Satoshi Ayuzawa

Magnetoencephalography using total intravenous anesthesia in pediatric patients with intractable epilepsy: Lesional vs nonlesional epilepsy

PURPOSE Magnetoencephalography (MEG) provides source localization of interictal spikes. We use total intravenous anesthesia (TIVA) with propofol to immobilize uncooperative children. We evaluate the effect of TIVA on interictal spikes in children who have intractable epilepsy with or without MRI lesions. METHODS We studied 28 children (3-14 years; mean, 6.6). We intravenously administered propofol (30-60 microg/kg/min) to record MEG with simultaneous EEG. We evaluated MEG spike sources (MEGSSs). We compared spikes on simultaneous EEG under TIVA with those on scalp video-EEG without TIVA. RESULTS There was a significant decrease in frequent spikes (10 patients, 36%) on simultaneous EEG under TIVA compared to those (22 patients, 79%) on scalp video-EEG without TIVA (P<0.01). MEGSSs were present in 21 (75%) of 28 patients. Clustered MEGSSs occurred in 15 (83%) of 18 lesional patients but in 3 (30%) of 10 nonlesional patients (P<0.05). MEGSSs were more frequently absent in nonlesional (6 patients, 60%) than lesional (one patient, 5%) patients (P<0.01). Thirteen patients with MRI and/or histopathologically confirmed neuronal migration disorder most frequently showed clustered MEGSSs (11 patients, 85%) compared to those of other lesional and nonlesional patients. CONCLUSION Propofol-based TIVA reduced interictal spikes on simultaneous EEG. TIVA for MEG still had utility in identifying spike sources in a subset of pediatric patients with intractable epilepsy who were uncooperative and surgical candidates. In lesional patients, MEG under TIVA frequently localized the clustered MEGSSs. Neuronal migration disorders were intrinsically epileptogenic and produced clustered MEGSSs under TIVA. Nonlesional patients often had no MEGSS under TIVA.

Smartphone-Based Real-time Assessment of Swallowing Ability From the Swallowing Sound

Dysphagia can cause serious challenges to both physical and mental health. Aspiration due to dysphagia is a major health risk that could cause pneumonia and even death. The videofluoroscopic swallow study (VFSS), which is considered the gold standard for the diagnosis of dysphagia, is not widely available, expensive and causes exposure to radiation. The screening tests used for dysphagia need to be carried out by trained staff, and the evaluations are usually non-quantifiable. This paper investigates the development of the Swallowscope, a smartphone-based device and a feasible real-time swallowing sound-processing algorithm for the automatic screening, quantitative evaluation, and the visualisation of swallowing ability. The device can be used during activities of daily life with minimal intervention, making it potentially more capable of capturing aspirations and risky swallow patterns through the continuous monitoring. It also consists of a cloud-based system for the server-side analyzing and automatic sharing of the swallowing sound. The real-time algorithm we developed for the detection of dry and water swallows is based on a template matching approach. We analyzed the wavelet transformation-based spectral characteristics and the temporal characteristics of simultaneous synchronised VFSS and swallowing sound recordings of 25% barium mixed 3-ml water swallows of 70 subjects and the dry or saliva swallowing sound of 15 healthy subjects to establish the parameters of the template. With this algorithm, we achieved an overall detection accuracy of 79.3% (standard error: 4.2%) for the 92 water swallows; and a precision of 83.7% (range: 66.6%-100%) and a recall of 93.9% (range: 72.7%-100%) for the 71 episodes of dry swallows.

Prediction of the Reversibility of the Brain Stem Dysfunction in Head Injury Patients: MRI and Auditory Brain Stem Response Study

16 cases of head injury patients were examined by magnetic resonance imaging (MRI) and auditory brain stem response (ABR) simultaneously in acute stage in order to investigate the possibility of the prediction for long term outcome. Among 13 primary brain injury patients, brain stem injury was seen on MRI in 9 cases (69%) and ABR abnormality was seen in 6 cases (46%). MRI and ABR findings were equal in 8 cases (75%). In 6 cases, only MRI could show positive brain stem findings while ABR remained normal. MRI was more sensitive in detecting primary brain stem damage. Abnormal ABR findings and normal MRI was seen only in secondary brain damage cases. In primary brain injury cases, unilateral MRI abnormality in the brain stem and normal ABR were the signs for good recovery even if the consciousness disturbance persisted for a long period. Contrary to this group, bilateral brain stem damage on MRI and/or absent ABR were the signs for poor recovery. From these findings, it was concluded that MRI is thus useful in predicting the prognosis of primary brain damage in the acute stage based on the degree of the brain stem damage.

Swallowscope: A smartphone based device for the assessment of swallowing ability

Dysphagia can cause serious challenges to both physical and mental health. Aspiration due to dysphagia is a major health risk that could cause pneumonia, and even death. As a result, monitoring and managing dysphagia is of utmost importance. This study investigates the development of a smartphone-based device and a feasible real-time swallowing sound processing algorithm for the automatic screening for swallowing ability. The videofluoroscopic swallow study (VFSS), which is considered the gold standard for the diagnosis of dysphagia, is not widely available, expensive and causes exposure to radiation. The screening tests used for dysphagia need to be carried out by trained staff and the evaluations are often non-quantifiable. The Swallowscope we developed is a wearable device based on mobile health, and uses the swallowing sound to quantitatively evaluate swallowing ability. As swallowing sound can be captured continuously and during activities of daily life with minimal intervention, it is an ideal approach to monitor swallowing activities, and its continuous monitoring has a better probability of capturing aspirations and risky swallow patterns. This paper describes the real-time smartphone based algorithm and the application we developed to monitor swallowing activities and evaluates the recognition accuracy by comparing them with VFSS evidence.

Coagulation and Fibrinolysis in Head Injury: An Analysis with New Molecular Markers

Coagulation and fibrinolytic abnormality is a frequent complication in head injury patients. Fibrin and fibrinogen degradation products (FDP), D-dimer (DD), alpha 2-plasmin inhibitor (a2PI), plasmin-alpha 2-plasmin inhibitor complex (PIC), antithrombin III (AT-III), and thrombin- antithrombin III complex (TAT) were measured sequentially and hemostatic abnormality was analyzed in detail. The result indicate that coagulation and fibrinolytic activity is markedly accelerated in severe head injury patients with high FDP, DD, PIC, TAT, and with low a2PI, AT-III. Monitoring these markers is beneficial for early diagnosis of the hemostatic abnormalities. In the cases of delayed traumatic intracerebral hematoma, fibrinolytic activity are progressively accelerated in several hours immediately after the injury. From our results, early administration of anti-thrombin drug is strongly recommended to normalize the coagulation and fibrinolytic activity and to prevent hemostatic complications in severe head injury, and we also proposed the necessity of anti-thrombin for brain protection.

Clinical Effect of C2 Peripheral Nerve Field Stimulation Using Electroacupuncture for Primary Headache: PNFS ACUPUNCTURE FOR HEADACHE

We applied C2 peripheral nerve field stimulation using electroacupuncture (EA‐C2‐PNfS) for primary headache, and investigated its clinical effectiveness.

Distinct transcriptional and metabolic profiles associated with empathy in Buddhist priests: a pilot study

BackgroundGrowing evidence suggests that spiritual/religious involvement may have beneficial effects on both psychological and physical functions. However, the biological basis for this relationship remains unclear. This study explored the role of spiritual/religious involvement across a wide range of biological markers, including transcripts and metabolites, associated with the psychological aspects of empathy in Buddhist priests.MethodsTen professional Buddhist priests and 10 age-matched non-priest controls were recruited. The participants provided peripheral blood samples for the analysis of gene expression and metabolic profiles. The participants also completed validated questionnaires measuring empathy, the Health-Promoting Lifestyle Profile-II (HPLP-II), and a brief-type self-administered diet history questionnaire (BDHQ).ResultsThe microarray analyses revealed that the distinct transcripts in the Buddhist priests included up-regulated genes related to type I interferon (IFN) innate anti-viral responses (i.e., MX1, RSAD2, IFIT1, IFIT3, IFI27, IFI44L, and HERC5), and the genes C17orf97 (ligand of arginyltranseferase 1; ATE1), hemoglobin γA (HBG1), keratin-associated protein (KRTAP10-12), and sialic acid Ig-like lectin 14 (SIGLEC14) were down-regulated at baseline. The metabolomics analysis revealed that the metabolites, including 3-aminoisobutylic acid (BAIBA), choline, several essential amino acids (e.g., methionine, phenylalanine), and amino acid derivatives (e.g., 2-aminoadipic acid, asymmetric dimethyl-arginine (ADMA), symmetric dimethyl-arginine (SMDA)), were elevated in the Buddhist priests. By contrast, there was no significant difference of healthy lifestyle behaviors and daily nutrient intakes between the priests and the controls in this study. With regard to the psychological aspects, the Buddhist priests showed significantly higher empathy compared with the control. Spearman’s rank correlation analysis showed that empathy aspects in the priests were significantly correlated with the certain transcripts and metabolites.ConclusionsWe performed in vivo phenotyping using transcriptomics, metabolomics, and psychological analyses and found an association between empathy and the phenotype of Buddhist priests in this pilot study. The up-regulation of the anti-viral type I IFN responsive genes and distinct metabolites in the plasma may represent systemic biological adaptations with a unique signature underlying spiritual/religious practices for Buddhists.

Electroneurophysiology and Brain Functional Imaging for Brain-Machine-Interface

Engineering is indispensable for the development of clinical devices. The devices are also utilized for basic neuroscience, brain-machine-interface (BMI) research, neuromodulation and so on. This paper will outline the relations of clinical electroneurophysiology and BMI for cybernics research from clinical standpoints. First, we have a run-through of neurophysiology. Thereafter, this paper will introduce the techniques of visualization of brain functions and neuromodulation.

The patient had a normal magnetic resonance imaging and temporal lobe epilepsy secondary to a porencephalic cyst but showed structural lesions (hippocampal sclerosis)

Patients with a porencephalic cyst frequently develop intractable temporal lobe epilepsy (TLE). We report a surgically-treated male patient with intractable mesial TLE (mTLE) secondary to a porencephalic cyst. Although magnetic resonance imaging showed no hippocampal abnormalities, long-term video-electrocorticography revealed seizure onset discharges in the hippocampus. Temporal lobectomy brought an end to the patients seizures. Hippocampal sclerosis was histopathologically confirmed (dual pathology). Careful evaluation of hippocampal epileptogenicity is required, and temporal lobectomy, which is less invasive than hemispherectomy, can be a treatment of choice for patients with mTLE secondary to a porencephalic cyst.