Juan A. Barcia

Recruitment of Occipital Cortex during Sensory Substitution Training Linked to Subjective Experience of Seeing in People with Blindness

Over three months of intensive training with a tactile stimulation device, 18 blind and 10 blindfolded seeing subjects improved in their ability to identify geometric figures by touch. Seven blind subjects spontaneously reported ‘visual qualia’, the subjective sensation of seeing flashes of light congruent with tactile stimuli. In the latter subjects tactile stimulation evoked activation of occipital cortex on electroencephalography (EEG). None of the blind subjects who failed to experience visual qualia, despite identical tactile stimulation training, showed EEG recruitment of occipital cortex. None of the blindfolded seeing humans reported visual-like sensations during tactile stimulation. These findings support the notion that the conscious experience of seeing is linked to the activation of occipital brain regions in people with blindness. Moreover, the findings indicate that provision of visual information can be achieved through non-visual sensory modalities which may help to minimize the disability of blind individuals, affording them some degree of object recognition and navigation aid.

Proper information during the surgical decision-making process lowers the anxiety of patients with high-grade gliomas

PurposeWe aim to analyse the relationship between the quality of information during the decision-making process regarding surgery to treat high-grade gliomas and the level of anxiety of the patients.MethodsThis is a transversal, descriptive and correlational study on 26 patients with a clinical and radiological diagnosis of high-grade glioma. They scored the quality (in terms of comprehension and satisfaction) of information received about the treatment options and prognosis during the surgical decision-making process, and the Hospital Anxiety and Depression Scale questionnaire (HADS) was applied immediately afterward.ResultsLower levels of anxiety were observed in patients who showed a desire to receive information regarding their illness, those with a higher degree of comprehension, and those with a higher level of satisfaction with the information provided.ConclusionsAn improvement in the communication process contributes to a decrease in the levels of anxiety, and consequently to enhancement of the well-being of these patients.

Intraventricular and intracerebral delivery of anti-epileptic drugs in the kindling model

SummaryA means to avoid the pharmacokinetic problems affecting the anti-epileptic drugs may be their direct intracerebroventricular (ICV) or intracerebral delivery. This approach may achieve a greater drug concentration at the epileptogenic area while minimizing it in other brain or systemic areas, and thus it could be an interesting therapeutic alternative in drug-resistant epilepsies. The objective of this article is to review a series of experiments, ranging from actute ICV injection to continuous intracerebral infusion of anti-epileptic drugs or grafting of neurotransmitter producing cells, in experimental models, especially in the kindling model of epilepsy in the rat.Acute ICV injection of phenytoin, phenobarbital or carbamacepine is able to diminish the intensity of kindling seizures, but it is also associated with a high neurologic toxicity, especially phenobarbital. Continuous ICV infusion of anti-epileptic drugs can effectively control seizures, but neurologic toxicity is not improved compared with systemic delivery. However, systemic toxicity may be improved, as in the case of valproic acid, whose continuous ICV infusion results in very low plasmatic or hepatic drug concentrations. Continuous intracerebral infusion at the epileptogenic area was studied as an alternative to minimize neurologic toxicity. Thus, intra-amygdalar infusion of gamma-aminobutyric acid (GABA) controls seizures with minimal neurotoxicity in amygdala-kindled rats. Similarly, continuous infusion of GABA into the dorsomedian nucleus of the thalamus improves seizure spread, while not affecting the local epileptogenic activity at the amygdala. Grafting of GABA releasing cells may reduce kindling parameter severity without behavioral side effects.We may conclude that ICV or intracerebral delivery of anti-epileptic drugs or neurotransmitters may be a useful technique to modulate epilepsy.

Assessment of a method to determine deep brain stimulation targets using deterministic tractography in a navigation system

Recent advances in imaging permit radiologic identification of target structures for deep brain stimulation (DBS) for movement disorders. However, these methods cannot detect the internal subdivision and thus cannot determine the appropriate DBS target located within those subdivisions. The aim of this study is to provide a straightforward method to obtain an optimized target (OT) within DBS target nuclei using a widely available navigation system. We used T1- and T2-weighted images, fluid-attenuated inversion recovery (FLAIR) sequence, and diffusion tensor imaging (DTI) of nine patients operated for DBS in our center. Using the StealthViz® software, we segmented the targeted deep structures (subcortical targets) and the anatomically identifiable areas to which these target nuclei were connected (projection areas). We generated fiber tracts from the projection areas. By identifying their intersections with the subcortical targets, we obtained an OT within the DBS target nuclei. We computed the distances from the clinically effective electrode contacts (CEEC) to the OT obtained by our method and the targets provided by the atlas. These distances were compared using a Wilcoxon signed-rank test, with p < 0.05 considered statistically significant. We were able to identify OT coincident with the motor part of the subthalamic nucleus and the ventral intermediate nucleus. We clinically tested the results and found that the CEEC were significantly more closely related to the OT than with the targets obtained by the atlas. Our present results show that this novel method permits optimization of the stimulation site within the internal subdivisions of target nuclei for DBS.

Injection of embryonic median ganglionic eminence cells or fibroblasts within the amygdala in rats kindled from the piriform cortex

BACKGROUND Intracerebral infusion of anticonvulsant agent secreting cells has proven to raise the threshold for seizure generation in epileptogenic areas. Median ganglionic eminence (MGE) is the main embryonic region where future GABAergic cells originate. Here we report the results of intraamygdaline grafting of MGE cells versus fibroblasts in a piriform cortex kindling model of epilepsy in the rat. MATERIAL AND METHODS Rats were implanted with an electrode in the left piriform cortex and subjected to infusion at the left basolateral amygdala of cells obtained from the MGE of embryos or fibroblasts. Some of the donor cells were obtained from transgenic rats expressing the green fluorescent protein (GFP). Seizure and neurologic behavior were recorded, and inmunohistochemical and ultrastructural studies were carried out. RESULTS Cells obtained from the embryonic MGE elevated both the afterdischarge and the seizure threshold progressively, being significant 3 weeks after their injection. On the contrary, fibroblasts injected into the amygdala raised the seizure thresholds the first week, the effect weaning during the following weeks. Fibroblasts and MGE cells were shown at the injected amygdala. No behavioral side effects were recorded in either experimental group. CONCLUSION MGE cells implanted at the amygdala may control the focal component of temporolimbic seizures. This effect may be mediated by local release of GABA.

Deep Brain Stimulation for Obsessive-Compulsive Disorder: Is the Side Relevant?

Background: Deep brain stimulation for obsessive-compulsive disorder (OCD) has targeted several subcortical nuclei, including the subthalamic nucleus (STN) and the nucleus accumbens. While the most appropriate target is still being looked for, little attention has been given to the side of the stimulated hemisphere in relationship to outcome. Methods: We report 2 patients diagnosed with OCD, one having symmetry obsessions and the other one with sexual-religious obsessive thoughts. They were implanted bilaterally with deep electrodes located at both STN and nuclei accumbens. The effectiveness of the stimulation was tested for every possible paired combination of electrodes guided by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score reduction. Results: In both cases, the combination of electrodes which best relieved the OCD symptoms was both the left STN and left accumbens. In case 1, the preoperative Y-BOCS score was 33, and 1 month after stimulation it was 16. In case 2, the Y-BOCS scores were 33 and 3, respectively, with the patient being free of obsessions. Conclusion: Some reports suggest that lesion stimulation or stimulation of only the right side relieves OCD symptoms. However, anatomical and functional studies are not conclusive as to which side is most affected in OCD. Possibly, each OCD patient has an individualized optimal side to stimulate.

Continuous bilateral infusion of GABA in the dorsomedian nucleus of the thalamus elevates the generalized seizure threshold in amygdala-kindled rats

In order to assess the role of continuous intracerebral infusion of GABA over the propagation of generalized seizures from the amygdala, Wistar rats were subjected to a kindling procedure at the left basolateral amygdala. Subsequently, they were implanted with miniosmotic pumps filled with 100mg/mL of GABA in saline, connected to catheters whose tips were placed bilaterally at both dorsomedian nuclei of the thalamus (DMNT). The threshold intensity to provoke local afterdischarges (ADT) and generalized seizures (GST) were measured before, during and after GABA infusion, as well as seizure intensity and signs of ataxia and sedation. While there was no observed variation on ADT, the median GST was significantly increased during, but not after infusion of GABA (P=0.047, compared to the preinfusion value). Seizure intensity was not changed. No signs of neurologic side effects were recorded. These data emphasize the role of DMNT in the generalization of seizures originated at the amygdala.

Directional local field potential recordings for symptom‐specific optimization of deep brain stimulation

more specific objective physiological measures. The electromagnetic fields will affect tissue up to 8 to 10 cm into the brain and are weakened when penetrating brain tissue. Because the putamen is located approximately 4 to 5 cm from the parietal scalp and the substantia nigra approximately 10 cm from the parietal scalp, it is likely that T-PEMF treatment does not reach the basal ganglia with sufficient power, with the result that the PD symptoms are not sufficiently alleviated. Extending the 8-week treatment period might compensate for this; however, the Danish Health Authority would not permit an extension. Based on experience from this current study, the Danish Health Authority has now extended the TPEMF treatment period from 8 to 26 weeks.

Tractographical model of the cortico-basal ganglia and corticothalamic connections: Improving Our Understanding of Deep Brain Stimulation.

The cortico‐basal ganglia and corticothalamic projections have been extensively studied in the context of neurological and psychiatric disorders. Deep brain stimulation (DBS) is known to modulate many of these pathways to produce the desired clinical effect. The aim of this work is to describe the anatomy of the main circuits of the basal ganglia using tractography in a surgical planning station. We used imaging studies of 20 patients who underwent DBS for movement and psychiatric disorders. We segmented the putamen, caudate nucleus (CN), thalamus, and subthalamic nucleus (STN), and we also segmented the cortical areas connected with these subcortical areas. We used tractography to define the subdivisions of the basal ganglia and thalamus through the generation of fibers from the cortical areas to the subcortical structures. We were able to generate the corticostriatal and corticothalamic connections involved in the motor, associative and limbic circuits. Furthermore, we were able to reconstruct the hyperdirect pathway through the corticosubthalamic connections and we found subregions in the STN. Finally, we reconstructed the cortico‐subcortical connections of the ventral intermediate nucleus, the nucleus accumbens and the CN. We identified a feasible delineation of the basal ganglia and thalamus connections using tractography. These results could be potentially useful in DBS if the parcellations are used as targets during surgery. Clin. Anat. 29:481–492, 2016.

Dynamic risk control by human nucleus accumbens

The nucleus accumbens is a key node in the network linking reward to action. Studying a rare series of patients with bilaterally implanted electrodes in the nucleus accumbens, Nachev et al. show that external electrical stimulation of the accumbens dynamically shifts behaviour towards more risky decision making.