Weight Gain Is Associated with Medial Contact Site of Subthalamic Stimulation in Parkinson's Disease

The aim of our study was to assess changes in body-weight in relation to active electrode contact position in the subthalamic nucleus. Regular body weight measurements were done in 20 patients with advanced Parkinson's disease within a period of 18 months after implantation. T1-weighted (1.5T) magnetic resonance images were used to determine electrode position in the subthalamic nucleus and the Unified Parkinson's disease rating scale (UPDRS-III) was used for motor assessment. The distance of the contacts from the wall of the third ventricle in the mediolateral direction inversely correlated with weight gain (r = −0.55, p<0.01) and with neurostimulation-related motor condition expressed as the contralateral hemi-body UPDRS-III (r = −0.42, p<0.01). Patients with at least one contact within 9.3 mm of the wall experienced significantly greater weight gain (9.4±(SD)4.4 kg, N = 11) than those with both contacts located laterally (3.9±2.7 kg, N = 9) (p<0.001). The position of the active contact is critical not only for motor outcome but is also associated with weight gain, suggesting a regional effect of subthalamic stimulation on adjacent structures involved in the central regulation of energy balance, food intake or reward

Characteristics of ammonia, acid gases, and PM_2.5 for three typical land-use types in the North China Plain

Air pollution is one of the most serious environmental problems in China due to its rapid economic development alongside a very large consumption of fossil fuel, particularly in the North China Plain (NCP). During the period 2011–2014, we integrated active and passive sampling methods to perform continuous measurements of NH3, HNO3, NO2, and PM2.5 at two urban, one suburban, and two rural sites in the NCP. The annual average concentrations of NH3, NO2, and HNO3 across the five sites were in the ranges 8.5–23.0, 22.2–50.5, and 5.5–9.7 μg m−3, respectively, showing no significant spatial differences for NH3 and HNO3 but significantly higher NO2 concentration at the urban sites. At each site, annual average concentrations of NH3 and NO2 showed increasing and decreasing trends, respectively, while there was no obvious trend in annual HNO3 concentrations. Daily PM2.5 concentrations ranged from 11.8 to 621.0 μg m−3 at the urban site, from 19.8 to 692.9 μg m−3 at the suburban site, and from 23.9 to 754.5 μg m−3 at the two rural sites, with more than 70 % of sampling days exceeding 75 μg m−3. Concentrations of water-soluble ions in PM2.5 ranked differently between the non-rural and rural sites. The three dominant ions were NH4 +, NO3 −, and SO4 2− and mainly existed as (NH4)2SO4, NH4HSO4, and NH4NO3, and their concentrations averaged 48.6 ± 44.9, 41.2 ± 40.8, and 49.6 ± 35.9 μg m−3 at the urban, suburban, and rural sites, respectively. Ion balance calculations indicated that PM2.5 was neutral at the non-rural sites but acidic at the rural sites. Seasonal variations of the gases and aerosols exhibited different patterns, depending on source emission strength and meteorological conditions. Our results suggest that a feasible pathway to control PM2.5 pollution in the NCP should target ammonia and acid gases together

Changes in background electroencephalography and regional cerebral glucose metabolism in focal epilepsy patients after 1-month administration of levetiracetam

Seong Hoon Kim,1,* Sung-Chul Lim,1,2,* Woojun Kim,1,2 Oh-hun Kwon,3 Chan Mi Kim,3 Jong-Min Lee,3 Young-Min Shon1,2 1Department of Neurology, 2Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea; 3Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea *These authors contributed equally to this work Abstract: The antiseizure efficacy and safety of levetiracetam (LEV) is well documented; however, few clinical studies have investigated the predictability of patient responsiveness to LEV, especially when the drug is first administered. The aim of this study was to ascertain the utility of clinical, electrophysiological, and neuroimaging parameters for assessing the early response to LEV treatment in focal epilepsy patients. Twelve confirmed focal epilepsy patients were included who had never taken LEV before. At baseline and 1 month after LEV administration, all subjects underwent 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and electroencephalography (EEG), and completed the Quality of Life in Epilepsy questionnaire (QOLIE-31). Participants were divided by drug response: good versus poor. The good response group (seven subjects) was defined by a &gt;50% decrease in seizure frequency compared to baseline (3 months before LEV intake). The other five participants with a &lt;50% decrease in seizure frequency were placed into the poor response group. We compared the differential changes in brain glucose metabolism on FDG-PET, power spectrum on the EEG, and QOLIE-31 results between the two groups after a 1-month LEV trial. In the good response group, it was possible to identify brain regions with increased glucose metabolism, including the bilateral caudate nuclei and both frontal and left parietal regions (uncorrected P&lt;0.005). In the poor response group, FDG-PET did not reveal any areas with significantly increased glucose metabolism. In the good response group, spectral EEG analysis revealed decreased delta power (1&ndash;3 Hz, P&lt;0.05) in the parietal region and increased beta1 power (13&ndash;19 Hz, P&lt;0.05) in the frontal region, whereas no significant changes were observed in the poor response group. There were no significant changes on the QOLIE-31 in either group after a 1-month LEV trial. Our results suggest that LEV-induced glucose metabolism and EEG spectral changes may be indicative of initial drug responsiveness as early as 1 month following treatment initiation. These parameters may be useful prognostic markers of antiseizure effects caused by LEV medication or may indicate an epiphenomenon of LEV-induced changes in glucose metabolism and EEG frequency. Further studies with larger sample sizes are warranted. Keywords: FDG-PET, responsiveness, background EEG, power spectral chang

Thalamo&ndash;cortical network underlying deep brain stimulation of centromedian thalamic nuclei in intractable epilepsy: a multimodal imaging analysis

Seong Hoon Kim,1 Sung Chul Lim,1 Dong Won Yang,1 Jeong Hee Cho,1 Byung-Chul Son,2 Jiyeon Kim,3 Seung Bong Hong,4 Young-Min Shon4 1Department of Neurology, 2Department of Neurosurgery, Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, Seoul, 3Department of Neurology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, 4Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Objective: Deep brain stimulation (DBS) of the centromedian thalamic nucleus (CM) can be an alternative treatment option for intractable epilepsy patients. Since CM may be involved in widespread cortico-subcortical networks, identification of the cortical sub-networks specific to the target stimuli may provide further understanding on the underlying mechanisms of CM DBS. Several brain structures have distinguishing brain connections that may be related to the pivotal propagation and subsequent clinical effect of DBS.Methods: To explore core structures and their connections relevant to CM DBS, we applied electroencephalogram (EEG) and diffusion tensor imaging (DTI) to 10 medically intractable patients &ndash; three generalized epilepsy (GE) and seven multifocal epilepsy (MFE) patients unsuitable for resective surgery. Spatiotemporal activation pattern was mapped from scalp EEG by delivering low-frequency stimuli (5&nbsp;Hz). Structural connections between the CM and the cortical activation spots were assessed using DTI.Results: We confirmed an average 72% seizure reduction after CM DBS and its clinical efficiency remained consistent during the observation period (mean 21&nbsp;months). EEG data revealed sequential source propagation from the anterior cingulate, followed by the frontotemporal regions bilaterally. In addition, maximal activation was found in the left cingulate gyrus and the right medial frontal cortex during the right and left CM stimulation, respectively. From DTI data, we confirmed concrete structural connections between CM and those maximal activation spots identified from EEG data.Conclusion: These results suggest that the anterior cingulate can be a core cortical structure for the bilateral propagation of CM stimulation. Our DTI findings also indicate that the propagation of CM stimulation may rely upon integrity of structural connections between CM and these key cortical regions. Structures and their connections found in this study may be relevant in the interpretation of the clinical outcomes of CM DBS. Keywords: deep brain stimulation, intractable epilepsy, centromedian thalamic nucleus, structural connectivity, cortical recruiting response, anterior cingulat

Clinical Experience with Topiramate in Korean Patients with Epilepsy

Purpose: This study aims to evaluate the clinical experiences, including efficacy and adverse events, of topiramate in Korea during the past 10 years. Method: This was an open-label, retrospective observation with post marketing surveillance data of topiramate. 4535 epilepsy patients were enrolled in this study. The subjects were only included from epileptologists whose data included studies of at least a 16-weeks duration period. The survey contained various issues, such as efficacy (responder rate, seizure-free rate), safety, adverse effects and the quality of life in patients.OAIID:oai:osos.snu.ac.kr:snu2010-01/102/2014017262/3SEQ:3PERF_CD:SNU2010-01EVAL_ITEM_CD:102USER_ID:2014017262ADJUST_YN:YEMP_ID:A079623DEPT_CD:801CITE_RATE:3.955DEPT_NM:의학과SCOPUS_YN:YCONFIRM: