for transfer learning of visually meaningless images made up of ECoG signals. Moreover, we could achieve high decoding accuracy using the raw ECoG signals, allowing us to dispense with the conventional extraction of high-γ power. Thus, the images derived from the raw ECoG signals were equivalent to those derived from the high-γ band for transfer deep learning