55 results on '"Eduardo Joaquim Lopes Alho"'
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2. Pilot study in neonates using low-level laser therapy in the immediate postoperative period of myelomeningocele
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Nathali Cordeiro Pinto, Fernando Campos Gomes Pinto, Eduardo Joaquim Lopes Alho, Elisabeth Matheus Yoshimura, Vera Lucia Jornada Krebs, Manoel Jacobsen Teixeira, and Maria Cristina Chavantes
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Infant, newborn ,Congenital, hereditary, neonatal diseases and abnormalities/surgery ,Laser therapy, low-level ,Surgical wound dehiscence/ prevention & control ,Meningomyelocele/surgery ,Guided tissue regeneration/methods ,Postoperative complications ,Medicine - Abstract
ABSTRACT Objective: To analyze the tissue repair behavior after corrective surgical incision in neonates submitted to low-level laser therapy, in an attempt to diminish the incidence of postoperative dehiscence following the surgery for myelomeningocele performed immediately after birth. Methods: It is a prospective pilot study with 13 myelomeningocele patients submitted to surgery at birth who received adjuvant treatment with low-level laser therapy (Group A). Diode laser C.W., λ = 685t nm, p = 21 mW, E = 0.19 J was punctually applied along the surgical incision, summing up 4 to 10 J energy delivered per patient, according to the surgical wound area and, then, compared with the previous results, which were obtained from 23 patients undergoing surgery without laser therapy (Group B). Results: This pilot study showed a significant decline in dehiscence of surgical wounds in neonates submitted to low-level laser therapy as compared to controls (7.69 versus 17.39%, respectively), demonstrating this is an effective, safe and noninvasive treatment method. conclusion: This new adjuvant therapeutic proposal with low-level laser therapy aided healing of surgical wounds, preventing morbidities, as well as decreasing hospital stay, which implies cost of reduction for patients and for the institution.
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- 2010
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3. Horner's syndrome after blunt cervical and chest trauma: case report Síndrome de Horner após trauma cérvico-torácico fechado: relato de caso
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Wellingson Silva Paiva, Robson Luis Oliveira De Amorim, Wagner Malago Tavares, Eduardo Joaquim Lopes Alho, Brasil Ping Jeng, and Eberval Gadelha Figueiredo
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síndrome de Horner ,trauma ,etiologia ,Horner syndrome ,etiology ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Horner‘s syndrome is the triad of miosis, ptosis, and anhidrosis, resulting from disruption of the sympathetic pathways. This article describes an uncommon case of Horner‘s syndrome in a 22-year-old man after blunt trauma to the neck and chest without carotid artery dissection. The patient was brought to the emergency service after motorcycle fall. Neurologic examination revealed a patient presenting the score 15 at Glasgow Coma Scale. The left eyelid was 1-2 mm lower than the right. Carotid Doppler and angiotomography were undertaken and revealed no abnormalities of the carotid artery. CT disclosed a mediastinal hematoma extending to the left apex, compressing the left sympathetic chain. The understanding of this clinical entity may help the surgeon to make a better differential diagnosis in trauma patients in whom prompt diagnosis is critical to stablish the correct treatment.A síndrome de Horner compreende a tríade de miose, ptose e anidrose, resultado de lesão em algum ponto das vias simpáticas. O referido estudo apresenta um caso da referida síndrome em um jovem de 22 anos vitima de queda de moto, com escoriações no tórax e no pescoço, sem dissecção carotídea. Ao exame neurológico, encontrava-se com 15 pontos na Escala de Coma de Glasgow, com miose à esquerda e ptose palpebral ipsilateral. Realizado Doppler de carótidas e angiotomografia dos vasos cérvico-cranianos não sendo evidenciadas anormalidades. A tomografia de tórax mostrou um hematoma no ápice pulmonar esquerdo, comprimindo a cadeia simpática ipsilateral. O conhecimento desta entidade clínica pode ajudar o cirurgião a fazer um diagnóstico diferencial adequado nos pacientes vítimas de traumas, nos quais o diagnóstico correto e eficaz pode ser fundamental para a definição da conduta a ser tomada.
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- 2007
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4. Directional Deep Brain Stimulation of the Posteromedial Hypothalamus for Refractory Intermittent Explosive Disorder: A Case Series Using a Novel Neurostimulation Device and Intraoperative Microdialysis
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Raquel Chacon Ruiz Martinez, Erich Talamoni Fonoff, William Omar Contreras Lopez, Aline V.V. Auada, Eduardo Joaquim Lopes Alho, Paula Alejandra Navarro, Ivo Lebrun, and Flavia Venetucci Gouveia
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Adult ,Male ,Microdialysis ,Deep brain stimulation ,Deep Brain Stimulation ,medicine.medical_treatment ,Hypothalamus ,Stimulation ,Young Adult ,Epilepsy ,Neuromodulation ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Adverse effect ,business.industry ,medicine.disease ,Disruptive, Impulse Control, and Conduct Disorders ,Treatment Outcome ,medicine.anatomical_structure ,Anesthesia ,Female ,Surgery ,Neurology (clinical) ,Intermittent explosive disorder ,business - Abstract
Background Intermittent explosive disorder (IED) is a psychiatric disorder characterized by recurrent outbursts of aggressive behavior. Deep brain stimulation (DBS) in the posteromedial nucleus of the hypothalamus (pHyp) is an alternative therapy for extreme cases and shows promising results. Intraoperative microdialysis can help elucidate the neurobiological mechanism of pHyp-DBS. We sought to evaluate efficacy and safety of pHyp-DBS using 8-contact directional leads in patients with refractory IED (rIED) and the accompanying changes in neurotransmitters. Methods This was a prospective study in which patients with a diagnosis of rIED were treated with pHyp-DBS for symptom alleviation. Bilateral pHyp-DBS was performed with 8-contact directional electrodes. Follow-up was performed at 3, 6, and 12 months after surgery. Results Four patients (3 men, mean age 27 ± 2.8 years) were included. All patients were diagnosed with rIED and severe intellectual disability. Two patients had congenital rubella, one had a co-diagnosis of infantile autism, and the fourth presented with drug-resistant epilepsy. There was a marked increase in the levels of gamma-aminobutyric acid and glycine during intraoperative stimulation. The average improvement in aggressive behavior in the last follow-up was 6 points (Δ: 50%, P = 0.003) while also documenting an important improvement of the Short Form Health Survey in all domains except bodily pain. No adverse events associated with pHyp-DBS were observed. Conclusions This is the first study to show the safety and beneficial effect of directional lead pHyp-DBS in patients with rIED and to demonstrate the corresponding mechanism of action through increases in gamma-aminobutyric acid and glycine concentration in the pHyp.
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- 2021
5. Dissecting neuropathic from poststroke pain: the white matter within
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Luis Garcia-Larrea, Antonia Lilian de Lima Rodrigues, Manoel Jacobsen Teixeira, Jefferson Rosi, Daniel Ciampi de Andrade, Luciana Mendonça Barbosa, Valquíria Aparecida da Silva, Ricardo Galhardoni, Adriana Bastos Conforto, I. Faillenot, Marcelo Delboni Lemos, Roland Peyron, Eduardo Joaquim Lopes Alho, Leandro Tavares Lucato, and Clarice Listik
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medicine.medical_specialty ,business.industry ,Chronic pain ,medicine.disease ,Magnetic Resonance Imaging ,White Matter ,Stroke ,White matter ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Physical medicine and rehabilitation ,Thalamus ,Neurology ,Neuropathic pain ,medicine ,Humans ,Neuralgia ,Neurology (clinical) ,business - Abstract
Poststroke pain (PSP) is a heterogeneous term encompassing both central neuropathic (ie, central poststroke pain [CPSP]) and nonneuropathic poststroke pain (CNNP) syndromes. Central poststroke pain is classically related to damage in the lateral brainstem, posterior thalamus, and parietoinsular areas, whereas the role of white matter connecting these structures is frequently ignored. In addition, the relationship between stroke topography and CNNP is not completely understood. In this study, we address these issues comparing stroke location in a CPSP group of 35 patients with 2 control groups: 27 patients with CNNP and 27 patients with stroke without pain. Brain MRI images were analyzed by 2 complementary approaches: an exploratory analysis using voxel-wise lesion symptom mapping, to detect significant voxels damaged in CPSP across the whole brain, and a hypothesis-driven, region of interest-based analysis, to replicate previously reported sites involved in CPSP. Odds ratio maps were also calculated to demonstrate the risk for CPSP in each damaged voxel. Our exploratory analysis showed that, besides known thalamic and parietoinsular areas, significant voxels carrying a high risk for CPSP were located in the white matter encompassing thalamoinsular connections (one-tailed threshold Z3.96, corrected P value0.05, odds ratio = 39.7). These results show that the interruption of thalamocortical white matter connections is an important component of CPSP, which is in contrast with findings from nonneuropathic PSP and from strokes without pain. These data can aid in the selection of patients at risk to develop CPSP who could be candidates to pre-emptive or therapeutic interventions.
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- 2021
6. Use of computational fluid dynamics for 3D fiber tract visualization on human high-thickness histological slices: histological mesh tractography
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Eduardo Joaquim Lopes Alho, Ana Tereza Di Lorenzo Alho, Erich Talamoni Fonoff, Helmut Heinsen, and József Nagy
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Histology ,Internal capsule ,Computer science ,Water flow ,General Neuroscience ,05 social sciences ,Anterior commissure ,Dark field microscopy ,050105 experimental psychology ,Visualization ,White matter ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,medicine ,0501 psychology and cognitive sciences ,Anatomy ,030217 neurology & neurosurgery ,Tractography ,Biomedical engineering ,Diffusion MRI - Abstract
Understanding the intricate three-dimensional relationship between fiber bundles and subcortical nuclei is not a simple task. It is of paramount importance in neurosciences, especially in the field of functional neurosurgery. The current methods for in vivo and post mortem fiber tract visualization have shortcomings and contributions to the field are welcome. Several tracts were chosen to implement a new technique to help visualization of white matter tracts, using high-thickness histology and dark field images. Our study describes the use of computational fluid dynamic simulations for visualization of 3D fiber tracts segmented from dark field microscopy in high-thickness histological slices (histological mesh tractography). A post mortem human brain was MRI scanned prior to skull extraction, histologically processed and serially cut at 430 µm thickness as previously described by our group. High-resolution dark field images were used to segment the outlines of the structures. These outlines served as basis for the construction of a 3D structured mesh, were a Finite Volume Method (FVM) simulation of water flow was performed to generate streamlines representing the geometry. The simulations were accomplished by an open source computer fluid dynamics software. The resulting simulation rendered a realistic 3D impression of the segmented anterior commissure, the left anterior limb of the internal capsule, the left uncinate fascicle, and the dentato-rubral tracts. The results are in line with clinical findings, diffusion MR imaging and anatomical dissection methods.
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- 2021
7. Deep brain stimulation modulates hypothalamic-brainstem fibers in cluster headache: case report
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Eduardo Joaquim Lopes Alho, Juliano Jose da Silva, Erich Talamoni Fonoff, Sergio Adrian Fernandes Dantas, Clement Hamani, and Nilson Nogueira Mendes Neto
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Deep brain stimulation ,business.industry ,Mammillary body ,medicine.medical_treatment ,Cluster headache ,Stimulation ,medicine.disease ,White matter ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,nervous system ,030220 oncology & carcinogenesis ,Dorsal longitudinal fasciculus ,Medicine ,Brainstem ,Medial forebrain bundle ,business ,Neuroscience ,030217 neurology & neurosurgery - Abstract
Hypothalamic deep brain stimulation (DBS) has been used for more than a decade to treat cluster headache (CH) but its mechanisms remain poorly understood. The authors have successfully treated a patient with CH using hypothalamic DBS and found that the contact used for chronic stimulation was located in a white matter region posterior to the mammillary bodies. Fiber tracts crossing that region were the medial forebrain bundle and those interconnecting the hypothalamus and brainstem, including the dorsal longitudinal fasciculus. Because the stimulation of axons is an important mechanism of DBS, some of its clinical effects in CH may be related to the stimulation of fibers interconnecting the hypothalamus and brainstem.
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- 2020
8. High-resolution resources and histological mesh tractography
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Eduardo Joaquim Lopes Alho, Erich Talamoni Fonoff, and Helmut Heinsen
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High resolution ,Biology ,Biomedical engineering ,Tractography - Published
- 2022
9. Contributors
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Harith Akram, Bassam Al-Fatly, Eduardo Joaquim Lopes Alho, Juan Carlos Baldermann, Richard F. Betzel, Alexandre Boutet, K. Butenko, Ki Sueng Choi, Volker A. Coenen, Gustavo Deco, Till Anselm Dembek, Thijs Dhollander, Gavin J.B. Elias, Henrique M. Fernandes, Francisca Ferreira, Erich Talamoni Fonoff, Michael D. Fox, Jürgen Germann, Helmut Heinsen, Frank Hertel, Barbara Hollunder, Andreas Horn, Andreas Husch, Friederike Irmen, Robert Jech, Juho Joutsa, Paul Krack, Morten L. Kringelbach, Andrea A. Kühn, Jonathan C. Lau, Ningfei Li, Roxanne Lofredi, Aaron Loh, Andres M. Lozano, Helen Mayberg, Karsten Mueller, Clemens Neudorfer, Wolf-Julian Neumann, Simon Oxenford, Roohie Parmar, Thushara Perera, Nanditha Rajamani, Marco Reisert, U. van Rienen, James M. Shine, Shan H. Siddiqi, Alaa Taha, Svenja Treu, Emily H.Y. Wong, and Joseph Yuan-Mou Yang
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- 2022
10. Motor Cortex Stimulation: Neural Circuits and Practical Approach on Electrode Implantation Technique
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Eduardo Joaquim Lopes Alho, Kleber Carlos de Azevedo Junior, and Erich Talamoni Fonoff
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business.industry ,medicine.medical_treatment ,Sensory system ,Stimulation ,humanities ,Neuromodulation (medicine) ,body regions ,medicine.anatomical_structure ,Amputation ,Cerebral cortex ,Neuropathic pain ,Biological neural network ,Medicine ,business ,Neuroscience ,Motor cortex - Abstract
Motor cortex stimulation (MCS) is a useful technique for the treatment of pain in severe neuropathic pain syndrome in the face of superior limbs. Most descriptions drive implantation of epidural electrodes for MCS under general anesthesia, using navigation merely based on anatomic landmarks or in combination with intraoperative sensory evoked potentials (SEPs) for functional localization. However, intraoperative SEP is not able to provide target refining when there is massive deafferentation pain syndromes (e.g., brachial plexus avulsion or amputation). In this chapter, the authors share their experience of a simple technique for refining the localization and intraoperative mapping of motor cortex by the implementation of transdural electrical stimulation of cerebral cortex. Also they review the anatomical pathways possibly related to analgesic effects during MCS.
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- 2021
11. Introduction and History of Neuromodulation for Pain
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Bernardo Assumpção de Monaco, Joacir Graciolli Cordeiro, Eduardo Joaquim Lopes Alho, and Jonathan R. Jagid
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Deep brain stimulation ,business.industry ,medicine.medical_treatment ,Medicine ,Spinal cord stimulation ,business ,Neuroscience ,humanities ,Neuromodulation (medicine) - Abstract
Neuromodulation techniques for pain treatment have been used since ancient Rome, but knowledge about the interaction of electricity and drugs with the central nervous system (electrical and chemical neuromodulation) was not clear until the middle of the twentieth century. It was only then that the advent of neuromodulatory techniques allowed for more widespread clinical application for the treatment of several neurological and psychiatric conditions, including pain. In this chapter, we present the history of neuromodulation techniques for the treatment of pain, from its first applications to a more organized approach encompassing physiological and technological improvements producing the current concepts in neuromodulation. We also take an in-depth look at the current surgical techniques for neuromodulatory improvement of pain.
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- 2021
12. Abstract #16 Current Steering DBS of the Hypothalamus: A Pilot Study Using Directional Leads with Multiple Independent Current Source
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William Omar Contreras Lopez, Raquel C.R. Martinez, Paula Alejandra Navarro, Eduardo Joaquim Lopes Alho, and Erich Talamoni Fonoff
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Surgery ,Neurology (clinical) - Published
- 2022
13. Abstract #20 Significant Clinical Improvement After ALIC/VS 8-Contact DBS for Central Poststroke Pain: Case Report
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William Omar Contreras Lopez, Eduardo Joaquim Lopes Alho, Paula Alejandra Navarro, and Erich Talamoni Fonoff
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Surgery ,Neurology (clinical) - Published
- 2022
14. Deep brain stimulation in Tourette’s syndrome: evidence to date
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Rubens Gisbert Cury, Erich Talamoni Fonoff, Eduardo Joaquim Lopes Alho, and Sara Carvalho Barbosa Casagrande
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medicine.medical_specialty ,Movement disorders ,Deep brain stimulation ,Tics ,Mechanism (biology) ,business.industry ,medicine.medical_treatment ,medicine.disease ,nervous system diseases ,030227 psychiatry ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Neurodevelopmental disorder ,nervous system ,Randomized controlled trial ,Refractory ,Quality of life ,law ,medicine ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Tourette's syndrome (TS) is a neurodevelopmental disorder that comprises vocal and motor tics associated with a high frequency of psychiatric comorbidities, which has an important impact on quality of life. The onset is mainly in childhood and the symptoms can either fade away or require pharmacological therapies associated with cognitive-behavior therapies. In rare cases, patients experience severe and disabling symptoms refractory to conventional treatments. In these cases, deep brain stimulation (DBS) can be considered as an interesting and effective option for symptomatic control. DBS has been studied in numerous trials as a therapy for movement disorders, and currently positive data supports that DBS is partially effective in reducing the motor and non-motor symptoms of TS. The average response, mostly from case series and prospective cohorts and only a few controlled studies, is around 40% improvement on tic severity scales. The ventromedial thalamus has been the preferred target, but more recently the globus pallidus internus has also gained some notoriety. The mechanism by which DBS is effective on tics and other symptoms in TS is not yet understood. As refractory TS is not common, even reference centers have difficulties in performing large controlled trials. However, studies that reproduce the current results in larger and multicenter randomized controlled trials to improve our knowledge so as to support the best target and stimulation settings are still lacking. This article will discuss the selection of the candidates, DBS targets and mechanisms on TS, and clinical evidence to date reviewing current literature about the use of DBS in the treatment of TS.
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- 2019
15. Amygdala and Hypothalamus: Historical Overview With Focus on Aggression
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Helena Brentani, Eduardo Joaquim Lopes Alho, Raquel Chacon Ruiz Martinez, Erich Talamoni Fonoff, Rosa Magaly Campelo Borba de Morais, Sergio P. Rigonatti, Clement Hamani, Flavia Venetucci Gouveia, and Aline Luz de Souza
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Deep brain stimulation ,medicine.medical_treatment ,Population ,Hypothalamus ,Review ,Functional neurosurgery ,Amygdala ,Neurosurgical Procedures ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Stereotactic neurosurgery ,Humans ,Medicine ,education ,education.field_of_study ,business.industry ,Aggression ,Surgical procedures ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Surgery ,Neurology (clinical) ,Deep brain simulation ,medicine.symptom ,business ,Neuroscience ,030217 neurology & neurosurgery - Abstract
Aggressiveness has a high prevalence in psychiatric patients and is a major health problem. Two brain areas involved in the neural network of aggressive behavior are the amygdala and the hypothalamus. While pharmacological treatments are effective in most patients, some do not properly respond to conventional therapies and are considered medically refractory. In this population, surgical procedures (ie, stereotactic lesions and deep brain stimulation) have been performed in an attempt to improve symptomatology and quality of life. Clinical results obtained after surgery are difficult to interpret, and the mechanisms responsible for postoperative reductions in aggressive behavior are unknown. We review the rationale and neurobiological characteristics that may help to explain why functional neurosurgery has been proposed to control aggressive behavior.
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- 2019
16. Unilateral Campotomy of Forel for Acquired Hemidystonia: An Open-Label Clinical Trial
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Angelo Rafael Cunha de Azevedo, William Omar Contreras López, Paula Alejandra Navarro, Flavia Venetucci Gouveia, Jürgen Germann, Gavin J.B. Elias, Raquel Chacon Ruiz Martinez, Eduardo Joaquim Lopes Alho, and Erich Talamoni Fonoff
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Dystonia ,Treatment Outcome ,Dystonic Disorders ,Deep Brain Stimulation ,Humans ,Surgery ,Neurology (clinical) ,Globus Pallidus - Abstract
Hemidystonia (HD) is characterized by unilateral involuntary torsion movements and fixed postures of the limbs and face. It often develops after deleterious neuroplastic changes secondary to injuries to the brain. This condition usually responds poorly to medical treatment, and deep brain stimulation often yields unsatisfactory results. We propose this study based on encouraging results from case reports of patients with HD treated by ablative procedures in the subthalamic region.To compare the efficacy of stereotactic-guided radiofrequency lesioning of the subthalamic area vs available medical treatment in patients suffering from acquired HD.This is an open-label study in patients with secondary HD allocated according to their treatment choice, either surgical or medical treatment; both groups were followed for one year. Patients assigned in the surgical group underwent unilateral campotomy of Forel. The efficacy was assessed using the Unified Dystonia Rating Scale, Fahn-Marsden Dystonia Scale, Arm Dystonia Disability Scale, and SF-36 questionnaire scores.Patients in the surgical group experienced significant improvement in the Unified Dystonia Rating Scale, Fahn-Marsden Dystonia Scale, and Arm Dystonia Disability Scale (39%, 35%, and 15%, respectively) 1 year after the surgery, with positive reflex in quality-of-life measures, such as bodily pain and role-emotional process. Patients kept on medical treatment did not experience significant changes during the follow-up. No infections were recorded, and no neurological adverse events were associated with either intervention.The unilateral stereotaxy-guided ablation of Forel H1 and H2 fields significantly improved in patients with HD compared with optimized clinical treatment.
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- 2021
17. The ansa subthalamica as a substrate for DBS-induced manic symptoms
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E. C. Miguel, Pedro Gomes de Alvarenga, Flavia Venetucci Gouveia, Eduardo Joaquim Lopes Alho, Rachel Emy Straus Takahashi, Antonio Carlos Lopes, Erich Talamoni Fonoff, Ruth Rocha Franco, Manoel Jacobsen Teixeira, Durval Damiani, and Clement Hamani
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Pediatrics ,medicine.medical_specialty ,Deep brain stimulation ,business.industry ,General Neuroscience ,medicine.medical_treatment ,Biophysics ,Stimulation ,Manic symptoms ,lcsh:RC321-571 ,nervous system diseases ,Hypomania ,medicine ,Lateral hypothalamic region ,Neurology (clinical) ,medicine.symptom ,business ,lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry ,Mania - Abstract
Over the years, important insight on the neurocircuitry of psychiatric symptoms have emerged from side effects recorded during deep brain stimulation (DBS). We have recently treated obesity in Prader Willi syndrome (PWS) using lateral hypothalamic region (LH) DBS[1Franco R.R. Fonoff E.T. Alvarenga P.G. Alho E.J.L. Lopes A.C. Hoexter M.Q. et al.Assessment of Safety and Outcome of Lateral Hypothalamic Deep Brain Stimulation for Obesity in a Small Series of Patients With Prader-Willi Syndrome.JAMA Netw Open. 2018; 1e185275Crossref Scopus (1) Google Scholar, 2Talakoub O. Paiva R.R. Milosevic M. Hoexter M.Q. Franco R. Alho E. et al.Lateral hypothalamic activity indicates hunger and satiety states in humans.Ann Clin Transl Neurol. 2017; 4: 897-901Crossref Scopus (2) Google Scholar] and noticed that two out of four patients developed stimulation-induced hypomania/mania.
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- 2020
18. Pedunculopontine Nucleus Microstructure Predicts Postural and Gait Symptoms in Parkinson's Disease
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Nicola J. Ray, Paul S. Holmes, John-Stuart Brittain, Eduardo Joaquim Lopes Alho, Michel J. Grothe, Ned Jenkinson, Ana Tereza Di Lorenzo Alho, Chesney E. Craig, Lynn Rochester, Monty Silverdale, Michael J. Fox Foundation for Parkinson's Research, and Wellcome Trust
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0301 basic medicine ,medicine.medical_specialty ,therapy [Parkinson Disease] ,Parkinson's disease ,Deep Brain Stimulation ,Disease ,03 medical and health sciences ,etiology [Gait Disorders, Neurologic] ,0302 clinical medicine ,Gait (human) ,Physical medicine and rehabilitation ,Dopamine ,diagnostic imaging [Gait Disorders, Neurologic] ,medicine ,diagnostic imaging [Parkinson Disease] ,Pedunculopontine Tegmental Nucleus ,Humans ,ddc:610 ,Gait ,Postural Balance ,Gait Disorders, Neurologic ,Pedunculopontine nucleus ,Postural instability and gait difficulties ,Receiver operating characteristic ,business.industry ,Dopaminergic ,diagnostic imaging [Pedunculopontine Tegmental Nucleus] ,Parkinson Disease ,medicine.disease ,030104 developmental biology ,Diffusion Tensor Imaging ,Neurology ,Neurology (clinical) ,complications [Parkinson Disease] ,business ,human activities ,030217 neurology & neurosurgery ,prognostic markers ,Diffusion MRI ,medicine.drug - Abstract
[Background] There is an urgent need to identify individuals at risk of postural instability and gait difficulties, and the resulting propensity for falls, in Parkinson's disease., [Objectives] Given known relationships between posture and gait and degeneration of the cholinergic pedunculopontine nucleus, we investigated whether metrics of pedunculopontine nucleus microstructural integrity hold independent utility for predicting future postural instability and gait difficulties and whether they could be combined with other candidate biomarkers to improve prognostication of these symptoms., [Methods] We used stereotactic mapping of the pedunculopontine nucleus and diffusion tensor imaging to extract baseline pedunculopontine nucleus diffusivity metrics in 147 participants with Parkinson's disease and 65 controls enrolled in the Parkinson's Progression Markers Initiative. We also recorded known candidate markers of posture and gait changes: loss of caudate dopamine and CSF β‐amyloid 1‐42 levels at baseline; as well as longitudinal progression motor symptoms over 72‐months., [Results] Survival analyses revealed that reduced dopamine in the caudate and increased axial diffusivity in the pedunculopontine nucleus incurred independent risk of postural instability and gait difficulties. Binary logistic regression and receiver operating characteristics analysis in 117 participants with complete follow‐up data at 60 months revealed that only pedunculopontine nucleus microstructure provided more accurate discriminative ability for predicting future postural instability and gait difficulties than clinical and demographic variables alone., [Conclusion] Dopaminergic and cholinergic loss incur independent risk for future postural instability and gait difficulties, and pedunculopontine nucleus microstructure can be used to prognosticate these symptoms from early Parkinson's disease stages. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society., The Parkinson's Progression Markers Initiative is sponsored and partially funded by the Michael J. Fox Foundation for Parkinson's Research. Other funding partners include a consortium of industry players, nonprofit organizations, and private individuals. Additional funding to support the current analysis was provided by the Wellcome Trust.
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- 2020
19. Stereotactic Gamma Ray Radiosurgery to the Centromedian and Parafascicular Complex of the Thalamus for Trigeminal Neuralgia and Other Complex Pain Syndromes
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Fidel Campos, William A Reyes, William Omar Lopez Contreras, Claudia B. Cruz, Eduardo E Lovo, Eduardo Joaquim Lopes Alho, Kaory C Barahona, Boheris Torres, Juan C. Arias, and Victor Caceros
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Visual analogue scale ,medicine.medical_treatment ,Thalamus ,Neurosurgery ,030204 cardiovascular system & hematology ,Radiosurgery ,neurosurgical management ,03 medical and health sciences ,0302 clinical medicine ,Posterior commissure ,Trigeminal neuralgia ,functional radiosurgery ,Medicine ,Pain Management ,pain ,Trigeminal nerve ,trigeminal neuralgia ,business.industry ,Thalamotomy ,General Engineering ,radiosurgery ,Pain scale ,thalamotomy ,medicine.disease ,Radiation Oncology ,business ,Nuclear medicine ,030217 neurology & neurosurgery - Abstract
Introduction We report our initial series of patients treated with radiosurgery to the Centromedian (CM) and Parafascicular (Pfc) Complex (CM-Pf) of the contralateral thalamus mainly for trigeminal neuralgia that had failed most known forms of conventional treatments. The coordinates were co-registered to a three-dimensional atlas of the thalamus in order to have a better comprehension of isodose curves distribution. Methods A fully automated rotating gamma ray unit was used to deliver a high dose of radiation (140 Gy) using a 4-mm collimator to the CM-Pf of the contralateral thalamus in 14 patients suffering from refractory trigeminal pain and other complex pain syndromes. The best stereotactic coordinates were plotted in a thalamic three-dimensional atlas space along with isodose curves corresponding to 50% of the dose prescription and the dose gradient. Results From November 2016 to July 2019, 14 patients experiencing severe forms of different pain syndromes were treated, and 10 were eligible for follow-up evaluation. Pain deriving from trigeminal neuralgia was present in the majority (80%) of patients and from other complex pain syndromes in the rest (20%). Median follow-up was 384 days (range: 30-994). The Visual Analogue Scale (VAS) score before treatment was 9 (range: 7-10) and standardized to 10. Before treatment, all the patients had a Barrow Neurological Institute Pain Scale (BNI) of 5 (V). The median years suffering from pain was 4.5 years (range: 1-15), the number of procedures including radiosurgery to the trigeminal nerve before thalamotomy was four (range: 1-10). Most patients (90%) reported some form of relief, the average VAS at the time of response was 3.5 (range: 0-9), and the average time to response was 67.3 days (range: 2-210). The neuromodulation effect of radiation was seen in 60% of patients. The average BNI score at response was 2.7 (range: 1-5). The final VAS score at last follow-up was 5.5 (range: 0-10) in six patients. In four patients (40%), the procedure had failed with a final BNI of IV, and V, three patients (30%) had excellent response (BNI of I), and three patients (30%) had worthwhile results with BNI of IIIa and IIIb. The total success rate (BNI of I to IIIb) was 60%, and the number of patients experiencing more than 50% of pain reduction at final follow-up was five (50%). Excluding both patients that were treated for pain outside of trigeminal neuralgia, 75% of the patients responded. The best coordinates on average were X: 5.5 mm from the thalamic border, Y: 3.7 mm anterior to the posterior commissure, and Z: 3.7 mm from the intercomissural line. There were no complications to report. Conclusion Radiosurgery to the CM-Pf of the thalamus was demonstrated to be a safe and relatively effective alternative to treat refractory trigeminal neuralgia. Further studies are needed to optimize target dimensions based on the three-dimensional studies of isodose curves as well as coordinates. Longer follow-up is necessary to evaluate recurrence rates that could not be reached.
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- 2019
20. Hemorragia subaracnóidea traumática
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Wellingson Silva Paiva, Eduardo Joaquim Lopes Alho, Manoel Jacobsen Teixeira, Robson Luis Oliveira de Amorim, Eberval Gadelha Figueiredo, and Almir Ferreira de Andrade
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medicine.medical_specialty ,Poor prognosis ,Subarachnoid hemorrhage ,medicine.anatomical_structure ,business.industry ,General surgery ,Incidence (epidemiology) ,medicine ,MEDLINE ,In patient ,Subarachnoid space ,medicine.disease ,business - Abstract
Introduction: Recent studies have shown association between the presence of blood in subarachnoid space in the first head computed tomography and the prognosis of patients with traumatic brain injury. The importance for the pathophysiology of brain trauma and the large incidence of traumatic subarachnoid hemorrhage led the authors to conduct a review with specificguidelines for classification, diagnosis and treatment. Material and Methods: Review articles listed in MEDLINE/Index Medicus database and LILACS, comprising a period from January 1970 to March 2008, were collected. Results: Thirty seven articles with the greatest impact from a collection of 192 were selected, considering 132 written in English or in Portuguese. Conclusions: Traumatic subarachnoid hemorrhage is a marker of poor prognosis in patients with moderate and severe head trauma and management involves advanced neurointensive care.
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- 2018
21. Pedunculopontine Nucleus Cholinergic Deficiency in Cervical Dystonia
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Edson Amaro, Mark Hallett, Eduardo Joaquim Lopes Alho, D Iacono, Nancy A. Edwards, Demelio Urbano, Ana Tereza Di Lorenzo Alho, Abhik Ray-Chaudhury, Karin Mente, and Silvina G. Horovitz
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0301 basic medicine ,Dystonia ,Pathology ,medicine.medical_specialty ,business.industry ,Putamen ,Striatum ,medicine.disease ,Choline acetyltransferase ,nervous system diseases ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,nervous system ,Neurology ,medicine ,Cholinergic ,Neurology (clinical) ,Cervical dystonia ,Cholinergic neuron ,business ,030217 neurology & neurosurgery ,Pedunculopontine nucleus - Abstract
Background The etiology of cervical dystonia is unknown. Cholinergic abnormalities have been identified in dystonia animal models and human imaging studies. Some animal models have cholinergic neuronal loss in the striatum and increased acetylcholinesterase activity in the pedunculopontine nucleus. Objectives The objective of this study was to determine the presence of cholinergic abnormalities in the putamen and pedunculopontine nucleus in cervical dystonia human brain donors. Methods Formalin-fixed brain tissues were obtained from 8 cervical dystonia and 7 age-matched control brains (controls). Pedunculopontine nucleus was available in only 6 cervical dystonia and 5 controls. Neurodegeneration was evaluated pathologically in the putamen, pedunculopontine nucleus, and other regions. Cholinergic neurons were detected using choline acetyltransferase immunohistochemistry in the putamen and pedunculopontine nucleus. Putaminal cholinergic neurons were quantified. A total of 6 cervical dystonia patients and 6 age-matched healthy controls underwent diffusion tensor imaging to determine if there were white matter microstructural abnormalities around the pedunculopontine nucleus. Results Decreased or absent choline acetyltransferase staining was identified in all 6 pedunculopontine nucleus samples in cervical dystonia. In contrast, strong choline acetyltransferase staining was present in 4 of 5 pedunculopontine nucleus controls. There were no differences in pedunculopontine nucleus diffusion tensor imaging between cervical dystonia and healthy controls. There was no difference in numbers of putaminal cholinergic neurons between cervical dystonia and controls. Conclusions Our findings suggest that pedunculopontine nucleus choline acetyltransferase deficiency represents a functional cholinergic deficit in cervical dystonia. Structural lesions and confounding neurodegenerative processes were excluded by absence of neuronal loss, gliosis, diffusion tensor imaging abnormalities, and beta-amyloid, tau, and alpha-synuclein pathologies. © 2018 International Parkinson and Movement Disorder Society.
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- 2018
22. High thickness histological sections as alternative to study the three-dimensional microscopic human sub-cortical neuroanatomy
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Ana Tereza Di Lorenzo Alho, Glaucia Aparecida Bento dos Santos, Manoel Jacobsen Teixeira, Lea T. Grinberg, Ricardo Caires Neves, Rafael Emidio da Silva, Helmut Heinsen, Daniel Boari Coelho, Maryana Alegro, Edson Amaro, Eduardo Joaquim Lopes Alho, and Erich Talamoni Fonoff
- Subjects
Male ,0301 basic medicine ,Histology ,Computer science ,Medical Physiology ,Article ,Imaging ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Thalamus ,Neural Pathways ,medicine ,Humans ,Segmentation ,Spatial localization ,TÉCNICAS HISTOLÓGICAS ,Aged ,Brain Mapping ,Sub-cortical atlas ,Neurology & Neurosurgery ,medicine.diagnostic_test ,General Neuroscience ,Neurosciences ,Brain ,Tissue Processing ,Magnetic resonance imaging ,Anatomy ,Human brain ,Middle Aged ,Magnetic Resonance Imaging ,Neuroanatomy ,030104 developmental biology ,medicine.anatomical_structure ,Cytoarchitecture ,Stereotaxy ,Three-Dimensional ,Neurological ,Biomedical Imaging ,Female ,Cognitive Sciences ,030217 neurology & neurosurgery ,Developmental Biology ,Biomedical engineering - Abstract
Stereotaxy is based on the precise image-guided spatial localization of targets within the human brain. Even with the recent advances in MRI technology, histological examination renders different (and complementary) information of the nervous tissue. Although several maps have been selected as a basis for correlating imaging results with the anatomical locations of sub-cortical structures, technical limitations interfere in a point-to-point correlation between imaging and anatomy due to the lack of precise correction for post-mortem tissue deformations caused by tissue fixation and processing. We present an alternative method to parcellate human brain cytoarchitectural regions, minimizing deformations caused by post-mortem and tissue-processing artifacts and enhancing segmentation by means of modified high thickness histological techniques and registration with MRI of the same specimen and into MNI space (ICBM152). A three-dimensional (3D) histological atlas of the human thalamus, basal ganglia, and basal forebrain cholinergic system is displayed. Structure's segmentations were performed in high-resolution dark-field and light-field microscopy. Bidimensional non-linear registration of the histological slices was followed by 3D registration with in situ MRI of the same subject. Manual and automated registration procedures were adopted and compared. To evaluate the quality of the registration procedures, Dice similarity coefficient and normalized weighted spectral distance were calculated and the results indicate good overlap between registered volumes and a small shape difference between them in both manual and automated registration methods. High thickness high-resolution histological slices in combination with registration to in situ MRI of the same subject provide an effective alternative method to study nuclear boundaries in the human brain, enhancing segmentation and demanding less resources and time for tissue processing than traditional methods.
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- 2017
23. Lateral hypothalamic activity indicates hunger and satiety states in humans
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Marcelo Q. Hoexter, Cary R. Savage, Milos R. Popovic, Manoel Jacobsen Teixeira, Eduardo Joaquim Lopes Alho, Clement Hamani, Durval Damiani, Raquel R. Paiva, Erich Talamoni Fonoff, Matija Milosevic, Antonio Carlos Lopes, Pedro Gomes de Alvarenga, José F. Pereira, Marcelo C. Batistuzzo, E. C. Miguel, Jessie Navarro, Omid Talakoub, and Ruth Rocha Franco
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0301 basic medicine ,Food intake ,medicine.medical_specialty ,Deep brain stimulation ,medicine.medical_treatment ,satiety ,Local field potential ,Prader‐Willi syndrome ,Brief Communication ,hunger ,03 medical and health sciences ,0302 clinical medicine ,Alpha rhythm ,Internal medicine ,Sensation ,medicine ,Obesity ,hypothalamus ,business.industry ,General Neuroscience ,digestive, oral, and skin physiology ,Neuromodulation (medicine) ,Clinical neurology ,deep brain stimulation ,030104 developmental biology ,Endocrinology ,Hypothalamus ,Neurology (clinical) ,business ,Brief Communications ,030217 neurology & neurosurgery - Abstract
Lateral hypothalamic area (LHA) local field potentials (LFPs) were recorded in a Prader–Willi patient undergoing deep brain stimulation (DBS) for obesity. During hunger, exposure to food‐related cues induced an increase in beta/low‐gamma activity. In contrast, recordings during satiety were marked by prominent alpha rhythms. Based on these findings, we have delivered alpha‐frequency DBS prior to and during food intake. Despite reporting an early sensation of fullness, the patient continued to crave food. This suggests that the pattern of activity in LHA may indicate hunger/satiety states in humans but attest to the complexity of conducting neuromodulation studies in obesity.
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- 2017
24. Thalamic deep brain stimulation for tremor in Parkinson disease, essential tremor, and dystonia
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Anna Castrioto, Stephan Chabardes, Rubens Gisbert Cury, Alim-Louis Benabid, Valérie Fraix, Paul Krack, Maricely Ambar Pérez Fernández, Elena Moro, Eduardo Joaquim Lopes Alho, and Eric Seigneuret
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Adult ,Male ,0301 basic medicine ,Deep brain stimulation ,Deep Brain Stimulation ,Essential Tremor ,Ocular tremor ,medicine.medical_treatment ,Disease ,03 medical and health sciences ,0302 clinical medicine ,Rating scale ,medicine ,Humans ,Thalamic stimulator ,Aged ,Retrospective Studies ,Dystonia ,Ventral Thalamic Nuclei ,Essential tremor ,business.industry ,Parkinson Disease ,Retrospective cohort study ,Middle Aged ,medicine.disease ,ddc:616.8 ,Treatment Outcome ,030104 developmental biology ,Anesthesia ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Objective:To report on the long-term outcomes of deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus (VIM) in Parkinson disease (PD), essential tremor (ET), and dystonic tremor.Methods:One hundred fifty-nine patients with PD, ET, and dystonia underwent VIM DBS due to refractory tremor at the Grenoble University Hospital. The primary outcome was a change in the tremor scores at 1 year after surgery and at the latest follow-up (21 years). Secondary outcomes included the relationship between tremor score reduction over time and the active contact position. Tremor scores (Unified Parkinson's Disease Rating Scale-III, items 20 and 21; Fahn, Tolosa, Marin Tremor Rating Scale) and the coordinates of the active contacts were recorded.Results:Ninety-eight patients were included. Patients with PD and ET had sustained improvement in tremor with VIM stimulation (mean improvement, 70% and 66% at 1 year; 63% and 48% beyond 10 years, respectively; p < 0.05). There was no significant loss of stimulation benefit over time (p > 0.05). Patients with dystonia exhibited a moderate response at 1-year follow-up (41% tremor improvement, p = 0.027), which was not sustained after 5 years (30% improvement, p = 0.109). The more dorsal active contacts' coordinates in the right lead were related to a better outcome 1 year after surgery (p = 0.029). During the whole follow-up, forty-eight patients (49%) experienced minor side effects, whereas 2 (2.0%) had serious events (brain hemorrhage and infection).Conclusions:VIM DBS is an effective long-term (beyond 10 years) treatment for tremor in PD and ET. Effects on dystonic tremor were modest and transient.Classification of evidence:This provides Class IV evidence. It is an observational study.
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- 2017
25. Magnetic resonance diffusion tensor imaging for the pedunculopontine nucleus: proof of concept and histological correlation
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L. L. Carreira, G. Magalhães, Daniel Boari Coelho, Ana Tereza Di Lorenzo Alho, Erich Talamoni Fonoff, C. A. Pasqualucci, Edson Amaro, Clement Hamani, R. E. da Silva, Helmut Heinsen, María M. Martín, Eduardo Joaquim Lopes Alho, Ricardo Caires Neves, Maryana Alegro, C. M. M. Araujo, Lea T. Grinberg, and Glaucia Aparecida Bento dos Santos
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Adult ,Male ,0301 basic medicine ,Inferior colliculus ,Histology ,Deep brain stimulation ,medicine.medical_treatment ,Article ,White matter ,Young Adult ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Predictive Value of Tests ,Image Interpretation, Computer-Assisted ,Fractional anisotropy ,Pedunculopontine Tegmental Nucleus ,medicine ,Humans ,Aged ,Pedunculopontine nucleus ,medicine.diagnostic_test ,business.industry ,General Neuroscience ,Medial lemniscus ,Reproducibility of Results ,Magnetic resonance imaging ,Anatomy ,Middle Aged ,Magnetic Resonance Imaging ,Diffusion Tensor Imaging ,030104 developmental biology ,medicine.anatomical_structure ,Anisotropy ,Female ,Autopsy ,Anatomic Landmarks ,business ,030217 neurology & neurosurgery ,Diffusion MRI - Abstract
The pedunculopontine nucleus (PPN) has been proposed as target for deep brain stimulation (DBS) in patients with postural instability and gait disorders due to its involvement in muscle tonus adjustments and control of locomotion. However, it is a deep-seated brainstem nucleus without clear imaging or electrophysiological markers. Some studies suggested that diffusion tensor imaging (DTI) may help guiding electrode placement in the PPN by showing the surrounding fiber bundles, but none have provided a direct histological correlation. We investigated DTI fractional anisotropy (FA) maps from in vivo and in situ post-mortem magnetic resonance images (MRI) compared to histological evaluations for improving PPN targeting in humans. A post-mortem brain was scanned in a clinical 3T MR system in situ. Thereafter, the brain was processed with a special method ideally suited for cytoarchitectonic analyses. Also, nine volunteers had in vivo brain scanning using the same MRI protocol. Images from volunteers were compared to those obtained in the post-mortem study. FA values of the volunteers were obtained from PPN, inferior colliculus, cerebellar crossing fibers and medial lemniscus using histological data and atlas information. FA values in the PPN were significantly lower than in the surrounding white matter region and higher than in areas with predominantly gray matter. In Nissl-stained histologic sections, the PPN extended for more than 10 mm in the rostro-caudal axis being closely attached to the lateral parabrachial nucleus. Our DTI analyses and the spatial correlation with histological findings proposed a location for PPN that matched the position assigned to this nucleus in the literature. Coregistration of neuroimaging and cytoarchitectonic features can add value to help establishing functional architectonics of the PPN and facilitate neurosurgical targeting of this extended nucleus.
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- 2017
26. Longitudinal Changes After Amygdala Surgery for Intractable Aggressive Behavior: Clinical, Imaging Genetics, and Deformation-Based Morphometry Study-A Case Series
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Ana Paula Bortoletto Martins, Raihaan Patel, Helena Brentani, Eduardo Joaquim Lopes Alho, M. Mallar Chakravarty, Gabriel A. Devenyi, Erich Talamoni Fonoff, Rosa Magaly Campelo Borba de Morais, Robert Gramer, Jürgen Germann, Flavia Venetucci Gouveia, Raquel Chacon Ruiz Martinez, Clement Hamani, and Christopher J. Steele
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Oncology ,Adult ,Male ,medicine.medical_specialty ,Radiosurgery ,Preoperative care ,Amygdala ,Lesion ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Internal medicine ,medicine ,Image Processing, Computer-Assisted ,Humans ,Radiofrequency Ablation ,medicine.diagnostic_test ,Aggression ,business.industry ,Mental Disorders ,Brain atlas ,Magnetic resonance imaging ,Magnetic Resonance Imaging ,Neuromodulation (medicine) ,030227 psychiatry ,medicine.anatomical_structure ,Quality of Life ,Surgery ,Female ,Neurosurgery ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background Intractable aggressive behavior (iAB) is a devastating behavioral disorder that may affect psychiatric patients. These patients have reduced quality of life, are more challenging to treat as they impose a high caregiver burden and require specialized care. Neuromodulatory interventions targeting the amygdala, a key hub in the circuitry of aggressive behavior (AB), may provide symptom alleviation. Objective To Report clinical and imaging findings from a case series of iAB patients treated with bilateral amygdala ablation. Methods This series included 4 cases (3 males, 19-32 years old) who underwent bilateral amygdala radiofrequency ablation for iAB hallmarked by life-threatening self-injury and social aggression. Pre- and postassessments involved full clinical, psychiatric, and neurosurgical evaluations, including scales quantifying AB, general agitation, quality of life, and magnetic resonance imaging (MRI). Results Postsurgery assessments revealed decreased aggression and agitation and improved quality of life. AB was correlated with testosterone levels and testosterone/cortisol ratio in males. No clinically significant side effects were observed. Imaging analyses showed preoperative amygdala volumes within normal populational range and confirmed lesion locations. The reductions in aggressive symptoms were accompanied by significant postsurgical volumetric reductions in brain areas classically associated with AB and increases in regions related to somatosensation. The local volumetric reductions are found in areas that in a normal brain show high expression levels of genes related to AB (eg, aminergic transmission) using gene expression data provided by the Allen brain atlas. Conclusion These findings provide new insight into the whole brain neurocircuitry of aggression and suggest a role of altered somatosensation and possible novel neuromodulation targets.
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- 2019
27. Computer-assisted craniometric evaluation for diagnosis and follow-up of craniofacial asymmetries: SymMetric v. 1.0
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Fabio Okuda Furokawa, Bernardo Assumpção de Monaco, Eduardo Joaquim Lopes Alho, and Carlo Rondinoni
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Computer science ,Cephalometry ,Plagiocephaly ,Context (language use) ,Physical examination ,010501 environmental sciences ,01 natural sciences ,Craniosynostosis ,03 medical and health sciences ,0302 clinical medicine ,Software ,medicine ,Deformity ,Humans ,Craniofacial ,Set (psychology) ,0105 earth and related environmental sciences ,Orthodontics ,medicine.diagnostic_test ,Plagiocephaly, Nonsynostotic ,business.industry ,Computers ,Infant ,030206 dentistry ,General Medicine ,medicine.disease ,Treatment Outcome ,Pediatrics, Perinatology and Child Health ,Neurology (clinical) ,medicine.symptom ,business ,Facial symmetry ,Follow-Up Studies - Abstract
PurposeThe current assessment of patients with craniofacial asymmetries is accomplished by physical examination, anamnesis and radiological imaging.We propose a semi-automated, computer-assisted craniofacial evaluation (SymMetric v 1.0) based on orthogonal photography of the patient’s head in 3 positions. The system is simple, low-cost, no-radiation or special resources needed. Although it does not substitute CT in cases of doubt between craniosynostosis and positional plagiocephaly, multiple numeric evaluations indicate regional deformities and severity of the asymmetry, which can help in the clinical decision of indicating or not the orthosis in positional deformities, determining treatment duration or evaluating surgical outcomes after correction.MethodsA Matlab-based tool was developed for digital processing of photographs taken in 3 positions (anterior, superior and lateral). The software guides the user to select visible and reproducible landmarks in each photograph acquisition and calculates multiple indexes and metrics, generating a set of comprehensive plots to offer the user an overview of head and facial symmetry across the orthogonal views. For purposes of demonstration, we evaluated 2 patients (one control and one with non-sinostotic deformity).ResultsThe results show a clear differentiation of the control and plagiocephalic patient metrics mainly in the superior view, showing potential for diagnosis of the condition, and also detected the clinical improvement during helmet treatment in the follow-up, 3 and 5 months after orthosis’ use.ConclusionWe presented a proof-of-concept for a low cost, no radiation evaluation system for craniofacial asymmetries, that can be useful in a clinical context for diagnosis and follow-up of patients.
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- 2019
28. Clinical, imaging genetics and deformation based morphometry study of longitudinal changes after surgery for intractable aggressive behaviour
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Clement Hamani, Christopher J. Steele, Gabriel A. Devenyi, Helena Brentani, Flavia Venetucci Gouveia, Raihaan Patel, M. Mallar Chakravarty, Rosa Magaly Campelo Borba de Morais, Ana Paula Bortoletto Martins, Jürgen Germann, Raquel Chacon Ruiz Martinez, Robert Gramer, Eduardo Joaquim Lopes Alho, and Erich Talamoni Fonoff
- Subjects
Oncology ,medicine.medical_specialty ,business.industry ,Aggression ,Radiofrequency ablation ,Somatosensory system ,Amygdala ,Neuromodulation (medicine) ,law.invention ,Lesion ,medicine.anatomical_structure ,Quality of life ,law ,Internal medicine ,medicine ,medicine.symptom ,business ,Testosterone - Abstract
Intractable aggressive behaviour is a devastating behavioural disorder that reach 30% of psychiatric aggressive patients. Neuromodulatory surgeries may be treatment alternatives to reduce suffering. We investigated the outcomes of bilateral amygdala radiofrequency ablation in four patients with intractable aggressive behaviour (life-threatening-self-injury and social aggression) by studying whole brain magnetic resonance imaging and clinical data. Post-surgery assessments revealed decreases in aggression and agitation and improvements in quality of life. Aggressive behaviour was positively correlated with serum testosterone levels and the testosterone/cortisol ratio in males. No clinically significant side effects were observed. Imaging analyses revealed preoperative amygdala volumes within normal range and confirmed appropriate lesion locations. Reduction in aggressiveness were accompanied by volumetric reduction in brain areas associated with aggressive behaviour (express genes related to aggressive behaviour), and increases in regions related to somatosensation. These findings further elucidates the neurocircuitry of aggression and suggests novel neuromodulation targets.
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- 2019
29. Assessment of Safety and Outcome of Lateral Hypothalamic Deep Brain Stimulation for Obesity in a Small Series of Patients With Prader-Willi Syndrome
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Erich Talamoni Fonoff, Roseli G. Shavitt, Anita Taub, Marcelo C. Batistuzzo, Clement Hamani, Pedro Gomes de Alvarenga, Eduardo Joaquim Lopes Alho, Raquel R. Paiva, Antonio Carlos Lopes, Ruth Rocha Franco, Durval Damiani, Manoel Jacobsen Teixeira, Marcelo Q. Hoexter, and E. C. Miguel
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0301 basic medicine ,Adult ,Male ,Pediatrics ,medicine.medical_specialty ,congenital, hereditary, and neonatal diseases and abnormalities ,Deep brain stimulation ,Adolescent ,medicine.medical_treatment ,Deep Brain Stimulation ,Hypothalamus ,Polysomnography ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,medicine ,Humans ,Young adult ,Adverse effect ,Original Investigation ,medicine.diagnostic_test ,business.industry ,Research ,nutritional and metabolic diseases ,General Medicine ,Anthropometry ,Discontinuation ,nervous system diseases ,Obesity, Morbid ,Online Only ,030104 developmental biology ,surgical procedures, operative ,Neurology ,Cohort ,Female ,business ,Body mass index ,Prader-Willi Syndrome ,030217 neurology & neurosurgery - Abstract
Key Points Question Is lateral hypothalamic deep brain stimulation (DBS) safe for the treatment of obesity in Prader-Willi syndrome? Findings In this case series of 4 patients with Prader-Willi syndrome treated with lateral hypothalamic DBS, 2 developed stimulation-induced manic symptoms and 2 developed infections, 1 of which was associated with skin picking. No major differences were found when postoperative anthropometric and calorimetric data were compared with baseline; hormonal levels, and results of blood workup, sleep studies, and neuropsychological evaluations also showed no change. Meaning Safety of lateral hypothalamic DBS was in the range of that demonstrated in patients with similar psychiatric conditions receiving DBS; however, in the small cohort of patients with Prader-Willi syndrome treated, DBS seemed largely ineffective for the treatment of obesity., This study of a case series of 4 patients investigates the safety and efficacy of deep brain stimulation for obesity associated with Prader-Willi syndrome., Importance Deep brain stimulation (DBS) has been investigated for treatment of morbid obesity with variable results. Patients with Prader-Willi syndrome (PWS) present with obesity that is often difficult to treat. Objective To test the safety and study the outcome of DBS in patients with PWS. Design, Setting, and Participants This case series was conducted in the Hospital das Clínicas, University of São Paulo, Brazil. Four patients with genetically confirmed PWS presenting with severe obesity were included. Exposure Deep brain stimulation electrodes were bilaterally implanted in the lateral hypothalamic area. After DBS implantation, the treatment included the following phases: titration (1-2 months), stimulation off (2 months), low-frequency DBS (40 Hz; 1 month), washout (15 days), high-frequency DBS (130 Hz; 1 month), and long-term follow-up (6 months). Main Outcomes and Measures Primary outcome measures were adverse events recorded during stimulation and long-term DBS treatment. Secondary outcomes consisted of changes in anthropometric measures (weight, body mass index [calculated as weight in kilograms divided by height in meters squared], and abdominal and neck circumference), bioimpedanciometry, and calorimetry after 6 months of treatment compared with baseline. The following evaluations and measurements were conducted before and after DBS: clinical, neurological, psychiatric, neuropsychological, anthropometry, calorimetry, blood workup, hormonal levels, and sleep studies. Adverse effects were monitored during all follow-up visits. Results Four patients with PWS were included (2 male and 2 female; ages 18-28 years). Baseline mean (SD) body mass index was 39.6 (11.1). Two patients had previous bariatric surgery, and all presented with psychiatric comorbidity, which was well controlled with the use of medications. At 6 months after long-term DBS, patients had a mean 9.6% increase in weight, 5.8% increase in body mass index, 8.4% increase in abdominal circumference, 4.2% increase in neck circumference, 5.3% increase in the percentage of body fat, and 0% change in calorimetry compared with baseline. Also unchanged were hormonal levels and results of blood workup, sleep studies, and neuropsychological evaluations. Two patients developed stimulation-induced manic symptoms. Discontinuation of DBS controlled this symptom in 1 patient. The other required adjustments in medication dosage. Two infections were documented, 1 associated with skin picking. Conclusions and Relevance Safety of lateral hypothalamic area stimulation was in the range of that demonstrated in patients with similar psychiatric conditions receiving DBS. In the small cohort of patients with PWS treated in our study, DBS was largely ineffective.
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- 2019
30. Profound degeneration of wake-promoting neurons in Alzheimer’s disease
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Jun Oh, Helmut Heinsen, Jessica Kudlacek, William W. Seeley, Celica Cosme, Christine M. Walsh, Elisa de Paula França Resende, Thomas C. Neylan, Eduardo Joaquim Lopes Alho, Jackson C. Bittencourt, Rana Eser, Dulce Ovando Morales, Salvatore Spina, Bruce L. Miller, Cathrine Petersen, Lea T. Grinberg, Alexander J. Ehrenberg, Sara R. Dunlop, and Panos Theofilas
- Subjects
Male ,Sleep Wake Disorders ,0301 basic medicine ,Epidemiology ,Stereology ,Autopsy ,Degeneration (medical) ,Disease ,Article ,Progressive supranuclear palsy ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,Developmental Neuroscience ,Alzheimer Disease ,Humans ,Medicine ,Corticobasal degeneration ,Aged ,Neurons ,business.industry ,Health Policy ,Brain ,Middle Aged ,medicine.disease ,eye diseases ,Psychiatry and Mental health ,030104 developmental biology ,Tauopathies ,Locus coeruleus ,Female ,Wakefulness ,Supranuclear Palsy, Progressive ,Neurology (clinical) ,Geriatrics and Gerontology ,business ,Neuroscience ,030217 neurology & neurosurgery ,AUTÓPSIA - Abstract
Introduction Sleep-wake disturbances are a common and early feature in Alzheimer's disease (AD). The impact of early tau pathology in wake-promoting neurons (WPNs) remains unclear. Methods We performed stereology in postmortem brains from AD individuals and healthy controls to identify quantitative differences in morphological metrics in WPNs. Progressive supranuclear palsy (PSP) and corticobasal degeneration were included as disease-specific controls. Results The three nuclei studied accumulate considerable amounts of tau inclusions and showed a decrease in neurotransmitter-synthetizing neurons in AD, PSP, and corticobasal degeneration. However, substantial neuronal loss was exclusively found in AD. Discussion WPNs are extremely vulnerable to AD but not to 4 repeat tauopathies. Considering that WPNs are involved early in AD, such degeneration should be included in the models explaining sleep-wake disturbances in AD and considered when designing a clinical intervention. Sparing of WPNs in PSP, a condition featuring hyperinsomnia, suggest that interventions to suppress the arousal system may benefit patients with PSP.
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- 2019
31. The Retrograde Ventriculosinusal Shunt in an Animal Experimental Model of Hydrocephalus
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Luiz F. Poli-de-Figueiredo, Eduardo Joaquim Lopes Alho, Rodrigo Becco, Podalyro Amaral de Souza, Manoel Jacobsen Teixeira, Fernando Campos Gomes Pinto, and Matheus Fernandes de Oliveira
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Male ,0301 basic medicine ,Mean arterial pressure ,Cisterna magna ,Random Allocation ,03 medical and health sciences ,Dogs ,0302 clinical medicine ,medicine ,Animals ,Intracranial pressure ,business.industry ,General Medicine ,medicine.disease ,Cerebrospinal Fluid Shunts ,Shunt (medical) ,Hydrocephalus ,SSS ,Disease Models, Animal ,Catheter ,030104 developmental biology ,Pediatrics, Perinatology and Child Health ,Surgery ,Neurology (clinical) ,Nuclear medicine ,business ,030217 neurology & neurosurgery ,NEUROCIRURGIA ,Superior sagittal sinus - Abstract
Currently, hydrocephalus treatment is performed mainly with ventriculoperitoneal shunting. This experimental study aims at assessing whether the experimental model of hydrocephalus in dogs is applicable to the laboratory study of the retrograde ventriculosinusal shunt (RVSS). Four mongrel dogs were assessed. After randomization, the animals were divided into two groups: an experimental group that underwent the induction of hydrocephalus/RVSS and a control group, for the measurement of the mean arterial pressure, intracranial pressure and pressure in the superior sagittal sinus (SSS). The controls presented a mean arterial pressure of 68 mm Hg (71 and 65), an intracranial pressure of 163 mm H2O (149.6 and 176.8) and a pressure at the SSS of 40 mm H2O (40 and 40). The kaolin injection into the cisterna magna at a concentration of 0.3 mg/ml was capable of inducing the clinical and radiological mechanism of hydrocephalus (intracranial pressure = 250 mm H2O, pressure at the SSS = 50 mm H2O). The caliber of the SSS was 2.5 ± 1.0 mm. The fact that the SSS caliber of the dog was the same size as the external diameter of the catheter used resulted in the complete obstruction of the SSS when the catheter was inserted. We believe we could design and perform an experimental model to test the RVSS. It is applicable and feasible. The model of hydrocephalus, the surgical apparatus and the scenario were adequate, but the shunt system needs to be proportionally made to the canine anatomy.
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- 2016
32. Training with brain-machine interfaces, visuo-tactile feedback and assisted locomotion improves sensorimotor, visceral, and psychological signs in chronic paraplegic patients
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Sabrina Esteves de Matos Almeida, Dora Fischer, Guillaume Bao, Vania A. S. Braga, Patricia B. Augusto, Mikhail A. Lebedev, Eduardo Joaquim Lopes Alho, Solaiman Shokur, Miguel A. L. Nicolelis, Ana R. C. Donati, Allen W. Song, Debora S. F. Campos, Christopher Petty, and Claudia M. Gitti
- Subjects
Male ,030506 rehabilitation ,Muscle Physiology ,Critical Care and Emergency Medicine ,Physiology ,medicine.medical_treatment ,Social Sciences ,Pathology and Laboratory Medicine ,0302 clinical medicine ,Quality of life ,Feedback, Sensory ,Medicine and Health Sciences ,Psychology ,Spinal Cord Injury ,Spinal cord injury ,Musculoskeletal System ,Trauma Medicine ,Multidisciplinary ,Rehabilitation ,Physics ,Neurological Rehabilitation ,Classical Mechanics ,Touch Perception ,Neurology ,Brain-Computer Interfaces ,Physical Sciences ,Legs ,Medicine ,Female ,Sensory Perception ,Anatomy ,0305 other medical science ,Paraplegia ,Traumatic Injury ,Locomotion ,Research Article ,Muscle Contraction ,Adult ,medicine.medical_specialty ,Science ,Vibration ,Rehabilitation Medicine ,Pelvis ,03 medical and health sciences ,Physical medicine and rehabilitation ,Signs and Symptoms ,Diagnostic Medicine ,Sensation ,medicine ,Humans ,Neurorehabilitation ,Hip ,Proprioception ,business.industry ,Biology and Life Sciences ,Recovery of Function ,medicine.disease ,Body Limbs ,Chronic Disease ,Quality of Life ,Lesions ,Sexual function ,business ,Neurotrauma ,030217 neurology & neurosurgery ,Neuroscience - Abstract
Spinal cord injury (SCI) induces severe deficiencies in sensory-motor and autonomic functions and has a significant negative impact on patients’ quality of life. There is currently no systematic rehabilitation technique assuring recovery of the neurological impairments caused by a complete SCI. Here, we report significant clinical improvement in a group of seven chronic SCI patients (six AIS A, one AIS B) following a 28-month, multi-step protocol that combined training with non-invasive brain-machine interfaces, visuo-tactile feedback and assisted locomotion. All patients recovered significant levels of nociceptive sensation below their original SCI (up to 16 dermatomes, average 11 dermatomes), voluntary motor functions (lower-limbs muscle contractions plus multi-joint movements) and partial sensory function for several modalities (proprioception, tactile, pressure, vibration). Patients also recovered partial intestinal, urinary and sexual functions. By the end of the protocol, all patients had their AIS classification upgraded (six from AIS A to C, one from B to C). These improvements translated into significant changes in the patients’ quality of life as measured by standardized psychological instruments. Reexamination of one patient that discontinued the protocol after 12 months of training showed that the 16-month break resulted in neurological stagnation and no reclassification. We suggest that our neurorehabilitation protocol, based uniquely on non-invasive technology (therefore necessitating no surgical operation), can become a promising therapy for patients diagnosed with severe paraplegia (AIS A, B), even at the chronic phase of their lesion.
- Published
- 2018
33. Teaching NeuroImages: In vivo visualization of Edinger comb and Wilson pencils
- Author
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Helmut Heinsen, Jonathan R. Polimeni, Eduardo Joaquim Lopes Alho, Markus Axer, Erich Talamoni Fonoff, Todd M. Herrington, Siobhan Ewert, and Andreas Horn
- Subjects
Resident & Fellow Section ,Substantia nigra ,Internal pallidum ,Human brain ,Striatum ,Biology ,Globus Pallidus ,Magnetic Resonance Imaging ,Corpus Striatum ,Substantia Nigra ,03 medical and health sciences ,Subthalamic nucleus ,0302 clinical medicine ,medicine.anatomical_structure ,nervous system ,In vivo ,medicine ,Humans ,030212 general & internal medicine ,Neurology (clinical) ,Neuroscience ,030217 neurology & neurosurgery - Abstract
The “direct” and “indirect” pathways play crucial roles in movement disorder pathophysiology. Both traverse from the striatum to the internal pallidum and substantia nigra, the latter detouring to external pallidum and subthalamic nucleus. Anatomically, the pathways manifest within the striatofugal bundle that passes radially through the pallidum in the form of pencil-like tracts (first described by Wilson1; figure 1) before leaving the pallidum toward the substantia nigra in the form of a comb described by Edinger in 18962 (figure 2). A century later, these structures can be visualized in the living human brain (figures 1D and 2A).
- Published
- 2019
34. Oncostatic effects of fluoxetine in experimental colon cancer models
- Author
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Vinicius Kannen, Katrin G. Heinze, Romana Mönch, Helga Stopper, Eduardo Joaquim Lopes Alho, Claus-Jürgen Scholz, Wilson A. Silva, Ana Maria Waaga-Gasser, Sérgio Britto Garcia, Mike Friedrich, Martin Gasser, and Helmut Heinsen
- Subjects
medicine.medical_specialty ,animal structures ,Colorectal cancer ,Angiogenesis ,medicine.medical_treatment ,Population ,Mice, SCID ,Biology ,Resting Phase, Cell Cycle ,Mice ,Mice, Inbred NOD ,In vivo ,Fluoxetine ,Internal medicine ,medicine ,Animals ,Humans ,QUIMIOTERAPIA ,education ,Microvessel ,education.field_of_study ,Chemotherapy ,G1 Phase ,Neoplasms, Experimental ,Cell Biology ,Hypoxia (medical) ,medicine.disease ,Xenograft Model Antitumor Assays ,Cell Hypoxia ,Endocrinology ,Cell culture ,Colonic Neoplasms ,Cancer research ,Caco-2 Cells ,medicine.symptom - Abstract
Colon cancer is one of the most common tumors in the human population. Recent studies have shown a reduced risk for colon cancer in patients given the antidepressant fluoxetine (FLX). The exact mechanism by which FLX might protect from colon cancer remains however controversial. Here, FLX reduced the development of different colon tumor xenografts, as well as proliferation in hypoxic tumor areas within them. FLX treatment also decreased microvessel numbers in tumors. Although FLX did not increase serum and tumor glucose levels as much as the colon chemotherapy gold standard Fluorouracil did, lactate levels were significantly augmented within tumors by FLX treatment. The gene expression of the MCT4 lactate transporter was significantly downregulated. Total protein amounts from the third and fifth mitochondrial complexes were significantly decreased by FLX in tumors. Cell culture experiments revealed that FLX reduced the mitochondrial membrane potential significantly and disabled the reactive oxygen species production of the third mitochondrial complex. Furthermore, FLX arrested hypoxic colon tumor cells in the G0/G1 phase of the cell-cycle. The expression of key cell-cycle-related checkpoint proteins was enhanced in cell culture and in vivo experiments. Therefore, we suggest FLX impairs energy generation, cell cycle progression and proliferation in tumor cells, especially under condition of hypoxia. This then leads to reduced microvessel formation and tumor shrinkage in xenograft models.
- Published
- 2015
35. [P4–273]: TAU BURDEN IN OREXINERGIC WAKE‐PROMOTING NEURONS IN ALZHEIMER'S DISEASE IN COMPARISON TO CORTICAL BASAL DEGENERATION AND PROGRESSIVE SUPRANUCLEAR PALSY: A NEUROPATHOLOGICAL IMPLICATION IN SLEEP DISTURBANCES
- Author
-
Maria B. Mejia, Thomas C. Neylan, Panos Theofilas, William W. Seeley, Christine M. Walsh, Helmut Heinsen, Rana Eser, Bruce L. Miller, Cathrine Petersen, Lea T. Grinberg, Alexander J. Ehrenberg, Sara Dunlop, Jun Yeop Oh, and Eduardo Joaquim Lopes Alho
- Subjects
Epidemiology ,business.industry ,Health Policy ,Degeneration (medical) ,Disease ,medicine.disease ,Sleep in non-human animals ,Progressive supranuclear palsy ,Psychiatry and Mental health ,Cellular and Molecular Neuroscience ,Basal (phylogenetics) ,Developmental Neuroscience ,Medicine ,Neurology (clinical) ,Geriatrics and Gerontology ,business ,Neuroscience - Published
- 2017
36. Subthalamic nucleus deep brain stimulation: Basic concepts and novel perspectives
- Author
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Erich Talamoni Fonoff, Manoel Jacobsen Teixeira, Clement Hamani, Eduardo Joaquim Lopes Alho, Yasin Temel, Kamil Uludag, Edson Amaro, Birgit R. Plantinga, Gerson Florence, and Helmut Heinsen
- Subjects
Deep brain stimulation ,anatomy ,DECREASE IMPULSIVE CHOICE ,medicine.medical_treatment ,Parkinson Disease/therapy ,Deep Brain Stimulation ,Thalamus ,Review ,MPTP-TREATED MONKEYS ,BASAL GANGLIA ,ADVANCED PARKINSON-DISEASE ,NIGRA PARS RETICULATA ,Deep Brain Stimulation/methods ,Basal ganglia ,medicine ,Journal Article ,Animals ,Humans ,DOPAMINE DYSREGULATION SYNDROME ,REACTION-TIME-TASK ,subthalamic nucleus ,mechanisms ,neuroimaging ,Supplementary motor area ,General Neuroscience ,PRIMARY MOTOR CORTEX ,CÉREBRO ,Parkinson Disease ,General Medicine ,OBSESSIVE-COMPULSIVE DISORDER ,nervous system diseases ,Subthalamic nucleus ,Subthalamic Nucleus/physiology ,medicine.anatomical_structure ,Globus pallidus ,surgical procedures, operative ,nervous system ,plasticity ,physiology ,HIGH-FREQUENCY STIMULATION ,3.7 ,Disorders of the Nervous System ,Primary motor cortex ,Psychology ,Neuroscience ,therapeutics ,Neuroanatomy - Abstract
Over the last decades, extensive basic and clinical knowledge has been acquired on the use of subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson’s disease (PD). It is now clear that mechanisms involved in the effects of this therapy are far more complex than previously anticipated. At frequencies commonly used in clinical practice, neural elements may be excited or inhibited and novel dynamic states of equilibrium are reached. Electrode contacts used for chronic DBS in PD are placed near the dorsal border of the nucleus, a highly cellular region. DBS may thus exert its effects by modulating these cells, hyperdirect projections from motor cortical areas, afferent and efferent fibers to the motor STN. Advancements in neuroimaging techniques may allow us to identify these structures optimizing surgical targeting. In this review, we provide an update on mechanisms and the neural elements modulated by STN DBS.
- Published
- 2017
37. Multimodal Whole Brain Registration: MRI and High Resolution Histology
- Author
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Helmut Heinsen, Eduardo Joaquim Lopes Alho, Daniela Ushizima, Maryana Alegro, Lilla Zollei, Edson Amaro, Lea T. Grinberg, and B. Loring
- Subjects
Image fusion ,medicine.medical_specialty ,medicine.diagnostic_test ,Computer science ,business.industry ,Image registration ,Histology ,Magnetic resonance imaging ,Human brain ,Real-time MRI ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Lateral ventricles ,0302 clinical medicine ,medicine.anatomical_structure ,Neuroimaging ,Gyrus ,medicine ,Neurosurgery ,Artificial intelligence ,business ,030217 neurology & neurosurgery ,Biomedical engineering - Abstract
Three-dimensional brain imaging through cutting-edge MRI technology allows assessment of physical and chemical tissue properties at sub-millimeter resolution. In order to improve brain understanding as part of diagnostic tasks using MRI images, other imaging modalities to obtain deep cerebral structures and cytoarchitectural boundaries have been investigated. Under availability of postmortem samples, the fusion of MRI to brain histology supports more accurate description of neuroanatomical structures since it preserves microscopic entities and reveal fine anatomical details, unavailable otherwise. Nonetheless, histological processing causes severe tissue deformation and loss of the brain original 3D conformation, preventing direct comparisons between MRI and histology. This paper proposes an interactive computational pipeline designed to register multimodal brain data and enable direct histology-MRI correlation. Our main contribution is to develop schemes for brain data fusion, distortion corrections, using appropriate diffeomorphic mappings to align the 3D histological and MRI volumes. We describe our pipeline and preliminary developments of scalable processing schemes for highresolution images. Tests consider a postmortem human brain, and include qualitatively and quantitatively results, such as 3D visualizations and the Dice coefficient (DC) between brain structures. Preliminary results show promising DC values when comparing our scheme results to manually labeled neuroanatomical regions defined by a neurosurgeon on MRI and histology data sets. DC was computed for the left caudade gyrus (LC), right hippocampus (RH) and lateral ventricles (LV).
- Published
- 2016
38. Bilateral subthalamic nucleus stimulation for generalized dystonia after bilateral pallidotomy
- Author
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Eduardo Joaquim Lopes Alho, Wuilker Knoner Campos, Mauricio Mandel, Erich Talamoni Fonoff, and Manoel Jacobsen Teixeira
- Subjects
Dystonia ,medicine.medical_specialty ,Deep brain stimulation ,Thalamotomy ,business.industry ,medicine.medical_treatment ,medicine.disease ,nervous system diseases ,Subthalamic nucleus ,Physical medicine and rehabilitation ,Neurology ,Rating scale ,Anesthesia ,Generalized dystonia ,medicine ,Pallidotomy ,Neurology (clinical) ,business ,Subthalamic nucleus stimulation - Abstract
Background: Thalamotomies and pallidotomies were commonly performed before the deep brain stimulation (DBS) era. Although ablative procedures can lead to significant dystonia improvement, longer periods of analysis reveal disease progression and functional deterioration. Today, the same patients seek additional treatment possibilities. Methods: Four patients with generalized dystonia who previously had undergone bilateral pallidotomy came to our service seeking additional treatment because of dystonic symptom progression. Bilateral subthalamic nucleus DBS (B-STN-DBS) was the treatment of choice. The patients were evaluated with the Burke‐ Fahn‐Marsden Dystonia Rating Scale (BFMDRS) and the Unified Dystonia Rating Scale (UDRS) before and 2 years after surgery. Results: All patients showed significant functional improvement, averaging 65.3% in BFMDRS (P 5 .014) and 69.2% in UDRS (P 5.025). Conclusions: These results suggest that B-STN-DBS may be an interesting treatment option for generalized dystonia, even for patients who have already undergone bilateral pallidotomy. V C 2012 Movement Disorder Society
- Published
- 2012
39. Optimizing microdialysis for deep brain stimulation
- Author
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Travis S. Tierney, Maria Gabriela dos Santos Ghilardi, William Omar Contreras Lopez, Eduardo Joaquim Lopes Alho, Erich Talamoni Fonoff, Raquel Chacon Ruiz Martinez, Clement Hamani, and Manoel Jacobsen Teixeira
- Subjects
Microdialysis ,Deep brain stimulation ,General Immunology and Microbiology ,business.industry ,medicine.medical_treatment ,Deep Brain Stimulation ,Parkinson Disease ,Dialysis catheter ,General Biochemistry, Genetics and Molecular Biology ,Cerebral microdialysis ,Perfusion rate ,medicine ,Humans ,In patient ,business ,Biomedical engineering - Abstract
Cerebral microdialysis is a chemical detection method capable of identifying and simultaneously sampling a wide range of substances in the micromilieu of the monitoring probe. The interstitial space of biological tissues and fluids is sampled through a thin fenestrated dialysis catheter inserted into the brain. The technique has been reported in patients with Parkinson's disease. However, the procedure is not widely used by neurosurgeons, possibly owing to unclear indications and poor effective benefits, mostly secondary to significant pitfalls. In spite of the feasibility of microdialysis in humans, many factors can affect the quality of the process. Possible pitfalls include improperly designed probe, probe insertion effects, ineffective perfusion rate, issues to optimize stabilization period, and insufficient volume sample. This article reviews those key technical features necessary for performing microdialysis in humans during deep brain stimulation for Parkinson's Disease.
- Published
- 2015
40. Peduncolopontine DBS improves balance in progressive supranuclear palsy: Instrumental analysis
- Author
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Andrea Cristina de Lima-Pardini, Rachael Brant Machado, Daniel Boari Coelho, Eduardo Joaquim Lopes Alho, Erich Talamoni Fonoff, Ana Tereza Di Lorenzo Alho, Egberto Reis Barbosa, Manoel Jacobsen Teixeira, Luis Augusto Teixeira, and Carolina de Oliveira Souza
- Subjects
0301 basic medicine ,medicine.medical_specialty ,business.industry ,medicine.disease ,Sensory Systems ,Progressive supranuclear palsy ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Physical medicine and rehabilitation ,Neurology ,Physiology (medical) ,Medicine ,Neurology (clinical) ,business ,Neuroscience ,030217 neurology & neurosurgery ,Balance (ability) - Published
- 2016
41. Endoscopic-guided percutaneous radiofrequency cordotomy
- Author
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Erich Talamoni Fonoff, Eduardo Joaquim Lopes Alho, Ywzhe Sifuentes Almeida de Oliveira, William Omar Contreras Lopez, Nilton Alves Lara, and Manoel Jacobsen Teixeira
- Subjects
medicine.medical_specialty ,Cordotomy ,Percutaneous ,Endoscope ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,General Medicine ,Spinal cord ,Cannula ,Endoscopic Procedure ,Surgery ,medicine.anatomical_structure ,medicine ,Fluoroscopy ,Spinal canal ,business - Abstract
The authors present the first clinical implementation of an endoscopic-assisted percutaneous anterolateral radiofrequency cordotomy. The aim of this article is to demonstrate the intradural endoscopic visualization of the cervical spinal cord via a percutaneous approach to refine the spinal target for anterolateral cordotomy, avoiding undesired trauma to the spinal tissue or injury to blood vessels. Initially, a lateral puncture of the spinal canal in the C1–2 interspace is performed, guided by fluoroscopy. As soon as CSF is reached by the guide cannula (17-gauge needle), the endoscope can be inserted for visualization of the spinal cord and its surrounding structures. The endoscopic visualization provided clear identification of the pial surface of the spinal cord, arachnoid membrane, dentate ligament, dorsal and ventral root entry zone, and blood vessels. The target for electrode insertion into the spinal cord was determined to be the midpoint from the dentate ligament and the ventral root entry zone. The endoscopic guidance shortened the fluoroscopy usage time and no intrathecal contrast administration was needed. Cordotomy was performed by a standard radiofrequency method after refining of the neurophysiological target. Satisfactory analgesia was provided by the procedure with no additional complications or CSF leak. The initial use of this technique suggests that a percutaneous endoscopic procedure may be useful for particular manipulation of the spinal cord, possibly adding a degree of safety to the procedure and improving its effectiveness.
- Published
- 2010
42. Novel Treatment Immediately after Myelomeningocele Repair Applying Low-Level Laser Therapy in Newborns: A Pilot Study
- Author
-
Manoel Jacobsen Teixeira, Fernando Campos Gomes Pinto, Nathali Cordeiro Pinto, Eduardo Joaquim Lopes Alho, Hamilton Matushita, Vera Lúcia Jornada Krebs, M. Cristina Chavantes, and Elisabeth Mateus Yoshimura
- Subjects
Male ,medicine.medical_specialty ,Meningomyelocele ,medicine.medical_treatment ,MEDLINE ,Pilot Projects ,Surgical Wound Dehiscence ,Laser therapy ,medicine ,Humans ,Prospective Studies ,Low-Level Light Therapy ,Prospective cohort study ,Low level laser therapy ,business.industry ,Incidence ,Incidence (epidemiology) ,Infant, Newborn ,General Medicine ,Surgery ,Clinical trial ,Treatment Outcome ,Pediatrics, Perinatology and Child Health ,Female ,Neurology (clinical) ,Neurosurgery ,business - Abstract
Background/Aims: The use of low-level laser therapy (LLLT) in neurosurgery is still hardly disseminated and there are situations in which the effects of this therapeutic tool would be extremely relevant in this medical field. The aim of the present study is to analyze the effect of LLLT on tissue repair after the corrective surgical incision in neonates with myelomeningocele, in an attempt to diminish the incidence of postoperative dehiscences following surgical repair performed immediately after birth. Materials and Methods: Prospective pilot study with 13 patients submitted to surgery at birth who received adjuvant treatment with LLLT (group A). A diode laser CW, λ = 685 nm, p = 21 mW, was applied punctually along the surgical incision, with 0.19 J delivered per point, accounting for a total of 4–10 J delivered energy per patient, according to the surgical wound area and then compared with the results obtained in 23 patients who underwent surgery without laser therapy (group B). Results: This pilot study disclosed a significant decline in dehiscences of the surgical wounds in neonates who were submitted to LLLT (7.69 vs. 17.39%). Conclusion: This new adjuvant therapeutic modality with LLLT aided the healing of surgical wounds, preventing morbidities, as well as shortening the period of hospital stay, which implies a reduction of costs for patients and for the institution.
- Published
- 2010
43. Surgical Treatment of Myelomeningocele Carried Out at ‘Time Zero’ Immediately after Birth
- Author
-
Vera Lúcia Jornada Krebs, Victor Bunduki, Hamilton Matushita, Fernando Campos Gomes Pinto, Eduardo Joaquim Lopes Alho, Dov Charles Goldenberg, André Luiz Beer Furlan, and Manoel Jacobsen Teixeira
- Subjects
Male ,medicine.medical_specialty ,Meningomyelocele ,Time Factors ,Treatment outcome ,Young Adult ,Postoperative Complications ,Pregnancy ,Preoperative Care ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Surgical treatment ,Surgical repair ,Time zero ,business.industry ,Infant, Newborn ,Follow up studies ,General Medicine ,medicine.disease ,Surgery ,Hydrocephalus ,Treatment Outcome ,Pediatrics, Perinatology and Child Health ,Female ,Neurology (clinical) ,Neurosurgery ,business ,Follow-Up Studies - Abstract
Background/Aims: To present a protocol of immediate surgical repair of myelomeningocele (MMC) after birth (‘time zero’) and compare this surgical outcome with the surgery performed after the newborn’s admission to the nursery before the operation. Methods: Data from the medical files of 31 patients with MMC that underwent surgery after birth and after admission at the nursery (group I) were compared with a group of 23 patients with MMC admitted and prospectively followed, who underwent surgery immediately after birth – ‘at time zero’ (group II). Results: The preoperative rupture of the MMC occurred more frequently in group I (67 vs. 39%, p < 0.05). The need for ventriculoperitoneal shunt was 84% in group I and 65% in group II and 4 of them were performed during the same anesthetic time as the immediate MMC repair, with no statistically significant difference. Group I had a higher incidence of small dehiscences when compared to group II (29 vs. 13%, p < 0.05); however, there was no statistically significant difference regarding infections. After 1 year of follow-up, 61% of group I showed neurodevelopmental delay, whereas only 35% of group II showed it. Conclusions: The surgical intervention carried out immediately after the birth showed benefits regarding a lower incidence of preoperative rupture of the MMC, postoperative dehiscences and lower incidence of neurodevelopmental delay 1 year after birth.
- Published
- 2009
44. Neuronavigation-guided transcranial magnetic stimulation of the dentate nucleus improves cerebellar ataxia: A sham-controlled, double-blind n ¼ 1 study [Carta]
- Author
-
Catharina Maria Seixas, Victor Rossetto Barboza, Ricardo Galhardoni, Eduardo Joaquim Lopes Alho, Guilherme Lepski, Daniel Ciampi de Andrade, Manoel Jacobsen Teixeira, and Rubens Gisbert Cury
- Subjects
Ataxia ,Neuronavigation ,Cerebellar ataxia ,business.industry ,medicine.medical_treatment ,Treatment outcome ,Double blind ,Transcranial magnetic stimulation ,Dentate nucleus ,ESTIMULAÇÃO ELÉTRICA ,Neurology ,medicine ,Neurology (clinical) ,Geriatrics and Gerontology ,medicine.symptom ,business ,Neuroscience - Published
- 2015
45. Brain atrophy in primary progressive aphasia involves the cholinergic basal forebrain and Ayala’s nucleus
- Author
-
Wilhelm Flatz, Lea T. Grinberg, Arun L.W. Bokde, Christina Knels, Adrian Danek, Anne Ebert, Eduardo Joaquim Lopes Alho, Nibal Ackl, Michel J. Grothe, Helmut Heinsen, Ingo Kilimann, Stefan J. Teipel, Vanja Kljajevic, and Edson Amaro
- Subjects
Male ,Aging ,Nucleus subputaminalis ,Neurodegenerative ,Neuropsychological Tests ,Alzheimer's Disease ,Medical and Health Sciences ,Primary progressive aphasia ,Executive Function ,pathology [Prosencephalon] ,pathology [Brain] ,Diagnosis ,Prefrontal cortex ,Language ,Psychiatry ,Cerebral Cortex ,Basal forebrain ,Brain ,Anatomy ,respiratory system ,Middle Aged ,Magnetic Resonance Imaging ,Temporal Lobe ,Frontotemporal Dementia (FTD) ,Psychiatry and Mental health ,medicine.anatomical_structure ,Cholinergic Fibers ,Cerebral cortex ,Neurological ,Biomedical Imaging ,pathology [Cholinergic Fibers] ,Female ,Psychology ,Primary Progressive ,Neuroscience (miscellaneous) ,Prefrontal Cortex ,Article ,Temporal lobe ,Rare Diseases ,Atrophy ,Prosencephalon ,Aphasia ,Acquired Cognitive Impairment ,medicine ,Humans ,Post-mortem MRI ,Radiology, Nuclear Medicine and imaging ,ddc:610 ,Cholinergic neuron ,pathology [Aphasia, Primary Progressive] ,AFASIA PROGRESSIVA ,Aged ,Psychology and Cognitive Sciences ,Neurosciences ,Cholinergic system ,Alzheimer's Disease including Alzheimer's Disease Related Dementias (AD/ADRD) ,pathology [Temporal Lobe] ,medicine.disease ,pathology [Prefrontal Cortex] ,Brain Disorders ,Aphasia, Primary Progressive ,Cholinergic ,Dementia ,pathology [Cerebral Cortex] - Abstract
Primary progressive aphasia (PPA) is characterized by left hemispheric frontotemporal cortical atrophy. Evidence from anatomical studies suggests that the nucleus subputaminalis (NSP), a subnucleus of the cholinergic basal forebrain, may be involved in the pathological process of PPA. Therefore, we studied the pattern of cortical and basal forebrain atrophy in 10 patients with a clinical diagnosis of PPA and 18 healthy age-matched controls using high-resolution magnetic resonance imaging (MRI). We determined the cholinergic basal forebrain nuclei according to Mesulam's nomenclature and the NSP in MRI reference space based on histological sections and the MRI scan of a post-mortem brain in cranio. Using voxel-based analysis, we found left hemispheric cortical atrophy in PPA patients compared with controls, including prefrontal, lateral temporal and medial temporal lobe areas. We detected cholinergic basal forebrain atrophy in left predominant localizations of Ch4p, Ch4am, Ch4al, Ch3 and NSP. For the first time, we have described the pattern of basal forebrain atrophy in PPA and confirmed the involvement of NSP that had been predicted based on theoretical considerations. Our findings may enhance understanding of the role of cholinergic degeneration for the regional specificity of the cortical destruction leading to the syndrome of PPA.
- Published
- 2013
46. IC‐P‐190: Healthy aging affects cholinergic functional networks
- Author
-
Ingo Kilimann, Edson Amaro, Michel J. Grothe, Helmut Heinsen, Lea T. Grinberg, Eduardo Joaquim Lopes Alho, Karlheinz Hauenstein, and Stefan J. Teipel
- Subjects
Epidemiology ,business.industry ,Health Policy ,Functional networks ,Psychiatry and Mental health ,Cellular and Molecular Neuroscience ,Developmental Neuroscience ,Cholinergic ,Medicine ,Neurology (clinical) ,Geriatrics and Gerontology ,Healthy aging ,business ,Neuroscience - Published
- 2013
47. O5‐04‐06: Multicenter stability, diagnostic accuracy and regional specificity of cholinergic forebrain atrophy in Alzheimer's disease: An EDSD study
- Author
-
Stefan J. Teipel, Massimo Filippi, Giovanni B. Frisoni, Ingo Kilimann, Fellgiebel Andreas, Eduardo Joaquim Lopes Alho, Harald Hampel, Helmut Heinsen, Michel J. Grothe, Arun L.W. Bokde, and Stefan Klöppel
- Subjects
Pathology ,medicine.medical_specialty ,Epidemiology ,business.industry ,Health Policy ,Diagnostic accuracy ,Disease ,medicine.disease ,Psychiatry and Mental health ,Cellular and Molecular Neuroscience ,Atrophy ,Developmental Neuroscience ,Forebrain ,medicine ,Cholinergic ,Neurology (clinical) ,Geriatrics and Gerontology ,business ,Neuroscience - Published
- 2012
48. IC‐P‐112: Multicenter stability, diagnostic accuracy and regional specificity of cholinergic forebrain atrophy in Alzheimer's disease: A European Diffusion Tensor Imaging Study in Dementia (EDSD)
- Author
-
Giovanni B. Frisoni, Michel J. Grothe, Stefan J. Teipel, Massimo Filippi, Andreas Fellgiebel, Helmut Heinsen, Eduardo Joaquim Lopes Alho, Ingo Kilimann, Harald Hampel, Arun L.W. Bokde, and Stefan Klöppel
- Subjects
Epidemiology ,business.industry ,Null model ,Health Policy ,Modular design ,medicine.disease ,Psychiatry and Mental health ,Cellular and Molecular Neuroscience ,Dwell time ,Atrophy ,Developmental Neuroscience ,Forebrain ,medicine ,Cholinergic ,Dementia ,Neurology (clinical) ,Geriatrics and Gerontology ,business ,Neuroscience ,Mathematics ,Diffusion MRI - Abstract
related to the non-stationary nature of the connectivity within ICNs. Methods: We performed a large (n 1⁄4 892) high-dimensional independent component analysis decomposition of TF-fMRI data on cognitively normal (CN) subjects drawn from theMayo Clinic Study of Aging. This was used to atlas the brain into 68 regions, categorized based on network of origin, anatomical locations, and a functional meta-analysis. These regions were used to construct dynamic graphical representations of the brain within a sliding timewindow.We calculated dwell time in particular network configurations in 892 CN and 28 AD subjects. Results: The 80,280 graphs displayed a highly modular architecture relative to the null model (Q* 1⁄4 0.55 +/-0.06 vs. null Q*1⁄4 0.16 +/0.01, P
- Published
- 2012
49. Models of functional cerebral localization at the dawning of modern neurosurgery
- Author
-
Eduardo Joaquim Lopes Alho, Manoel Jacobsen Teixeira, and Antonio Nogueira de Almeida
- Subjects
Cognitive science ,Cerebral Cortex ,Pathology ,medicine.medical_specialty ,Brain Mapping ,business.industry ,Models, Neurological ,Neurosurgery ,History, 19th Century ,Brain mapping ,CÓRTEX CEREBRAL ,Phrenology ,medicine.anatomical_structure ,Cerebral cortex ,Cortex (anatomy) ,Aphasia ,medicine ,Humans ,Speech ,Surgery ,Neurology (clinical) ,medicine.symptom ,business - Abstract
The concept of a functional cerebral localization gave the needed support for the development of neurosurgery as a specialty. It should be noted though that the presence of functions on discrete areas of the cortex was a very controversial topic at that time. The objective of this paper is to review models of cortical organization at the end of the 19th century, highlighting beliefs, theories, and controversies behind them. A better understanding of this historical moment is essential to appreciate the debate between holists and localizers that stirred neuroscientists worldwide in the first half of the 20th century.
- Published
- 2012
50. Review of Printed and Electronic Stereotactic Atlases of the Human Brain
- Author
-
Erich Talamoni Fonoff, Eduardo Joaquim Lopes Alho, Helmut Heinsen, and Lea Teneholz Grinberg
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Computer science ,Brain Structure and Function ,Computed tomography ,Human brain ,Brain mapping ,Structure and function ,medicine.anatomical_structure ,Neuroimaging ,medicine ,Neurosurgery ,Neuroscience ,Mechanical devices - Abstract
The scientific developments of the latter half of the 19th century and the beginning of the 20th century supplied comprehensive data and insight on brain structure and function. Knowledge on structure and function provided strategies and tools for the management of previously lethal or highly incapacitating diseases, e.g. Parkinson’s disease (PD) and tremor. A major challenge for neurosurgery was the endeavor to reach some deep and hitherto hidden regions inside the brain without damaging the surrounding tissue, since most of these small regions are vital and not directly visible in situ. Using the Cartesian coordinate system based on cranial landmarks, Victor Horsley and Robert Clarke introduced in 1908 a new apparatus that allowed them to accurately target subcortical nuclei of monkeys (Horsley & Clarke, 1908) with quasi-mathematical precision. A modified version of this device was adopted by Spiegel and Wycsis (1947) for human intracerebral interventions. Nevertheless, the space in which these mechanical devices were navigating still remained obscure and perilous. Almost four decades later, the parallel progress of neuroimaging shed light into the hitherto hidden structures and regions of the human brain. However, in order to find out appropriate pathways to specific functional units within clinically relevant targets the necessity of detailed brain maps was mandatory. Even with the great advance in neuroimaging in the last twenty to thirty years, it is still not possible to unequivocally delineate closely related subcortical structures by means of high-resolution computed tomography (CT) or in magnetic resonance image (MRI) (Coffey, 2009). For this reason, brain atlases derived from appropriate histological, histochemical, or immunohistochemical techniques on post-mortem human brain tissue continue to represent an important tool for functional neurosurgeons and brain researchers. To supplement the post-mortem anatomic maps, electrophysiologic in vivo recording of neuronal activity was added to neurosurgeries. This technique is intended to be an ancillary method to assist neurosurgeons in verifying their targets. In this chapter we will summarize and critically review the merits and the shortcomings of the most frequently consulted atlases. Some ideas on scope, form, and presentation of future atlases will be forwarded.
- Published
- 2011
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