An electrical cortical stimulation provides important information for functional brain mapping. However, subjective responses (i.e. sensory, visual, and auditory symptoms) are purely detected by patients’ descriptions, and may be affected by patients’ awareness and intelligence levels. We experienced psychogenic responses in the electrical cortical stimulation of two patients with intractable epilepsy. A sham stimulation was useful for differentiating pseudo-responses from real responses in the electrical cortical stimulation. Inductive questions, long testing durations, and clear cues of stimulation onsets need to be avoided to prevent psychogenic pseudo-responses in the electrical cortical stimulation. Furthermore, a sham stimulation is applicable for detecting pseudo-responses the moment patients show atypical or inexplicable symptoms.
Abstract Background The physiological and pathological significance of the arachnoid membrane (AM) is still unknown. In this study, we investigated various characteristics of the AM, focusing on the influence of inflammation and fibrosis. Methods Small pieces of AM sample were obtained during neurosurgical procedures from 74 cases. The clinical and pathological characteristics of the hyperplastic AM group (≥ 50 µm) and the non-hyperplastic AM group (< 50 µm) were compared. Then, potential correlations between AM thickness and clinical characteristics were analyzed. Moreover, VEGFα, TGFβ, and TGFα levels were quantitated by real time PCR. Then, the potential correlations between AM thickness and these inflammatory or anti-inflammatory markers, and the influence of the original disease were calculated. Results The median age of the patients in hyperplastic AM group was significantly older than that of the non-hyperplastic AM group. Moreover, the number of fibroblasts, CD68 + cells, CD86 + cells, and CD206 + cells in the hyperplastic AM group was significantly higher than that in the non-hyperplastic AM group. The AM thickness was significantly correlated to age and number of fibroblasts, CD68 + cells, CD86 + cells, and CD206 + cells. The thickness of the AM was significantly correlated to the messenger RNA expression levels of VEGFα (ρ = 0.337), and the VEGFα expression levels were significantly correlated with TGFβ, which in turn was significantly correlated with TNFα. Conclusions The AM hyperplasia was influenced by aging and could be a result of inflammation and fibrosis through cytokine secretion from the inflammatory cells and fibroblasts in the AM.
The purpose of this study was to investigate whether and how vagus nerve stimulation (VNS) reduces the epileptogenic activity in the bilateral cerebral cortex in patients with intractable epilepsy. We analyzed the electrocorticograms (ECoGs) of five patients who underwent callosotomy due to intractable epilepsy even after VNS implantation. We recorded ECoGs and analyzed power spectrum in both VNS OFF and ON phases. We counted the number of spikes and electrodes with epileptic spikes, distinguishing unilaterally and bilaterally hemispherically spread spikes as synchronousness of the epileptic spikes in both VNS OFF and ON phases. There were 24.80 ± 35.55 and 7.20 ± 9.93 unilaterally spread spikes in the VNS OFF and ON phases, respectively (P = 0.157), and 35.8 ± 29.21 and 10.6 ± 13.50 bilaterally spread spikes in the VNS OFF and ON phases, respectively (P = 0.027). The number of electrodes with unilaterally and bilaterally spread spikes in the VNS OFF and ON phases was 3.84 ± 2.13 and 3.59 ± 1.82 (P = 0.415), and 8.20 ± 3.56 and 6.89 ± 2.89 (P = 0.026), respectively. The ECoG background power spectra recordings in the VNS OFF and ON phases were also analyzed. The spectral power tended to be greater in the high-frequency band at VNS ON phase than OFF phase. This study showed the reduction of epileptogenic spikes and spread areas of the spikes by VNS as immediate effects, electrophysiologically.
The optimal treatment strategy for large-vessel occlusion (LVO) related to intracranial atherosclerotic disease (ICAD), particularly for tandem lesions that complicate access and device delivery, remains unclear. We report a case in which angioplasty with a stent retriever (SR) and combined antithrombotic therapy was effective in treating re-occlusion associated with dissection of the residual stenosis after thrombectomy for acute atherosclerotic occlusion of the basilar artery (BA) with the left vertebral artery (VA) stenosis. An 80-year-old woman was brought to our hospital with progressively worsening consciousness and tetra-paresis. MRA revealed occlusion of the middle to proximal portion of the BA. The patient underwent percutaneous transluminal angioplasty using a balloon catheter for severe stenosis at the origin of the left VA, followed by mechanical thrombectomy for the BA occlusion. While initial recanalization was achieved, residual stenosis in the proximal portion of the BA led to re-occlusion. An attempt at angioplasty with a balloon catheter failed to reach the stenotic segment due to stenosis and tortuosity of the left VA. Consequently, the SR was redeployed into the BA, and a loading dose of antiplatelet agents and intravenous anticoagulant were administered during prolonged deployment. Following the confirmation of BA patency, the SR was re-sheathed and removed. The patient achieved remarkable improvement in consciousness and tetra-paresis without postoperative re-occlusion of the BA. Angioplasty with a SR and combined antithrombotic therapy may be a useful treatment option for ICAD-related LVO, particularly in cases such as tandem lesions that hinder access and make distal balloon catheter navigation challenging.
Objectives To evaluate the effects of nonadherence to antiseizure medications (ASMs) and clinical characteristics on seizure control, we employed a prospective cohort cross-sectional study using self-reports and medical records of patients with epilepsy (PWEs). Methods Eight hundred and fifty-five PWEs taking ASMs were enrolled from fourteen collaborative outpatient clinics from January 2018 to March 2019. Questions from the Morisky Medication Adherence Scale were used as adherence self-reports. If a PWE's questionnaire indicated that they had missed doses of their ASMs, outpatient physicians asked them directly about the details of their compliance, including the timing of intentionally or unintentionally missed doses. The association between lack of seizure control and utilization outcomes, such as missed doses, demographics, and clinical characteristics of the PWEs, were assessed by univariate and multivariate analyses. Results Multivariate analysis revealed that forgetting to take ASMs was associated with lack of seizure control and the existence of focal to bilateral tonic–clonic seizures. Dementia, younger age, use of three or more antiepileptic agents, and living in a one-person household were associated with the risk of forgetting to take ASMs. Significance For PWEs with poor drug management or a high incidence of missed doses of ASMs, efforts to improve adherence could facilitate better seizure control and decrease focal to bilateral tonic–clonic propagation.
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