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Biomedical subjects

Peter E Konrad

Publications and source records attributed to Peter E Konrad.

11 recordsLinked to original sources

Neuro-oncological applications of optical spectroscopy.

Advances in optics and molecular imaging have occurred rapidly in the past decade. One technique poised to take advantage of these developments is optical spectroscopy (OS). All optical spectroscopic techniques have in common tissue interrogation with light sources ranging from the ultraviolet (UV) to the infrared (IR) ranges of the spectrum, and collection of information on light reflected (reflectance spectroscopy) or light interactions with tissue and emergence at different wavelengths (fluorescence and Raman spectroscopy). OS can provide information regarding intrinsic tissue optical properties such as tissue structure, nuclear density, and the presence or absence of endogenous or exogenous fluorophores. Among other applications, this information has been used to distinguish tumor from normal brain tissues, to detect tumor margins in intrinsic, infiltrating gliomas, to identify radiation damage to tissues, and to assess tissue viability and predict the onset of apoptosis in vitro and in vivo. Potential applications of OS include detection of specific central nervous system (CNS) structures, such as brain nuclei, identification of cell types by the presence of specific neurotransmitters, and the detection of optically labeled cells or drugs during therapeutic interventions. All have potential utility in neuro-oncology, have been investigated in our laboratories, and will be the subject of this review.

Animals↗

Delayed occurrence of multiple spinal drop metastases from a posterior fossa choroid plexus papilloma. Case report.

Choroid plexus papilloma is a benign central nervous system tumor that occasionally spreads along the subarachnoid space. The authors report the case of a 49-year-old man who presented with back pain 19 years after resection of a posterior fossa choroid plexus papilloma. Magnetic resonance imaging revealed multiple spinal lesions without any residual or recurrent intracranial tumor. All spinal lesions were resected and histologically diagnosed as atypical choroid plexus papilloma. The authors suggest that patients in whom choroid plexus papilloma is diagnosed should undergo total neuraxis imaging at the time of initial diagnosis as well as periodic follow-up examinations after resection to rule out drop metastases.

Humans↗

Depression and intelligence in patients with Parkinson's disease and deep-brain stimulation.

The goal of this study is to examine the association of depression with intelligence and education in patients with Parkinson's disease treated with bilateral subthalamic nucleus stimulation (STN-DBS). The literature has been contradictory concerning depression in Parkinson's disease patients. Some studies have shown less depression in Parkinson's disease patients with more education not treated with STN-DBS. Other recently published studies indicate that STN-DBS improves the depression associated with Parkinson's disease. No studies have examined the correlation of these factors with depression in Parkinson's disease patients treated with STN-DBS. We administered the Beck Depression Inventory (BDI) pre- and postoperatively to 21 Parkinson's disease patients (seven women, 14 men, ages 49-75) who underwent STN-DBS. The postoperative scores of the lower 50th percentile (n=8) of the Verbal Comprehensive Index of the Wechsler Adult Intelligence Scale (WAIS-III) decreased significantly (P=0.036), while the upper 50th percentile (n=13) remained nearly constant (P=0.802). Furthermore, as the education increased from highschool to graduate level, patients demonstrated less improvement in depressive symptoms postoperatively. These findings suggest that Parkinson's disease patients with lower intelligence test scores and less education benefit more with regards to depressive symptomatology after STN-DBS than patients with higher scores and education.

Deep Brain Stimulation↗

Accuracy of customized miniature stereotactic platforms.

In this study, a new system was evaluated for implanting deep-brain stimulators based on a one-piece platform for each trajectory customized from a preoperative planning image. During surgery, the platform is attached to skull-implanted posts that extend through the scalp. The platform acts as a miniature stereotactic frame to provide guidance for parallel cannulas as they are advanced through a burr hole to the target. Accuracy is determined from a postoperative CT. For each implantation, the distance between the position observed in the postoperative image and the position calculated relative to the platform from the preoperative image is our measure of error. Because this measure incorporates the surgical error of electrode anchoring, brain shift between preoperative and postoperative scanning, and error in the measurement of the position of the electrode in CT, it will tend to overestimate the true error. The mean error was 2.8 mm for 20 implantations. These data reflect favorably the accuracy of this system when compared with others.

Artifacts↗

Automatic selection of DBS target points using multiple electrophysiological atlases.

In this paper we study and evaluate the influence of the choice of a particular reference volume as the electrophysiological atlas on the accuracy of the automatic predictions of optimal points for deep brain stimulator (DBS) implants. We refer to an electrophysiological atlas as a spatial map of electrophysiological information such as micro electrode recordings (MER), stimulation parameters, final implants positions, etc., which are acquired for each patient and then mapped onto a single reference volume using registration algorithms. An atlas-based prediction of the optimal point for a DBS surgery is made by registering a patient's image volume to that reference volume, that is, by computing a correct coordinate mapping between the two; and then by projecting the optimal point from the atlas to the patient using the transformation from the registration algorithm. Different atlases, as well as different parameterizations of the registration algorithm, lead to different and somewhat independent atlas-based predictions. We show how the use of multiple reference volumes can improve the accuracy of prediction by combining the predictions from the multiple reference volumes weighted by the accuracy of the non-rigid registration between each of the corresponding atlases and the patient volume.

Brain Mapping↗

Computer-aided placement of deep brain stimulators: from planning to intraoperative guidance.

In current practice, optimal placement of deep-brain stimulators (DBSs) used to treat movement disorders in patients with Parkinson's disease and essential tremor is an iterative procedure. A target is chosen preoperatively based on anatomical landmarks identified on magnetic resonance images. This point is used as an initial position that is refined intraoperatively using both microelectrode recordings and macrostimulation. In this paper, we report on our current progress toward developing a system for the computer-assisted preoperative selection of target points and for the intraoperative adjustment of these points. The system consists of a deformable atlas of optimal target points that can be used to select automatically the preoperative target, of an electrophysiological atlas, and of an intraoperative interface. Results we have obtained show that automatic prediction of target points is an achievable goal. Our results also indicate that electrophysiological information could be used to resolve structures not visible in anatomic images, thus improving both preoperative and intraoperative guidance. Our intraoperative system has reached the stage of a working prototype and we compare targeting accuracy as well as the number of paths needed to reach the targets with our system and with the method in current clinical use.

Algorithms↗

Deep brain stimulation of the subthalamic nucleus reduces antiparkinsonian medication costs.

This study reports a retrospective analysis of 16 patients to determine changes in medication costs associated with deep brain stimulation of the bilateral subthalamic nucleus (DBS B-STN). Antiparkinsonian medication (APMED) costs were evaluated pre- and post-operatively at 1 and 2 years, based on prescribed dosages. After treatment with DBS, patients experienced a 32% reduction in APMED costs after 1 year and a 39% reduction after 2 years. Hypothetical projections of total potential savings are presented, accounting for increasingly complex medication regimens and medication cost inflation. DBS patients may experience a significant long-term reduction in the cost of their pharmacologic treatment.

Amantadine↗

Bilateral globus pallidus internus deep brain stimulation therapy for primary generalized dystonia.

Primary generalized dystonia (PGD) associated with the early-onset generalized dystonia gene (DYT1) can cause severe disability, compromising an individual's ability to perform activities of daily living. Pharmacological treatment has been inadequate in alleviating the motor dysfunctions. Deep brain stimulation of the bilateral globus pallidus internus (DBS B-GPi) has been documented to reduce these debilitating motor abnormalities. This report details the successful treatment of a DYT1-positive 13 year-old boy suffering from PGD.

Botulinum Toxins↗

Lateral approach to a neurenteric cyst of the cervical spine: case presentation and review of surgical technique.

STUDY DESIGN: The lateral cervical spinal approach is illustrated by a case of neurenteric cyst. OBJECTIVES: To present a case of a neurenteric cyst resected the lateral cervical approach, and to review the approach in detail. SUMMARY OF BACKGROUND DATA: Intradural lesions located anterior to the high cervical spinal cord may present a difficult surgical problem. Neurenteric cysts are unusual lesions found in the brain and spinal cord. This report presents a case of cervical neurenteric cyst causing anterior cord compression that was resected using the lateral cervical approach. METHODS: A 32-year-old woman presented with chronic headaches and worsening nausea, tinnitus, dizziness, and hyperreflexia and clonus in her lower extremities. Magnetic resonance imaging of the cervical spine showed a mass compressing the anterior spinal cord at C3. Pathology showed that this lesion was a neurenteric cyst. The lesion was resected using the lateral cervical approach. RESULTS: At this writing, 36 months after surgery, the patient has continued resolution of her symptoms, and no cyst recurrence has been shown on repeat MRI imaging. She has no evidence of postlaminectomy kyphosis. CONCLUSIONS: The lateral cervical approach is useful for surgeons attempting to resect lateral and anterior intradural lesions of the cervical spine. It also gives excellent cranial-to-caudal access to the thecal sac, spinal cord, and the lesion to be resected. The neck incision preserves cosmesis, and neuromuscular function is maintained. Spinal fusion was avoided in the reported case.

Adult↗

Deep brain stimulation: a new treatment for Parkinson's disease.

Patients suffering from advanced Parkinson's disease (PD) often experience an array of symptoms that greatly affect their quality of life. Deep brain stimulation (DBS) of the bilateral subthalamic nuclei (STN) has produced remarkable improvements in people with advanced PD whose symptoms are not adequately controlled with medication. We present a case report on a patient who has benefitted immensely from bilateral STN stimulation. Levodopa responsiveness, disabling motor fluctuations and dyskinesias, cognition, and concurrent illness are major factors in identifying candidates who will receive the greatest benefit.

Adult↗

No increased herniation of the cerebellar tonsils in a group of patients with orthostatic intolerance.

Orthostatic intolerance, seen predominantly in young women, is characterized by symptoms of lightheadedness, fatigue and palpitations in the upright posture. With standing, plasma norepinephrine levels rise dramatically and heart rate often increases by more than 30 beats per minute, although blood pressure does not usually fall. A theory recently popularized in the media suggests that some cases of orthostatic intolerance are related to hindbrain compression, with or without a Chiari I malformation. As a preliminary investigation of this hypothesis, head or cervical spine MRI scans from 23 females with orthostatic intolerance were reviewed. The cerebellar tonsils averaged 0.3 +/- 1.9 mm below the foramen magnum. These results were compared to measurements from a control group averaging 0.4 +/- 2.6 mm above the foramen magnum (P > 0.05). Tonsillar depression of at least 3 mm occurred in 13 % of both the patient group and the control group. Tonsillar herniation was not found to influence supine or upright blood pressure, heart rate or plasma norepinephrine levels in the patients. We conclude that herniation of the cerebellar tonsils is not a common cause of orthostatic intolerance. However, the single measurement of tonsillar depression might underestimate the number of patients with hindbrain compression.

Adult↗