Brainstem101, is an innovative computer application that combines art and neuroanatomy ‐‐ brainstem structures, functionalities and clinical highlights‐‐ together to create an interactive learning module for medical students and professionals. The Application features an atlas of human brainstem that presents 9 horizontal Cross‐Sections (CSx) along with an index of structures. Selection of a CSx will provide a list of its structures, while selection from the index displays the structure in CSx(s) where present. Each CSx can be viewed individually in the “Profile Page”, where one can select a structure and read about functions and clinical relevance. The application allows user interaction not only by tapping to select the structures of a CSx, but also by allowing the user to put any CSx onto a “Draw Pad” where he can take notes/collaborate by writing on top of the diagram. Another major feature is the “Clinical Page”; this component provides a list of syndromes to choose from, with a detailed description of the syndromes' features (and structural origins) and artfully displays the physical manifestations of that syndrome on a human model. The associated vascular compromise is outlined on a 3D brainstem model. Other features include “Quiz Mode”, radiology imaging, search function, and supplemental schematics. Grant Funding Source : none
Most trigeminal neuralgia (TN) studies focus on a single strategy, microvascular decompression (MVD) or percutaneous rhizotomy (PR). We use a multimodality approach to TN. We perform MVD on patients younger than 70 years and PR on older patients or those where MVD has failed. We performed a chart review of the procedures for TN over the past 3 years and used a questionnaire for long-term follow-up. The questionnaire asked patients to rate their pre- and postoperative pain, outcome, and medication changes. Seventy-four procedures (40 MVDs and 34 PRs) were performed on 67 patients. Twenty patients had undergone previous procedures. 93% of the patients had significant initial pain relief. Over a 1.2-year mean follow-up, 51% of the patients had complete pain relief while 27% had a substantial improvement. There were no deaths and 5 complications. Our results suggest that a multimodality approach to TN yields excellent results with minimal complications.
There is considerable evidence that abnormal oscillatory activity in the basal ganglia contributes to the pathogenesis of Parkinson's disease. However, little is known regarding the relationship of oscillations to volitional movements. Our goal was to evaluate the dynamics of oscillatory activity at rest and during movement. We performed microelectrode recordings from the subthalamic nucleus (STN) of patients undergoing deep brain stimulation surgery. During recordings, the patients used a joystick to guide a cursor to one of four targets on a monitor. We recorded 184 cells and 47 pairs of cells in 11 patients. At rest, 26 cells (14%) demonstrated significant oscillatory activity, with a mean frequency of 18 Hz. During movement, this oscillatory activity was either reduced or completely abolished in all of the cells. At rest, 18 pairs (38%) of cells in five patients exhibited synchronized oscillatory activity, with a mean frequency of 15 Hz. In 17 of the 18 pairs, both of the cells exhibited oscillations, and, in one pair, only one of the cells was oscillatory. These synchronized oscillations were also significantly decreased with movement. There was a strong inverse correlation between firing rates and oscillatory activity. As the firing rates increased with movement, there was a decrease in oscillatory activity. These findings suggest that visually guided movements are associated with a dampening and desynchronization of oscillatory activity in STN neurons. One possible explanation for these observations is that the increased cortical drive associated with movement preparation and execution leads to a transient dampening of STN oscillations, hence facilitating movement.
Neurological disease is often associated with changes in firing activity in specific brain areas. Accurate statistical models of neural spiking can provide insight into the mechanisms by which the disease develops and clinical symptoms manifest. Point process theory provides a powerful framework for constructing, fitting, and evaluating the quality of neural spiking models. We illustrate an application of point process modeling to the problem of characterizing abnormal oscillatory firing patterns of neurons in the subthalamic nucleus (STN) of patients with Parkinson's disease (PD). We characterize the firing properties of these neurons by constructing conditional intensity models using spline basis functions that relate the spiking of each neuron to movement variables and the neuron's past firing history, both at short and long time scales. By calculating maximum likelihood estimators for all of the parameters and their significance levels, we are able to describe the relative propensity of aberrant STN spiking in terms of factors associated with voluntary movements, with intrinsic properties of the neurons, and factors that may be related to dysregulated network dynamics.
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