Abstract Lumbar diskitis/osteomyelitis (LDO) can cause destruction of the anterior and middle spi... more Abstract Lumbar diskitis/osteomyelitis (LDO) can cause destruction of the anterior and middle spinal column leading to loss of structural integrity further compounded by iatrogenic violation of the posterior tension band during initial decompressive surgeries. Progressive deformity and/or medically refractory infection may necessitate aggressive debridement and reconstructive arthrodesis. Anterior debridement and reconstruction with posterior stabilization is an effective treatment option; however, existing open surgical techniques have limited efficacy for correction of the focal deformity, which can expose the patient to long term sagittal imbalance, pain, and disability. The aim of this chapter is to briefly review the epidemiology, pathophysiology, clinical presentation, and the role of medical versus surgical management in LDO. The role of the lateral retroperitoneal approach to the lumbar spine is then discussed and illustrated with two clinical cases.
BACKGROUNDSynovial sarcoma of the nerve is a rare entity with several cases and case series repor... more BACKGROUNDSynovial sarcoma of the nerve is a rare entity with several cases and case series reported in the literature. Despite an improved understanding of the biology, the clinical course is difficult to predict.OBJECTIVETo compile a series of patients with synovial sarcoma of the peripheral nerve (SSPN) and assess clinical and pathological factors and their contribution to survival and recurrence.METHODSCases from 2 institutions collected in patients undergoing surgical intervention for SSPN. Systematic review including PubMed and Scopus databases were searched for related articles published from 1970 to December 2018. Eligibility criteria: (1) case reports or case series reporting on SSPN, (2) clinical course and/or pathological features of the tumor reported, and (3) articles published in English.RESULTSFrom patients treated at our institutions (13) the average follow-up period was 3.2 yr. Tumor recurrence was seen in 4 cases and death in 3. Systematic review of the literature yielded 44 additional cases with an average follow-up period of 3.6 yr. From pooled data, there were 10 recurrences and 7 deaths (20% and 14%, respectively). Adjuvant treatment used in 62.5% of cases. Immunohistochemical markers used in diagnosis varied widely; the most common are the following: Epithelial membrane antigen (EMA), cytokeratin, vimentin, cluster of differentiation (CD34), and transducin-like enhancer of split 1 (TLE1). Statistical analysis illustrated tumor size and use of chemotherapy to be negative predictors of survival. No other factors, clinically or from pathologist review, were correlated with recurrence or survival.CONCLUSIONBy combining cases from our institution with historical data and performing statistical analysis we show correlation between tumor size and death.
BACKGROUND Laser interstitial thermal therapy (LITT) presents an important new minimally invasive... more BACKGROUND Laser interstitial thermal therapy (LITT) presents an important new minimally invasive tool in the management of drug-resistant mesial temporal epilepsy (MTE). However, because of its relative novelty, not much is known about long-term seizure freedom rates. The objective of this study was to evaluate the postsurgical seizure outcome following LITT after a minimum follow-up period of 2 years. METHODS Medical records of all patients who underwent LITT for MTE from 2013 to 2018 at our comprehensive epilepsy center under a single surgeon were retrospectively reviewed. Data related to demographics, presurgical evaluations, and seizure outcome were compared between seizure-free (SF) and non-seizure-free (NSF) patients. RESULTS In all, 26 patients were identified with at least 2 years of follow-up. Mean age was 43.8 years ± 11.6 years, and 46.2% were female. After a mean follow-up time of 42.9 months (range, 24.3-58.8 months), 61.5% (16/26) were free of disabling seizures, and 26.9% (7/26) had only rare disabling seizures. Whereas seizure-freedom rates between patients with and without mesial temporal sclerosis (MTS) were not statistically different (68% vs. 43%, P = 0.23), NSF patients without MTS had a shorter median time to first seizure than did NSF patients with MTS (0.55 month vs. 10 months, log-rank test P = 0.007). Postoperative complications occurred in 2 patients (7.7%), consisting of 1 permanent and 1 transient homonymous hemianopia. CONCLUSIONS LITT appears to be a safe and effective initial surgical option for treatment-resistant MTE. Among patients who have seizures after treatment, those without MTS appear to have seizures earlier than those with MTS.
This is a zip file containing the example data for nSTAT matlab toolbox (http://doi.org/10.1016/j... more This is a zip file containing the example data for nSTAT matlab toolbox (http://doi.org/10.1016/j.jneumeth.2012.08.009) . The data directory should be un-zipped into the main nSTAT directory. Updated 7-2-2017
ABSTRACT Introduction: Optimal gain of upper limb (UL) function is pivotal for people with stroke... more ABSTRACT Introduction: Optimal gain of upper limb (UL) function is pivotal for people with stroke in order to carry out functional activities. However, half of the people surviving stroke remain with some form of UL impairment. Robot Therapy (RT) is one technique that can increase the intensity of rehabilitation and evidence shows that robot-assisted arm training results in improved short- and long-term arm strength and function of people with stroke. RT has also been combined with a non-invasive method of brain stimulation, transcranial Direct Current Stimulation (tDCS). The pilot study by Hesse et al. (2007) suggests that using both RT and tDCS results in short-term UL motor recovery of people with sub-acute stroke however, long-term and neurophysiological measurements were not involved in this study. Main Objective: To develop a protocol exploring the effectiveness and short- and long-term neural changes of tDCS and robot therapy on UL impairment and function of people with sub-acute stroke. Methods: An systematic literature review was carried out investigating different methodologies used for applying tDCS and RT, leading to the finalised protocol. Results: A pilot, double-blinded randomised controlled trial will be carried out involving two groups: 1) Armeo RT and active tDCS, and 2) Armeo RT and sham tDCS with 20 participants with sub-acute stroke in each group. Active or sham tDCS will be delivered before RT. In total, participants will receive 18 hours of RT and tDCS, spread out over 8 weeks. Clinical and neurophysiological measures using Transcranial Magnetic Stimulation will be utilised pre- and post- intervention and at 3 month follow-up. Conclusions: Research into non-invasive brain stimulation and RT seems promising but to translate research findings into clinical stroke practice, further research is needed. In the upcoming months, the aforementioned trial will be initiated which will add to the body of knowledge of neurorehabilitation research.
Journal of Neurology, Neurosurgery & Psychiatry
BackgroundMagnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally i... more BackgroundMagnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive alternative to surgical resection for drug-resistant mesial temporal lobe epilepsy (mTLE). Reported rates of seizure freedom are variable and long-term durability is largely unproven. Anterior temporal lobectomy (ATL) remains an option for patients with MRgLITT treatment failure. However, the safety and efficacy of this staged strategy is unknown.MethodsThis multicentre, retrospective cohort study included 268 patients consecutively treated with mesial temporal MRgLITT at 11 centres between 2012 and 2018. Seizure outcomes and complications of MRgLITT and any subsequent surgery are reported. Predictive value of preoperative variables for seizure outcome was assessed.ResultsEngel I seizure freedom was achieved in 55.8% (149/267) at 1 year, 52.5% (126/240) at 2 years and 49.3% (132/268) at the last follow-up ≥1 year (median 47 months). Engel I or II outcomes were achieved in 74.2% (...
This scientific commentary refers to ‘Multisite thalamic recordings to characterize seizure propa... more This scientific commentary refers to ‘Multisite thalamic recordings to characterize seizure propagation in the human brain’ by Wu et al. (https://doi.org/10.1093/brain/awad121).
OBJECTIVE Cerebral palsy (CP) represents the most common childhood physical disability that encom... more OBJECTIVE Cerebral palsy (CP) represents the most common childhood physical disability that encompasses disorders of movement and posture attributed to nonprogressive disturbances that occurred in the developmental fetal or infant brain. Dyskinetic CP (DCP), the second most common type of CP after spastic forms, refers to a subset of patients in whom dystonia and choreoathetosis are the predominant motor manifestations. Most children with CP have abnormal brain MRI studies indicative of cortical and deep gray matter damage consistent with hypoxic ischemic encephalopathy, which may preclude or suggest decreased efficacy of standard deep brain stimulation (DBS) targets. The cerebellum has been posited as an attractive target for treatment of DCP because it is frequently spared from hypoxic ischemic damage and has shown promise in alleviating patient symptoms both in early work in the 1970s and in more recent case series with DBS. METHODS The authors performed bilateral cerebellar DBS ...
OBJECTIVE Recent trends have moved from subdural grid electrocorticography (ECoG) recordings towa... more OBJECTIVE Recent trends have moved from subdural grid electrocorticography (ECoG) recordings toward stereo-electroencephalography (SEEG) depth electrodes for intracranial localization of seizures, in part because of perceived morbidity from subdural grid and strip electrodes. For invasive epilepsy monitoring, the authors describe the outcomes of a hybrid approach, whereby patients receive a combination of subdural grids, strips, and frameless stereotactic depth electrode implantations through a craniotomy. Evolution of surgical techniques was employed to reduce complications. In this study, the authors review the surgical hemorrhage and functional outcomes of this hybrid approach. METHODS A retrospective review was performed of consecutive patients who underwent hybrid implantation from July 2012 to May 2022 at an academic epilepsy center by a single surgeon. Outcomes included hemorrhagic and nonhemorrhagic complications, neurological deficits, length of monitoring, and number of el...
Objective The objective of this study was to develop a portable and modular brain–computer interf... more Objective The objective of this study was to develop a portable and modular brain–computer interface (BCI) software platform independent of input and output devices. We implemented this platform in a case study of a subject with cervical spinal cord injury (C5 ASIA A). Background BCIs can restore independence for individuals with paralysis by using brain signals to control prosthetics or trigger functional electrical stimulation. Though several studies have successfully implemented this technology in the laboratory and the home, portability, device configuration, and caregiver setup remain challenges that limit deployment to the home environment. Portability is essential for transitioning BCI from the laboratory to the home. Methods The BCI platform implementation consisted of an Activa PC + S generator with two subdural four-contact electrodes implanted over the dominant left hand-arm region of the sensorimotor cortex, a minicomputer fixed to the back of the subject’s wheelchair, a...
La presente invention concerne un systeme d'entrainement robotise pour reeducation de la marc... more La presente invention concerne un systeme d'entrainement robotise pour reeducation de la marche destine a traiter les deviations secondaires de la marche, telles que l'elevation de la hanche. Un ensemble actionnement suit les mouvements naturels du bassin d'un utilisateur, tout en appliquant des moments correcteurs a l'asymetrie du bassin. Une interface homme-robot, sous la forme d'un exosquelette de corps inferieur, est prevue pour ameliorer le transfert de moments correcteurs au bassin. Ledit systeme comprend un systeme de commande d'impedance incorporant une fonctionnalite de retroaction, qui permet de moduler les forces appliquees sur le corps en fonction des efforts du patient. L'invention porte egalement sur divers protocoles pour l'utilisation du systeme.
Objective: To report a case of multiple ischemic strokes secondary to cerebral AVM vascular steal... more Objective: To report a case of multiple ischemic strokes secondary to cerebral AVM vascular steal phenomenon. Background: An arteriovenous malformation (AVM) is an abnormal connection between an artery and a vein. There have been conflicting opinions about the in vivo existence of vascular steal phenomenon associated with cerebral AVM manifesting as focal neurological deficits. We present a case of multiple acute infarcts which may have been secondary to a vascular steal phenomenon due to the presence of the cerebral AVM. Design/Methods: Retrospective Chart review. Results: Case Description: 51-year-old right handed male with multiple cardiovascular risk factors and a known old right temporo-parietal AVM presented with new onset (>6h) left hemiparesis and dysarthria. His vital signs were unremarkable and his neurological exam demonstrated an upper motor neuron left facial palsy and left hemiparesis (MRC grade 3/5). MRI brain showed a large right hemispheric AVM and multiple corti...
Abstract Lumbar diskitis/osteomyelitis (LDO) can cause destruction of the anterior and middle spi... more Abstract Lumbar diskitis/osteomyelitis (LDO) can cause destruction of the anterior and middle spinal column leading to loss of structural integrity further compounded by iatrogenic violation of the posterior tension band during initial decompressive surgeries. Progressive deformity and/or medically refractory infection may necessitate aggressive debridement and reconstructive arthrodesis. Anterior debridement and reconstruction with posterior stabilization is an effective treatment option; however, existing open surgical techniques have limited efficacy for correction of the focal deformity, which can expose the patient to long term sagittal imbalance, pain, and disability. The aim of this chapter is to briefly review the epidemiology, pathophysiology, clinical presentation, and the role of medical versus surgical management in LDO. The role of the lateral retroperitoneal approach to the lumbar spine is then discussed and illustrated with two clinical cases.
BACKGROUNDSynovial sarcoma of the nerve is a rare entity with several cases and case series repor... more BACKGROUNDSynovial sarcoma of the nerve is a rare entity with several cases and case series reported in the literature. Despite an improved understanding of the biology, the clinical course is difficult to predict.OBJECTIVETo compile a series of patients with synovial sarcoma of the peripheral nerve (SSPN) and assess clinical and pathological factors and their contribution to survival and recurrence.METHODSCases from 2 institutions collected in patients undergoing surgical intervention for SSPN. Systematic review including PubMed and Scopus databases were searched for related articles published from 1970 to December 2018. Eligibility criteria: (1) case reports or case series reporting on SSPN, (2) clinical course and/or pathological features of the tumor reported, and (3) articles published in English.RESULTSFrom patients treated at our institutions (13) the average follow-up period was 3.2 yr. Tumor recurrence was seen in 4 cases and death in 3. Systematic review of the literature yielded 44 additional cases with an average follow-up period of 3.6 yr. From pooled data, there were 10 recurrences and 7 deaths (20% and 14%, respectively). Adjuvant treatment used in 62.5% of cases. Immunohistochemical markers used in diagnosis varied widely; the most common are the following: Epithelial membrane antigen (EMA), cytokeratin, vimentin, cluster of differentiation (CD34), and transducin-like enhancer of split 1 (TLE1). Statistical analysis illustrated tumor size and use of chemotherapy to be negative predictors of survival. No other factors, clinically or from pathologist review, were correlated with recurrence or survival.CONCLUSIONBy combining cases from our institution with historical data and performing statistical analysis we show correlation between tumor size and death.
BACKGROUND Laser interstitial thermal therapy (LITT) presents an important new minimally invasive... more BACKGROUND Laser interstitial thermal therapy (LITT) presents an important new minimally invasive tool in the management of drug-resistant mesial temporal epilepsy (MTE). However, because of its relative novelty, not much is known about long-term seizure freedom rates. The objective of this study was to evaluate the postsurgical seizure outcome following LITT after a minimum follow-up period of 2 years. METHODS Medical records of all patients who underwent LITT for MTE from 2013 to 2018 at our comprehensive epilepsy center under a single surgeon were retrospectively reviewed. Data related to demographics, presurgical evaluations, and seizure outcome were compared between seizure-free (SF) and non-seizure-free (NSF) patients. RESULTS In all, 26 patients were identified with at least 2 years of follow-up. Mean age was 43.8 years ± 11.6 years, and 46.2% were female. After a mean follow-up time of 42.9 months (range, 24.3-58.8 months), 61.5% (16/26) were free of disabling seizures, and 26.9% (7/26) had only rare disabling seizures. Whereas seizure-freedom rates between patients with and without mesial temporal sclerosis (MTS) were not statistically different (68% vs. 43%, P = 0.23), NSF patients without MTS had a shorter median time to first seizure than did NSF patients with MTS (0.55 month vs. 10 months, log-rank test P = 0.007). Postoperative complications occurred in 2 patients (7.7%), consisting of 1 permanent and 1 transient homonymous hemianopia. CONCLUSIONS LITT appears to be a safe and effective initial surgical option for treatment-resistant MTE. Among patients who have seizures after treatment, those without MTS appear to have seizures earlier than those with MTS.
This is a zip file containing the example data for nSTAT matlab toolbox (http://doi.org/10.1016/j... more This is a zip file containing the example data for nSTAT matlab toolbox (http://doi.org/10.1016/j.jneumeth.2012.08.009) . The data directory should be un-zipped into the main nSTAT directory. Updated 7-2-2017
ABSTRACT Introduction: Optimal gain of upper limb (UL) function is pivotal for people with stroke... more ABSTRACT Introduction: Optimal gain of upper limb (UL) function is pivotal for people with stroke in order to carry out functional activities. However, half of the people surviving stroke remain with some form of UL impairment. Robot Therapy (RT) is one technique that can increase the intensity of rehabilitation and evidence shows that robot-assisted arm training results in improved short- and long-term arm strength and function of people with stroke. RT has also been combined with a non-invasive method of brain stimulation, transcranial Direct Current Stimulation (tDCS). The pilot study by Hesse et al. (2007) suggests that using both RT and tDCS results in short-term UL motor recovery of people with sub-acute stroke however, long-term and neurophysiological measurements were not involved in this study. Main Objective: To develop a protocol exploring the effectiveness and short- and long-term neural changes of tDCS and robot therapy on UL impairment and function of people with sub-acute stroke. Methods: An systematic literature review was carried out investigating different methodologies used for applying tDCS and RT, leading to the finalised protocol. Results: A pilot, double-blinded randomised controlled trial will be carried out involving two groups: 1) Armeo RT and active tDCS, and 2) Armeo RT and sham tDCS with 20 participants with sub-acute stroke in each group. Active or sham tDCS will be delivered before RT. In total, participants will receive 18 hours of RT and tDCS, spread out over 8 weeks. Clinical and neurophysiological measures using Transcranial Magnetic Stimulation will be utilised pre- and post- intervention and at 3 month follow-up. Conclusions: Research into non-invasive brain stimulation and RT seems promising but to translate research findings into clinical stroke practice, further research is needed. In the upcoming months, the aforementioned trial will be initiated which will add to the body of knowledge of neurorehabilitation research.
Journal of Neurology, Neurosurgery & Psychiatry
BackgroundMagnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally i... more BackgroundMagnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive alternative to surgical resection for drug-resistant mesial temporal lobe epilepsy (mTLE). Reported rates of seizure freedom are variable and long-term durability is largely unproven. Anterior temporal lobectomy (ATL) remains an option for patients with MRgLITT treatment failure. However, the safety and efficacy of this staged strategy is unknown.MethodsThis multicentre, retrospective cohort study included 268 patients consecutively treated with mesial temporal MRgLITT at 11 centres between 2012 and 2018. Seizure outcomes and complications of MRgLITT and any subsequent surgery are reported. Predictive value of preoperative variables for seizure outcome was assessed.ResultsEngel I seizure freedom was achieved in 55.8% (149/267) at 1 year, 52.5% (126/240) at 2 years and 49.3% (132/268) at the last follow-up ≥1 year (median 47 months). Engel I or II outcomes were achieved in 74.2% (...
This scientific commentary refers to ‘Multisite thalamic recordings to characterize seizure propa... more This scientific commentary refers to ‘Multisite thalamic recordings to characterize seizure propagation in the human brain’ by Wu et al. (https://doi.org/10.1093/brain/awad121).
OBJECTIVE Cerebral palsy (CP) represents the most common childhood physical disability that encom... more OBJECTIVE Cerebral palsy (CP) represents the most common childhood physical disability that encompasses disorders of movement and posture attributed to nonprogressive disturbances that occurred in the developmental fetal or infant brain. Dyskinetic CP (DCP), the second most common type of CP after spastic forms, refers to a subset of patients in whom dystonia and choreoathetosis are the predominant motor manifestations. Most children with CP have abnormal brain MRI studies indicative of cortical and deep gray matter damage consistent with hypoxic ischemic encephalopathy, which may preclude or suggest decreased efficacy of standard deep brain stimulation (DBS) targets. The cerebellum has been posited as an attractive target for treatment of DCP because it is frequently spared from hypoxic ischemic damage and has shown promise in alleviating patient symptoms both in early work in the 1970s and in more recent case series with DBS. METHODS The authors performed bilateral cerebellar DBS ...
OBJECTIVE Recent trends have moved from subdural grid electrocorticography (ECoG) recordings towa... more OBJECTIVE Recent trends have moved from subdural grid electrocorticography (ECoG) recordings toward stereo-electroencephalography (SEEG) depth electrodes for intracranial localization of seizures, in part because of perceived morbidity from subdural grid and strip electrodes. For invasive epilepsy monitoring, the authors describe the outcomes of a hybrid approach, whereby patients receive a combination of subdural grids, strips, and frameless stereotactic depth electrode implantations through a craniotomy. Evolution of surgical techniques was employed to reduce complications. In this study, the authors review the surgical hemorrhage and functional outcomes of this hybrid approach. METHODS A retrospective review was performed of consecutive patients who underwent hybrid implantation from July 2012 to May 2022 at an academic epilepsy center by a single surgeon. Outcomes included hemorrhagic and nonhemorrhagic complications, neurological deficits, length of monitoring, and number of el...
Objective The objective of this study was to develop a portable and modular brain–computer interf... more Objective The objective of this study was to develop a portable and modular brain–computer interface (BCI) software platform independent of input and output devices. We implemented this platform in a case study of a subject with cervical spinal cord injury (C5 ASIA A). Background BCIs can restore independence for individuals with paralysis by using brain signals to control prosthetics or trigger functional electrical stimulation. Though several studies have successfully implemented this technology in the laboratory and the home, portability, device configuration, and caregiver setup remain challenges that limit deployment to the home environment. Portability is essential for transitioning BCI from the laboratory to the home. Methods The BCI platform implementation consisted of an Activa PC + S generator with two subdural four-contact electrodes implanted over the dominant left hand-arm region of the sensorimotor cortex, a minicomputer fixed to the back of the subject’s wheelchair, a...
La presente invention concerne un systeme d'entrainement robotise pour reeducation de la marc... more La presente invention concerne un systeme d'entrainement robotise pour reeducation de la marche destine a traiter les deviations secondaires de la marche, telles que l'elevation de la hanche. Un ensemble actionnement suit les mouvements naturels du bassin d'un utilisateur, tout en appliquant des moments correcteurs a l'asymetrie du bassin. Une interface homme-robot, sous la forme d'un exosquelette de corps inferieur, est prevue pour ameliorer le transfert de moments correcteurs au bassin. Ledit systeme comprend un systeme de commande d'impedance incorporant une fonctionnalite de retroaction, qui permet de moduler les forces appliquees sur le corps en fonction des efforts du patient. L'invention porte egalement sur divers protocoles pour l'utilisation du systeme.
Objective: To report a case of multiple ischemic strokes secondary to cerebral AVM vascular steal... more Objective: To report a case of multiple ischemic strokes secondary to cerebral AVM vascular steal phenomenon. Background: An arteriovenous malformation (AVM) is an abnormal connection between an artery and a vein. There have been conflicting opinions about the in vivo existence of vascular steal phenomenon associated with cerebral AVM manifesting as focal neurological deficits. We present a case of multiple acute infarcts which may have been secondary to a vascular steal phenomenon due to the presence of the cerebral AVM. Design/Methods: Retrospective Chart review. Results: Case Description: 51-year-old right handed male with multiple cardiovascular risk factors and a known old right temporo-parietal AVM presented with new onset (>6h) left hemiparesis and dysarthria. His vital signs were unremarkable and his neurological exam demonstrated an upper motor neuron left facial palsy and left hemiparesis (MRC grade 3/5). MRI brain showed a large right hemispheric AVM and multiple corti...
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