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The impact of the coronavirus disease 2019 (COVID-19) pandemic on epilepsy care across Japan was investigated by conducting a multicenter retrospective cohort study.This study included monthly data on the frequency of (1) visits by outpatients with epilepsy, (2) outpatient electroencephalography (EEG) studies, (3) telemedicine for epilepsy, (4) admissions for epilepsy, (5) EEG monitoring, and (6) epilepsy surgery in epilepsy centers and clinics across Japan between January 2019 and December 2020. We defined the primary outcome as epilepsy-center-specific monthly data divided by the 12-month average in 2019 for each facility. We determined whether the COVID-19 pandemic-related factors (such as year [2019 or 2020], COVID-19 cases in each prefecture in the previous month, and the state of emergency) were independently associated with these outcomes.In 2020, the frequency of outpatient EEG studies (-10.7%, p0.001) and cases with telemedicine (+2,608%, p=0.031) were affected. The number of COVID-19 cases was an independent associated factor for epilepsy admission (-3.75*10We demonstrated the significant impact that the COVID-19 pandemic had on epilepsy care. These results support those of previous studies and clarify the effect size of each pandemic-related factor on epilepsy care.

Background Brain tumor patients tend to develop postoperative epileptic seizures, which can lead to an unfavorable outcome. Although the incidence of postoperative epileptic seizures and adverse events are improved with the advent of levetiracetam (LEV), postoperative epilepsy occurs at a frequency of 4.6% or higher. In brain tumor patients, the addition of sodium channel blockers (SCBs) to LEV significantly reduces seizures, though confirmed in a non-postoperative study. Thus, the combination of SCBs with LEV might be promising. Objective In this prospective randomized controlled trial we investigated the safety, evaluated by adverse events during one and two weeks after surgery, and the efficacy, evaluated by the incidence of early epilepsy, including non-convulsive status epilepticus (NCSE), of using LEV alone or SCBs added to LEV in patients who underwent craniotomy or biopsy for brain tumors or brain mass lesions. Methods Patients with brain tumors or brain mass lesions undergoing surgical interventions, excluding endoscopic endonasal surgery (EES), with a diagnosis of epilepsy were eligible for this study. Patients are randomized into either Group A or B (B1 or B2) after the informed consents are taken; LEV alone in Group A patients, while LEV and SCBs in Group B patients (GroupB1, intravenous fosphenytoin plus oral lacosamide (LCM) and GroupB2, intravenous LCM plus oral LCM) were administered postoperatively. Fifty-three patients were enrolled during the first two and a half years of the study and four of them were excluded, resulting in the accumulation of 49 patients' data. Results Postoperative epileptic seizures occurred only in three out of 49 patients during the first week (6.1%) and in seven patients within two weeks after surgery (14.3%, including the three patients during the first week). In Group A, epileptic seizures occurred in two out of 26 patients during the first week (7.7%) and in five patients within two weeks (19.2%) after surgery. In Group B, epileptic seizures occurred in one out of 23 patients during the first week (4.3%) and in two patients during the first two weeks (8.7%). Low complication grade of epileptic seizures was observed in Group B rather than in Group A, however, without significant difference (p=0.256). There was no difference in the frequency of adverse effects in each group. Conclusion Although not statistically significant, the incidence of epileptic seizures within one week after surgery was lesser in LEV+SCBs groups than in LEV alone. No hepatic damage or renal function worsening occurred with the addition of LCM, suggesting the safety of LEV+SCBs therapy.

EQUULEUS (EQUilibriUm Lunar-Earth point 6U Spacecraft) will be the world's smallest spacecraft to explore the Earth-Moon Lagrange point. It is being jointly developed by JAXA (Japan Aerospace Exploration Agency) and the University of Tokyo, and will be launched by NASA's Space Launch System Exploration Mission-1. The spacecraft will fly to a libration orbit around the Earth-Moon L2 point (EML2) and will demonstrate low-energy trajectory-control techniques within the Sun-Earth-Moon region for the first time by a nano-class spacecraft. EQUULEUS also carries three scientific observation missions: imaging of Earth's plasmasphere by extreme ultraviolet wavelength, lunar impact flash observation on the far side of the moon, and micrometeoroid flux measurements in the cis-lunar region. While all these missions have their own scientific objectives, they will also contribute to future human activity and/or infrastructure development in the cis-lunar region. Most parts of the spacecraft system use commercial off-the-shelf components, or are designed based on the experiences of various past space missions, with the exception of the newly developed water resistojet propulsion system. EQUULEUS uses X-band frequency for deep space telecommunication. Japanese deep space antennas (64-m and 34-m) will be nominally used for spacecraft operation, and support from the deep space network of JPL (Jet Propulsion Laboratory) is also being planned, especially for the initial phase of operation. The spacecraft will fly to EML2 in less than one year, and will remain there for scientific observations until shortly before the depletion of the onboard propellant, when the spacecraft will leave the orbit for space-debris compliance.

Background Hemispherotomy, which involves disconnecting hemispherical fibers, is a treatment option for medically intractable epilepsy. As various neurological disorders can cause strabismus, we hypothesized that hemispherotomy can cause post-operative strabismus in patients with medically intractable epilepsy. Methods Nineteen patients underwent the Hirschberg test before and after hemispherical disconnection surgery. Among the 19 patients, 16 patients (six females and 10 males; mean age, 12.2 years; range, 0.17–43 years) who underwent hemispherotomy were included in this study. Results The difference in the angle between the left and right eyes was significantly widened (p = 0.025). Nine (56%) of 16 patients exhibited post-operative chronic strabismus as evaluated with the Hirschberg test. Intermittent strabismus was noticed by family members or caregivers in 10 (63%) of 16 patients. Patients older than 12 years did not show post-operative strabismus as evaluated by the Hirschberg test. Conclusion Hemispherotomy can cause or worsen post-operative strabismus in pediatric patients.

Farmland has various beneficial functions, such as flood control, water purification, and habitat provision, in addition to food production. These functions are highly compatible with green infrastructure, and the use of farmland as green infrastructure has been discussed in recent years. In order to utilize these functions of farmland, it is preferable to include their usefulness and utilization measures in administrative plans and link them to actual projects. In this research, we collected eight types of administrative plans from local governments across Japan that could be related to the multifunctionality of farmland and reviewed the extent to which they contain descriptions of the multifunctionality of farmland as basic information for promoting the utilization of the multifunctionality of farmland. As a result, we discovered that farmland’s multifunctionality was incorporated into the plans of many municipalities. Municipalities with a certain population size and a high financial strength index, in particular, tended to mention the multifunctional role of farmland in their plans more frequently. In addition, we found that some of the functions were mentioned less frequently in the plans. While descriptions of “conservation of natural environment” and “landscape/culture formation and recreation” were common in many plans, descriptions of “disaster mitigation and response” and “water and food supply” in times of disaster were less common. Finally, we drew some recommendations that can be used as a reference for future planning and project promotion, including dissemination of knowledge and information of farmland’s multifunctionality to government and citizens.

OBJECTIVE To identify the risk factors for psychological distress in electroencephalography (EEG) technicians during the coronavirus disease 2019 (COVID-19) pandemic. METHOD In this national-level cross-sectional survey initiated by Japan Young Epilepsy Section (YES-Japan), which is a national chapter of The Young Epilepsy Section of the International League Against Epilepsy (ILAE-YES), a questionnaire was administered to 173 technicians engaged in EEG at four clinics specializing in epilepsy care and 20 hospitals accredited as (quasi-) epilepsy centers or epilepsy training facilities in Japan from March 1 to April 30, 2021. We collected data on participants' profiles, information about work, and psychological distress outcome measurements, such as the K-6 and Tokyo Metropolitan Distress Scale for Pandemic (TMDP). Linear regression analysis was used to identify the risk factors for psychological distress. Factors that were significantly associated with psychological distress in the univariate analysis were subjected to multivariate analysis. RESULTS Among the 142 respondents (response rate: 82%), 128 were included in the final analysis. As many as 35.2% of EEG technicians have been under psychological distress. In multivariate linear regression analysis for K-6, female sex, examination for patients (suspected) with COVID-19, and change in salary or bonus were independent associated factors for psychological distress. Contrastingly, in multivariate linear regression analysis for TMDP, female sex, presence of cohabitants who had to be separated from the respondent due to this pandemic, and change in salary or bonus were independent associated factors for psychological distress. CONCLUSION We successfully identified the risk factors associated with psychological distress in EEG technicians during the COVID-19 pandemic. Our results may help in understanding the psychological stress in EEG technicians during the COVID-19 pandemic and improving the work environment, which is necessary to maintain the mental health of EEG technicians.

AIM Controlling epileptic seizures in elderly populations is widely considered to be relatively easy, but we hypothesized that the lifestyles of elderly individuals may affect the outcomes of epilepsy treatment. The purpose of this study was to review the activities of daily living (ADL) of elderly individuals with epilepsy and compare them with the outcomes of epilepsy treatment. METHODS Of the 177 patients ≥65 years old who were referred to our epilepsy centre, epilepsy was diagnosed in 84. ADL and treatment outcomes were then reviewed, with ADL classified into three levels: ADL I, without disability; ADL II, disabled only in some instrumental ADL; and ADL III, disabled in some basic ADL. Epilepsy syndromes and use of anti-seizure drugs were also evaluated. RESULTS Forty-five patients (53.6%) achieved freedom from seizures, 23 (27.4%) achieved ≥80% but

Objective Few studies have examined the localization of seizures presenting with ictal eye deviation (ED) in the absence of other motor symptoms. We aimed to investigate differences in the localization of the ictal onset zone (IOZ) between patients with isolated ED and those with ED plus head turning (HT) during focal seizures. Methods We reviewed intracranial video-EEG data for 931 seizures in 80 patients with focal onset epilepsy in whom the IOZ could be confirmed. The 233 seizures in 49 patients with ED were classified into two semiological groups based on initial ED and the presence/absence of HT: (1) isolated ED (i.e., ED without HT), and (2) ED + HT (i.e., ED with HT). We analyzed the localization and lateralization of IOZs in each semiological group. We performed multivariate logistic regression analysis using a mixed-effects to determine the associations between IOZs and isolated ED/ED + HT. Results A total of 183 IOZs in 24 patients were included in the isolated ED group, while a total of 143 IOZs in 31 patients were included in the ED + HT group. Sixty-eight IOZs of eight patients in the isolated ED group were located in the ipsilateral frontal interhemispheric fissure (F-IHF). Only ipsilateral F-IHF was significantly associated with isolated ED (odds ratio [OR], 2.43; 95% confidence interval [CI], 0.37–4.49; P = 0.021). The contralateral lateral frontal cortex (latF) (P = 0.007) and ipsilateral mesial temporal region (mT) (P = 0.029) were significantly associated with ED + HT. Conclusion The present study is the first to demonstrate that seizures with an F-IHF focus tend to present with initial ipsilateral isolated ED. This finding may aid in identifying the seizure focus in patients with isolated ED prior to resection.

Ayataka Fujimoto,1 Tohru Okanishi,1 Yosuke Masuda,1 Keishiro Sato,1 Mitsuyo Nishimura,1 Shimpei Baba,1 Shinji Itamura,1 Yoichiro Homma,2 Hideo Enoki1 1Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan; 2Department of General Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan Purpose: Diagnosing epilepsy in the elderly population can be difficult due to mimicking symptoms. Furthermore, epileptic symptoms can also be masked by various symptoms. We hypothesized that elderly patients with epilepsy exhibit specific clinical features among the various symptoms.Patients and methods: From 2009 to 2017, 177 patients who were older than 65 years were referred to our epilepsy center. Out of this group, the onset of symptoms occurred after reaching the age of 50 years in 152 of the patients, who were additionally being treated at our clinic. We divided their symptoms in accordance with their consciousness levels, which were defined as follows: full wakefulness level I, impaired awareness level II, and loss of consciousness level III. We also classified the duration of the symptoms as

Tumor angiogenesis has attracted increasing attention because of its potential as a valuable marker in the differential diagnosis of brain tumors as well as a novel therapeutic target. Prostate-specific membrane antigen (PSMA) is expressed by the neovasculature endothelium of some tumors, with little to no expression by the tumor cells or normal vasculature endothelium. The aim of this study was to investigate the potential of PSMA for the evaluation of the tumor neovasculature of various brain tumors and the possibility of detecting PSMA expression in brain tumors using PET imaging with 89Zr-Df-IAB2M (anti-PSMA minibody). Eighty-three tissue specimens including gliomas, metastatic brain tumors, primary central nervous system lymphomas (PCNSL), or radiation necroses were analyzed by immunohistochemical staining with PSMA antibody. 89Zr-Df-IAB2M PET scans were performed in three patients with recurrent high-grade gliomas or metastatic brain tumor. PSMA was highly expressed in the vascular endothelium of high-grade glioma and metastatic brain tumor, whereas PSMA was poorly expressed in the vascular endothelium of PCNSL and radiation necrosis. PSMA expression in high-grade gliomas and a metastatic brain tumor was clearly visualized by PET imaging with 89Zr-Df-IAB2M. Furthermore, a trend toward a positive correlation between the degree of 89Zr-Df-IAB2M uptake and PSMA expression levels in tumor specimens was observed. PET imaging of PSMA using 89Zr-Df-IAB2M may have potential value in the differential diagnosis of high-grade glioma from PCNSL or radiation necrosis as well as in the prediction of treatment efficacy and assessment of treatment response to bevacizumab therapy for high-grade glioma.

We recently reported that the Gibbs free energy of hydrolytic water molecules (ΔGwat) in acyl-trypsin intermediates calculated by hydration thermodynamics analysis could be a useful metric for estimating the catalytic rate constants (kcat) of mechanism-based reversible covalent inhibitors. For thorough evaluation, the proposed method was tested with an increased number of covalent ligands that have no corresponding crystal structures. After modeling acyl-trypsin intermediate structures using flexible molecular superposition, ΔGwat values were calculated according to the proposed method. The orbital energies of antibonding π* molecular orbitals (MOs) of carbonyl C=O in covalently modified catalytic serine (Eorb) were also calculated by semi-empirical MO calculations. Then, linear discriminant analysis (LDA) was performed to build a model that can discriminate covalent inhibitor candidates from substrate-like ligands using ΔGwat and Eorb. The model was built using a training set (10 compounds) and then validated by a test set (4 compounds). As a result, the training set and test set ligands were perfectly discriminated by the model. Hydrolysis was slower when (1) the hydrolytic water molecule has lower ΔGwat; (2) the covalent ligand presents higher Eorb (higher reaction barrier). Results also showed that the entropic term of hydrolytic water molecule (-TΔSwat) could be used for estimating kcat and for covalent inhibitor optimization; when the rotational freedom of the hydrolytic water molecule is limited, the chance for favorable interaction with the electrophilic acyl group would also be limited. The method proposed in this study would be useful for screening and optimizing the mechanism-based reversible covalent inhibitors.

Introduction: Intracranial subdural empyema (ISDE) can cause drug-resistant epilepsy. We attempted to cure post-ISDE refractory epilepsy by operative surgery and assessed the neuropathological findings. Patient and method: A 23-year-old right-handed man with refractory epilepsy had ISDE on the right temporal and occipital areas at 14 years old. He underwent ISDE drainage operation at the time. A week after the infection, he developed epileptic seizure, which consisted of epigastric sensation, followed by loss of awareness with gelastic seizure. This type of seizure occurred around five times a day. He underwent right posterior disconnection and the temporal lobe was submitted to histopathological examination. Result: The patient has remained seizure-free for more than 3 months. Histopathological diagnosis showed focal cortical dysplasia (FCD) type IB. Conclusion: We cured post-ISDE refractory epilepsy by posterior quadrant disconnection. Epileptogenicity of FCD might be triggered by ISDE. Keywords: Subdural empyema, Focal cortical dysplasia, Posterior quadrant disconnection, Refractory epilepsy

Background: To control brain tumor-related epilepsy (BTRE), both epileptological and neuro-oncological approaches are required. We hypothesized that using depth electrodes (DEs) as fence post catheters, we could detect the area of epileptic seizure onset and achieve both brain tumor removal and epileptic seizure control. Methods: Between August 2009 and April 2018, we performed brain tumor removal for 27 patients with BTRE. Patients who underwent lesionectomy without DEs were classified into Group 1 (13 patients) and patients who underwent the fence post DE technique were classified into Group 2 (14 patients). Results: The patients were 15 women and 12 men (mean age, 28.1 years; median age 21 years; range, 5–68 years). The brain tumor was resected to a greater extent in Group 2 than Group 1 (P < 0.001). Shallower contacts showed more epileptogenicity than deeper contacts (P < 0.001). Group 2 showed better epilepsy surgical outcomes than Group 1 (P = 0.041). Conclusion: Using DEs as fence post catheters, we detected the area of epileptic seizure onset and controlled epileptic seizures. Simultaneously, we removed the brain tumor to a greater extent with fence post DEs than without.

A high-capacity thick cathode has been studied as one of ways to improve the energy density of lithium secondary batteries. In this study, the LiFePO 4 cathode with a capacity per unit area of 8.4 m Ah cm −2 corresponding to four times the capacity of conventional cathodes has been developed using a three-dimensional porous aluminum current collector called “FUSPOROUS”. This unique current collector enables the smooth transfer of electrons and Li + -ions through the thick cathode, resulting in a good rate capability (discharge capacity ratio of 1.0 C/0.2 C = 0.980) and a high charge-discharge cycle performance (80% of the initial capacity at 2000th cycle) even though the electrode thickness is 400 μm. To take practical advantage of the developed thick cathode, conceptual designs for a 10-Ah class cell were also carried out using graphite and lithium-metal anodes.

We report a case of superficial siderosis (SS) of the central nervous system that developed approximately 8 years after the treatment of cerebral arteriovenous malformation (AVM). A 17-year-old boy was diagnosed with cerebral AVM in the right frontal lobe, which was treated with embolization and radiation therapy. Radiation-induced encephalopathy occurred 5 years later, and the lesion was resected. Although the patient could walk with a cane following the surgery and rehabilitation, he exhibited complete paresis of the left upper extremity. In the course of the next 9 years, he showed cognitive function decline, paresis of the lower right extremity, and the inability to walk. He also exhibited dysarthria and paresis of the right arm. Respiratory failure developed at age 39 years, necessitating mechanical ventilation. Cerebral angiography revealed no recurrence of cerebral AVM; however, brain and spinal magnetic resonance imaging revealed broad hemosiderin deposition, which is characteristic of SS, and the presence of a postoperative cyst that was suspected to be the bleeding source. While eliminating the source of the bleeding is considered the best line of treatment for SS, this was not pursued due to the patient's irreversible neurological condition. Thus, clinicians should consider SS as a differential diagnosis for patients that exhibit gradual and progressive neurological defects several years after successful AVM treatment. Keywords: Superficial siderosis, Radiation-induced encephalopathy, Arteriovenous malformation

Background We sought to examine the incidence of postoperative epileptic seizures, particularly nonconvulsive status epilepticus (NCSE), in brain tumor patients after craniotomy surgery. Methods This was a retrospective, single-center study of 388 patients who underwent brain tumor surgery via craniotomy at our hospital from January 2015 to August 2017. We used medical charts to retrospectively select patients with postoperative epileptic seizures (ES) and examined the incidence of postoperative ES, generalized convulsive status epilepticus (GCSE), and NCSE. Results Nineteen patients (4.9%) were diagnosed as having postoperative ES. The number of patients who had NCSE (14 cases) was larger than the number of those who had GCSE (3 cases) or focal aware seizures (2 cases). In most of the 19 seizure cases, the tumors were located in the intraparenchymal area (17 cases) or the frontal lobe (13 cases). Conclusions Postoperative ES was diagnosed in 4.9% of patients after brain tumor surgery, and NCSE constituted the overwhelming majority of postoperative ES.

Background Using a stereotactic technique, surgeons can accurately place a depth electrode (DE), but sometimes the DE deviates from the intended target due to movement of the electrode or leakage of cerebrospinal fluid when placing the electrode. If DEs can be anchored before removing the catheter insertion guide pipe, more accurate placement may be possible. Methods We made a side slit guide pipe. When the DEs were anchored to the dura or the edge of the burr hole, the DE did not move when the guide pipe was removed. We measured the distance between the planned target and the tip of the electrode in 13 patients (3 female and 10 male patients; age range, 7–43 years; mean age 23.0 years; median age 27 years) with medically intractable epilepsy who underwent DE placement with stereotactic neuronavigation guidance. Results There were 30 DEs implanted. The mean distance from the planned target to the tip of the DE was 0.570 mm (range, 0.3–1.2 mm; median 0.5 mm; SD 0.212). The mean distance from the planned target to the tip of the DE with dural anchoring was 0.467 mm (range, 0.3–0.6 mm; median 0.45 mm; SD 0.121) and with burr hole edge anchoring was 0.596 mm (range, 0.3–1.2 mm; median 0.50 mm; SD 0.224; P = 0.205). Conclusions DEs can be anchored using the side slit guide pipe for more precise placement.

Background This retrospective study is designed to determine whether the thickness of the corpus callosum can predict corpus callosotomy outcome in pediatric patients with epileptic or tonic spasms. Methods We retrospectively studied 25 patients (18 boys) with intractable childhood-onset epileptic or tonic spasms who underwent corpus callosotomy between March 2008 and January 2017. Seizure outcomes were classified as favorable (class I and II of Engel's outcome classification) or unfavorable (class III and IV of Engel's outcome classification) at 12 months postoperatively. We measured the corpus callosum area on the midline and maximum cerebral area on the para-midline in sagittal magnetic resonance images just before surgery. We statistically analyzed the associations between surgical outcomes and corpus callosum area, corpus callosum area/maximum cerebral area (corpus callosum/cerebrum ratio), or age at magnetic resonance imaging just before surgery, using univariate and multivariate logistic regression analyses. Results Age at surgery ranged from six to 237 months (mean: 119). Main seizure types were epileptic spasms in 17 patients and tonic spasms in eight. Favorable outcomes occurred in 10 (40%) patients and unfavorable outcomes in 15 (60%). Both corpus callosum area and corpus callosum/cerebrum ratio did not show significant associations with the outcomes in the univariate and multivariate analyses. The 95% confidence intervals of corpus callosum/cerebrum ratio strongly overlapped between the favorable and unfavorable outcome groups. Conclusions Our data failed to support that corpus callosum thickness on the sagittal image is associated with corpus callosotomy outcomes in pediatric patients with epileptic spasms or tonic spasms.

Tumor angiogenesis has attracted increasing attention because of its potential as a valuable marker in the differential diagnosis of brain tumors as well as a novel therapeutic target. Prostate-specific membrane antigen (PSMA) is expressed by the neovasculature endothelium of some tumors, with little to no expression by the tumor cells or normal vasculature endothelium. The aim of this study was to investigate the potential of PSMA for the evaluation of the tumor neovasculature of various brain tumors and the possibility of detecting PSMA expression in brain tumors using PET imaging with

Background Carmustine (BCNU) wafer (Gliadel(®) Wafer) implantation after tumor resection is an approved treatment for high-grade glioma (HGG). These wafers change various characteristics on early postoperative magnetic resonance imaging (ep-MRI) including slight expansion of high-intensity areas on T2-weighted imaging (ep-T2-HIAs) into adjacent parenchyma without restricted diffusivity. We assessed the frequency of the ep-T2-HIAs after BCNU wafer implantation in HGG patients. Moreover, we focused on ep-T2-HIA expansion and its relation to delayed cerebral edema. Methods Twenty-five consecutive HGG patients who underwent BCNU wafer implantation were assessed. First, patients were divided into ep-T2-HIA and non-ep-T2-HIA groups, and the incidence of delayed adverse effects was compared between the two groups. Subsequently, the patients were divided into delayed edema and non-delayed edema groups, and pre-, intra-, and postoperative data were compared between the two groups. Results The ep-T2-HIA expansion and the delayed edema were evident in 9 cases (36%) and 12 cases (48%), respectively. In comparison of the ep-T2-HIA and non-ep-T2-HIA groups, delayed edema was the only delayed adverse effect associated with ep-T2-HIA expansion (P = 0.004). Univariate analysis showed a significantly higher ratio of delayed edema in the subgroups with maximal diameter of removed cavity ≤40 mm (P = 0.047) and the ep-T2-HIA expansion in comparison of the delayed edema and non-delayed edema groups. Multivariate analysis showed that the ep-T2-HIA expansion was the only independent factor associated with delayed edema (P = 0.021). Conclusion In BCNU wafer implantation cases, ep-T2-HIA expansion was a predictive factor for delayed cerebral edema.

Introduction A high-field ceiling-mounted and movable intraoperative MR imaging (iMRI) can minimize additional risks for MRI and enhance safety by not moving the patient. In this system, hanging the heavy magnet from the ceiling requires structural stability; this stability was confirmed in earlier studies, but not proved during a seismic event. Objective We have installed a 1.5 T movable iMRI system with an incorporated seismic system in our hospital in Japan, a seismic event-prone region. This arrangement is the first in the world, to our knowledge. The objective of this study was to describe the mechanism of this seismic system and the first clinical experience using this system. Methods The seismic system consists of a stabilizer pad that is mounted directly under the magnet, in addition to the structural stability. The seismic system was tested with using a shaker table testing at a test laboratory. Results Ninety-one patients underwent neurosurgical intervention using this iMRI and seismic system at our hospital. In all patients, intra-, pre, and/or postoperative MR images were successfully obtained, and image quality was excellent. The workflow of moving the magnet and scanning were smooth and unproblematic. We had 169 seismic events in our city during this time period, but had no incidental or accidental events related to the seismic events. Conclusion With the use of the seismic system, a ceiling-mounted, movable iMRI system can be more safely used. This seismic system may contribute to the spread of movable iMRI systems in countries where seismic events occur.

Objective Criteria for motor evoked potential (MEP) monitoring include the amplitude criterion and threshold criterion. The aim of our study for the amplitude criterion during removal of brain lesions was to determine a suitable stimulus intensity that can reduce the variability in amplitudes. We also assessed the usefulness of the threshold criterion and amplitude criterion by comparing the variability between the two methods as a preliminary study. Methods Seventeen patients including 12 cases with no neurological deterioration after surgery were enrolled in this study. The amplitudes in various stimulus intensities and the stimulation threshold (ST) were repeatedly measured during surgery. The stimulus intensities used in the amplitude criterion are described as ‘the ST just after dura opening (ST (0) )+additional intensity'. The variability was assessed with the coefficient of variation (CV). Results With direct cortical stimulation (DCS), the CVs of amplitudes were significantly lower at stimulus intensities of more than ST (0) +4mA, with the smallest at ST (0) +10mA. The CV of STs was significantly smaller than that of amplitudes. Conclusions The variability in the amplitude criterion was significantly reduced using stimulus intensities of more than ST (0) +4mA. The variability in the threshold criterion was significantly smaller than that of the amplitude criterion, even when using a strong stimulus intensity. Significance The maximal stimulus intensity with no body motion should be used in the amplitude criterion for intraoperative MEP elicited by DCS.

Purpose Polymicrogyria, a malformation of the cerebral cortex, frequently causes epilepsy. Diffuse bilateral polymicrogyria (DBP) is related to poor epilepsy prognosis, but most patients with DBP are not good candidates for resective epilepsy surgery and effectiveness of corpus callosotomy (CC), a palliative surgery, for patients without resective epileptogenic cortices, has not been established in DBP. Because CC might be effective against DBP-related epilepsy, we conducted total CC in three pediatric DBP cases. Methods Case 1. A girl developed epilepsy at 3 months of age, with focal versive seizures and epileptic spasms. The electroencephalogram (EEG) showed a suppression-burst pattern. Total CC was performed at 6 months of age. Case 2. A female infant developed epilepsy on the day of birth, exhibiting epileptic spasms, generalized tonic-clonic seizures, and eye-deviating seizures. She had a history of clusters of tonic seizures. Total CC was performed at 1 year and 2 months of age. After CC, the epileptic focus of the tonic seizures was identified; a secondary resective surgery was conducted. Case 3. A girl developed multiple types of seizures at 3 years of age. Frequent atypical absence status was refractory to antiepileptic drugs. Total CC was conducted at 8 years of age. Results Case 1: Frequencies of both seizure types decreased. The background EEG changed to continuous high-voltage slow waves. Case 2: Clusters of tonic seizures were well-controlled. Case 3: Atypical absence seizures completely disappeared. Conclusion CC could be effective for patients with DBP, whose habitual seizures include epileptic spasms and absence seizures.

OBJECTIVEMRI scans obtained within 48–72 hours (early postoperative MRI [epMRI]), prior to any postoperative reactive changes, are recommended for the accurate assessment of the extent of resection (EOR) after glioma surgery. Diffusion-weighted imaging (DWI) enables ischemic lesions to be detected and distinguished from the residual tumor. Prior studies, however, revealed that postoperative reactive changes were often present, even in epMRI. Although intraoperative MRI (iMRI) is widely used to maximize safe resection during glioma surgery, it is unclear whether iMRI is superior to epMRI when evaluating the EOR, because it theoretically shows fewer postoperative reactive changes. In addition, the ability to detect ischemic lesions using iMRI has not been investigated.METHODSThe authors retrospectively analyzed prospectively collected data in 30 patients with glioma (22 and 8 patients with enhancing and nonenhancing lesions, respectively) who underwent tumor resection. These patients had received preoperative MRI within 24 hours prior to surgery, postresection radiological evaluation with iMRI during surgery, and epMRI within 24 hours after surgery, with all neuroimaging performed using identical 1.5T MRI scanners. The authors compared iMRI or epMRI with preoperative MRI, and defined a postoperative reactive change as a new postoperative enhancement or T2 high-intensity area (HIA), if this lesion was outside of the preoperative original tumor location. In addition, postoperative ischemia was evaluated on DWI. The iMRI and epMRI findings were compared in terms of 1) postoperative reactive changes, 2) evaluation of the EOR, and 3) presence of ischemic lesion on DWI.RESULTSIn patients with enhancing lesions, a new enhancement was seen in 8 of 22 patients (36.4%) on iMRI and in 12 of 22 patients (54.5%) on epMRI. In patients with nonenhancing lesions, a new T2 HIA was seen in 4 of 8 patients (50.0%) on iMRI and in 7 of 8 patients (87.5%) on epMRI. A discrepancy between the EOR measured on iMRI and epMRI was noted in 5 of the 22 patients (22.7%) with enhancing lesions, and in 3 of the 8 patients (37.5%) with nonenhancing lesions. The occurrence of ischemic lesions on DWI was found in 5 of 30 patients (16.7%) on iMRI, whereas it was found in 16 of 30 patients (53.3%) on epMRI (p = 0.003); ischemic lesions were underestimated on iMRI in 11 patients.CONCLUSIONSOverall, given the lower incidence of postoperative reactive changes on iMRI, it was superior to epMRI in evaluating the EOR in patients with glioma, both with enhancing and nonenhancing lesions. However, because ischemic lesions can be overlooked on iMRI, the authors recommend only the additional DWI scan during the early postoperative period. Clinicians need to be mindful about not overestimating the presence of residual tumor on epMRI due to the high incidence of postoperative reactive changes.

In order to predict the potencies of mechanism-based reversible covalent inhibitors, the relationships between calculated Gibbs free energy of hydrolytic water molecule in acyl-trypsin intermediates and experimentally measured catalytic rate constants (kcat) were investigated. After obtaining representative solution structures by molecular dynamics (MD) simulations, hydration thermodynamics analyses using WaterMap™ were conducted. Consequently, we found for the first time that when Gibbs free energy of the hydrolytic water molecule was lower, logarithms of kcat were also lower. The hydrolytic water molecule with favorable Gibbs free energy may hydrolyze acylated serine slowly. Gibbs free energy of hydrolytic water molecule might be a useful descriptor for computer-aided discovery of mechanism-based reversible covalent inhibitors of hydrolytic enzymes.

The force driving the conversion from the acyl intermediate to the tetrahedral intermediate in the deacylation reaction of serine proteases remains unclear. The crystal structure of 6-guanidinohexanoyl trypsin was determined at pH 7.0, near the optimum reaction pH, at 1.94 A resolution. In this structure, three water molecules are observed around the catalytic site. One acts as a nucleophile to attack the acyl carbonyl carbon while the other two waters fix the position of the catalytic water through a hydrogen bond. When the acyl carbonyl oxygen oscillates thermally, the water assumes an appropriate angle to catalyze the deacylation.

Intracranial nongerminomatous germ cell tumors (NGGCTs) in unusual locations are extremely rare. Here, we report a case of a yolk sac tumor in the frontal lobe in a middle-aged patient. A 42-year-old man was admitted to our hospital for headache and nausea. Magnetic resonance imaging (MRI) showed an enhanced mass lesion with a marked cyst component. The serum alpha-fetoprotein (αFP) level was extremely high. Histological examination of specimens after subtotal removal revealed a primary mixed germ cell tumor with extensive yolk sac tumor elements, often referred to as an intracranial “yolk sac tumor.” The preoperative diagnosis of NGGCTs in unusual age and locations is extremely difficult. Clinicians should consider the possibility of NGGCTs, including yolk sac tumors, when intracranial tumors with unusual MRI findings are encountered.

We herein present a case of bilateral chronic subdural hematoma(bilateral CSDH)caused by spontaneous intracranial hypotension(SIH)without orthostatic headache. A 67-year-old male patient with mild head injury suffered from a chronic, non-postural headache. Computed tomography of the brain showed bilateral CSDH. The hematomas were surgically evacuated using a closed drainage method. His headache immediately disappeared, but it recurred after 2 weeks. We further performed hematoma irrigation;however, his neurological status deteriorated with the development of pneumocephalus. Magnetic resonance imaging with gadolinium-DTPA showed diffuse pachymeningeal enhancement. His cerebrospinal fluid pressure was 3cmH

Marfan syndrome can demonstrate tortuous and elongated intracranial arteries. However, these arteries rarely cause neurovascular compression resulting in hemifacial spasm or trigeminal neuralgia. The authors report a 33-year-old woman who was diagnosed as Marfan syndrome, suffered from trigeminal neuralgia. Magnetic resonance (MR) angiography showed tortuous and elongated left vertebral artery (VA). The coronal section of three dimensional (3D) MR cisternography with contrast enhancement showed that the left trigeminal nerve was compressed from underneath by the tortuous and elongated left VA. After successful surgery of microvascular decompression, the patient’s symptom resolved and no recurrence was encountered. Neurosurgeons should not only be aware of hemifacial spasm but also of trigeminal neuralgia caused by elongated vessels in a patient with Marfan syndrome, although it is an extremely rare condition. In addition, offending vessel is not atherosclerotic in younger patients unlike usual cases of trigeminal neuralgia. Thus, microvascular decompression can be easier than usual cases. Care should be taken to prevent arterial dissection during transposition by using some technical tips.

The force driving the conversion from the acyl intermediate to the tetrahedral intermediate in the deacylation reaction of serine proteases remains unclear. The crystal structure of 6-guanidinohexanoyl trypsin was determined at pH 7.0, near the optimum reaction pH, at 1.94 Å resolution. In this structure, three water molecules are observed around the catalytic site. One acts as a nucleophile to attack the acyl carbonyl carbon while the other two waters fix the position of the catalytic water through a hydrogen bond. When the acyl carbonyl oxygen oscillates thermally, the water assumes an appropriate angle to catalyze the deacylation.

Background: In navigation-guided endoscopic surgery performed via a single port, the interference of surgical instruments often disturbs the resection and hemostasis. Case Description: With regard to this, we designed a dual-port technique for navigation-guided endoscopic surgery in a 62-year-old man, with intraparenchymal anaplastic astrocytoma. Two transparent sheaths with Nelaton tubes were inserted in the front of the target lesion via an infinity-shaped burr hole, under the control of the navigation system. The lesion was removed partially using a rigid endoscope and several surgical tools through the bilateral ports. Using the new method, it was convenient to perform hemostasis with bipolar coagulation and aspiration, without any interference from the surgical instruments during the surgery. Conclusion: The offered dual-port technique may be included in surgery planning for elderly patients or patients in particular conditions, with intraparenchymal brain tumors.