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In JoVE (1)
Other Publications (25)
- Journal of Computer Assisted Tomography
- Magnetic Resonance Imaging
- Autonomic Neuroscience : Basic & Clinical
- American Journal of Health Promotion : AJHP
- Journal of Neuroengineering and Rehabilitation
- Movement Disorders : Official Journal of the Movement Disorder Society
- Journal of Neurosurgery
- Movement Disorders : Official Journal of the Movement Disorder Society
- Journal of Clinical Hypertension (Greenwich, Conn.)
- Clinical Autonomic Research : Official Journal of the Clinical Autonomic Research Society
- Journal of Cutaneous Pathology
- Magnetic Resonance Imaging
- Fogorvosi Szemle
- Neurosurgery
- Neuroscience Letters
- Fogorvosi Szemle
- International Journal of Hyperthermia : the Official Journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group
- American Journal of Hypertension
- Acta Neurochirurgica
- Stroke; a Journal of Cerebral Circulation
- Neurology
- IEEE Transactions on Bio-medical Engineering
- Journal of the Neurological Sciences
- Neurosurgery
- Diabetes Care
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Articles by Peter Novak in JoVE
JoVE Clinical and Translational Medicine
मात्रात्मक स्वायत परीक्षण
Department of Neurology, University of Massachusetts Medical School
मानकीकृत, autonomic कार्यों का व्यापक और पूरी तरह से मात्रात्मक परीक्षण वर्णित है. स्वायत्त परीक्षण सभी तीन cardiovagal एड्रीनर्जिक, और sudomotor सहित प्रमुख स्वायत्त डोमेन के मूल्यांकन से मिलकर बनता है. दुःस्वायत्तता की गंभीरता और वितरण समग्र स्वायत गंभीरता स्कोर का उपयोग quantitated है.
Other articles by Peter Novak on PubMed
Comparison of 1.5 and 8 Tesla High-resolution Magnetic Resonance Imaging of Lacunar Infarcts
We present a case report comparing 1.5 fast spin-echo (FSE) and high-resolution 8 Tesla (T) gradient echo (GE) MRI of a patient with multiple lacunar infarcts.
Venous Cavernoma at 8 Tesla MRI
Cavernous angiomas or cavernomas are vascular malformations, which may be associated with risk of bleeding episodes. We present a case report comparing high resolution 8 Tesla gradient echo (GE) imaging with routine fast spin echo (FSE) at 1.5 Tesla in a patient with venous cavernoma. A 55-year-old male with a history of hemorrhagic stroke was studied using high-resolution 8 Tesla magnetic resonance imaging (MRI) system, which revealed venous cavernoma (9 x 8.6 mm) in the left parietal region and visualized adjacent microvascular supply. Signal loss was prominent in the cavernoma region compared to surrounding brain tissue, and signal intensity declined by factor 7.3 +/- 2.4 (679 +/- 62%) on GE images at 8 Tesla. Cavernoma was not apparent on routine T(2)-weighted FSE images at 1.5 Tesla MRI. This case report indicates that GE images at 8 Tesla can be useful for evaluation of vascular pathologies and microvasculature.
Spectral Analysis of Slow Modulation of EEG Amplitude and Cardiovascular Variables in Subjects with Postural Tachycardia Syndrome
Previous studies have reported slow (<0.5 Hz) modulation of electroencephalographic (EEG) background amplitude and suggested that this reflects periodic neuronal activity in the brainstem, such as may be recorded from cardiovascular and respiratory centers in animals. We searched for a relationship between EEG amplitude modulation and modulation of simultaneously recorded cardiovascular variables and attempted to determine whether this relationship was altered in subjects with postural tachycardia syndrome (POTS).
Motives for Smoking Cessation Are Associated with Stage of Readiness to Quit Smoking and Sociodemographics Among German Industrial Employees
To test the relationships among particular motives for smoking cessation, stage of readiness to quit (preparation or contemplation), and sociodemographic characteristics.
Effect of Step-synchronized Vibration Stimulation of Soles on Gait in Parkinson's Disease: a Pilot Study
Previous studies have suggested that impaired proprioceptive processing in the striatum may contribute to abnormal gait in Parkinson's disease (PD).
G2019S Mutation in the Leucine-rich Repeat Kinase 2 Gene is Not Associated with Multiple System Atrophy
Multiple system atrophy (MSA) is characterized clinically by Parkinsonism, cerebellar dysfunction, and autonomic impairment. Multiple mutations in the LRRK2 gene are associated with parkinsonian disorders, and the most common one, the G2019S mutation, has been found in approximately 1% of sporadic cases of Parkinsonism. In a well-characterized cohort of 136 subjects with probable MSA and 110 neurologically evaluated control subjects, none carried the G2019S mutation. We conclude that the G2019S mutation in the LRRK2 gene is unlikely to be associated with MSA.
Detection of the Subthalamic Nucleus in Microelectrographic Recordings in Parkinson Disease Using the High-frequency (> 500 Hz) Neuronal Background. Technical Note
Accurate and fast localization of the subthalamic nucleus (STN) during intraoperative electrophysiological monitoring can improve the outcome of deep brain stimulation surgery. The authors show a simple method of detecting the STN that is based on an analysis of the high-frequency (> 500 Hz) background (HFB) activity of neurons. The HFB reflects multiunit spiking activity close to the recording electrode, and its characteristic profile, which is higher in the STN than in neighboring structures, and facilitates delineation of both the dorsal and ventral STN borders.
Potential Outcome Measures and Trial Design Issues for Multiple System Atrophy
Multiple system atrophy (MSA) is a neurodegenerative disorder exhibiting a combination of parkinsonism, cerebellar ataxia, and autonomic failure. A disease-specific scale, the Unified Multiple System Atrophy Rating Scale (UMSARS), has been developed and validated to measure progression of MSA, but its use as an outcome measure for therapeutic trials has not been evaluated. On the basis of twelve months of follow-up from an observational study of 67 patients with probable MSA, we evaluated three disease-specific scores: Activities of Daily Living, Motor Examination, and a combined score from the UMSARS and two general health scores, the Physical Health and Mental Health scores of the SF-36 health survey, for their use as outcome measures in a therapeutic trial. We discuss related design issues and provide sample size estimates. Scores based on the disease-specific UMSARS seemed to be equal or superior to scores based on the SF-36 health survey. They appeared to capture disease progression, were well correlated and required the smallest sample size. The UMSARS Motor Examination score exhibited the most favorable characteristics as an outcome measure for a therapeutic trial in MSA with 1 year of follow-up.
The Relationship Between Nighttime Dipping in Blood Pressure and Cerebral Hemodynamics in Nonstroke Patients
Inadequate dipping in nighttime blood pressure (BP) is associated with cerebrovascular disease. The authors aimed to determine whether inadequate nocturnal dipping was associated with abnormalities in cerebrovascular hemodynamics in individuals without stroke. Participants in this study underwent 24-hour ambulatory BP monitoring followed by morning transcranial Doppler measurements of blood flow velocities (BFVs) in the middle cerebral artery during supine rest, head-up tilt, hypocapnia, and hypercapnia. Nighttime BP decline by <10% was considered nondipping. Of the 102 nonstroke participants (mean age, 53.6 years), 35 (34%) were dippers. Although nondippers had similar BFV and cerebrovascular resistance (CVR) while supine, they had a lower BFV (P=.04) and greater CVR (P=.02) during head-up tilt compared with dippers. Moreover, greater nighttime dipping in both systolic BP (P=.006) and diastolic BP (P=.03) were associated with higher daytime BFV and lower CVR (P=.01 for systolic BP; P=.02 for diastolic BP). Inadequate nocturnal BP dipping is associated with lower daytime cerebral blood flow, especially during head-up tilt.
The Effects of Body Mass Index on Cerebral Blood Flow Velocity
Obesity is a risk factor for cerebrovascular disease. We aimed to determine the effects of high body mass index (BMI) on cerebral blood flow regulation in patients with type-2 diabetes mellitus, hypertension, and stroke.
Dermal Sheet Preparations in the Evaluation of Dermal Innervation in Parkinson's Disease and Multiple System Atrophy
Evaluation of dermal nerve fibers in conventional vertical sections is difficult because of the small number of fibers available for examination. In this study, we evaluated dermal sheet mounts for fibers in which the majority of fibers can be visualized.
White Matter Hyperintensities and Dynamics of Postural Control
White matter hyperintensities (WMHs) on MRI have been associated with age, cardiovascular risk factors and falls in the elderly. This study evaluated the relationship between WMHs and dynamics of postural control in older adults without history of falls.
[Osseointegration of Dental Implants After Radiotherapy for Oral Cancer]
The goal of rehabilitation following radical surgery and radiotherapy for oral cancer is the restoration of oral functions and aesthetics. Osseointegrated implants improve prosthesis stability. Previous radiotherapy was originally considered a contraindication for implant placement. The aim of this study was to evaluate the survival of dental implants following radiotherapy. Nine oral cancer patients who had undergone radical surgery and radiotherapy were selected. A total of 23 implants were inserted. Twenty-one implants (91.3%) have been functioning without discomfort or infection. This study shows that osseointegrated implants should be considered part of the treatment plan for the rehabilitation of oral cancer patients after radiotherapy.
Isolation of the Brain-related Factor of the Error Between Intended and Achieved Position of Deep Brain Stimulation Electrodes Implanted into the Subthalamic Nucleus for the Treatment of Parkinson's Disease
Although a few studies have quantified errors in the implantation of deep brain stimulation electrodes into the subthalamic nucleus (STN), a significant trend in error direction has not been reported. We have previously found that an error in axial plane, which is of most concern because it cannot be compensated for during deep brain stimulation programming, had a posteromedial trend. We hypothesized that this trend results from a predominance of a directionally oriented error factor of brain origin. Accordingly, elimination of nonbrain (technical) error factors could augment this trend. Thus, implantation accuracy could be improved by anterolateral compensation during target planning.
Effect of Deep Brain Stimulation of the Subthalamic Nucleus Upon the Contralateral Subthalamic Nucleus in Parkinson Disease
High frequency stimulation (HFS) of the subthalamic nucleus (STN) is an effective treatment of idiopathic Parkinson disease (PD). Exactly how HFS works remains unclear. Although HFS of the STN is most effective in improving contralateral motor functions, clinical studies have shown bilateral beneficial effects suggesting that unilateral STN HFS affects both ipsilateral and contralateral basal ganglia networks. In this study we evaluated the effect of STN HFS upon the contralateral STN in 14 PD subjects. The neural recordings were done during stereotaxic neurosurgery for implantation of deep brain stimulation electrodes in the second STN. Neuronal activity of the STN was analyzed before and during two minutes of HFS. There was a significant increase in the multiunit spiking activity of the STN during HFS in the contralateral STN. Our study provides direct electrophysiological evidence that the STN HFS is associated with increased activity of the contralateral STN. These findings suggest that increased STN output underlies therapeutic mechanisms of action of HFS.
[Clear Cell Adenocarcinoma of the Tongue. Coincidence or Distant Metastasis?]
Malignant tumors of the salivary glands are rare, they account for less than 0.5% of all malignancies and for 5% of cancers of maxillofacial regions. Clear cell adenocarcinoma represents 1% of malignant tumors of the salivary glands. The present case involved a 63-years-old Hungarian woman with a painless, non-ulcerated, nodular mass on the right side of the middle part of the tongue. Her past medical history included right nephrectomy of renal cell carcinoma, seven years before the tongue tumor. The initial orofacial clinical examination suspected lipoma, neurinoma or distant metastasis of the renal cell carcinoma. The histomorphological analysis of the resected tongue tumor showed similar clear cell adenocarcinoma mimicking the phenotype of renal cell carcinoma but detailed immunohistochemical analysis proved the primary origin of tongue indicating second primary metachronous malignant tumor.
Severe, Short-duration (0-3 Min) Heat Shocks (50-52 Degrees C) Inhibit the Repair of DNA Damage
The goal of this study was to determine whether short-duration (15 s-3 min) high-temperature (50 degrees C) heat shocks inhibit the repair of DNA damage.
Association of Blood Pressure Elevation and Nocturnal Dipping with Brain Atrophy, Perfusion and Functional Measures in Stroke and Nonstroke Individuals
Although both blood pressure elevation and lower nocturnal dipping increase vascular risk, it is not known whether either or both are also associated with brain atrophy, cerebral perfusion, and functional status.
Assessment of the Variability in the Anatomical Position and Size of the Subthalamic Nucleus Among Patients with Advanced Parkinson's Disease Using Magnetic Resonance Imaging
Targeting of the subthalamic nucleus (STN) during deep brain stimulation (DBS) surgery using standard atlas coordinates is used in some centers. Such coordinates are accurate for only a subgroup of patients, and subgroup size depends on the extent of inter-individual variation in STN position/size and degree to which atlas represents average anatomical relations. Few studies have addressed this issue.
Cerebral Flow Velocities During Daily Activities Depend on Blood Pressure in Patients with Chronic Ischemic Infarctions
Target blood pressure (BP) values for optimal cerebral perfusion after an ischemic stroke are still debated. We sought to examine the relationship between BP and cerebral blood flow velocities (BFVs) during daily activities.
Assessment of Sympathetic Index from the Valsalva Maneuver
Blood pressure (BP) decline and recovery during the Valsalva maneuver (VM) are used to evaluate the degree of sympathetic failure (SF) but a reliable sympathetic index (SI) derived from VM is lacking.
Analysis of EMG and Acceleration Signals for Quantifying the Effects of Deep Brain Stimulation in Parkinson's Disease
Deep brain stimulation (DBS) is effective in reducing motor symptoms in Parkinson's disease (PD). However, objective methods for quantifying its efficacy are lacking. We present a principal component (PC)-based tracking method for quantifying the effects of DBS in PD by using electromyography (EMG) and acceleration measurements. Ten parameters capturing PD characteristic signal features were initially extracted from isometric EMG and acceleration recordings. Using a PC approach, the original parameters were transformed into a smaller number of PCs. Finally, the effects of DBS were quantified by examining the PCs in a low-dimensional feature space. The EMG and acceleration data from 13 PD patients with DBS ON and OFF, and 13 healthy age-matched controls were used for analysis. Clinical evaluation of patients showed that their motor symptoms were effectively reduced with DBS. The analysis results showed that the signal characteristics of 12 patients were more similar to those of the healthy controls with DBS ON than with DBS OFF. These observations indicate that the PC-based tracking method can be used to objectively quantify the effects of DBS on the neuromuscular function of PD patients. Further studies are suggested to estimate the clinical sensitivity of the method to different types of PD.
Localization of the Subthalamic Nucleus in Parkinson Disease Using Multiunit Activity
Refinement of the subthalamic nucleus (STN) coordinates using intraoperative microelectrode recordings (MER) is routinely performed during deep brain stimulation (DBS) surgeries in Parkinson disease (PD). The commonly used criteria for electrophysiological localization of the STN are qualitative. The goal of this study was to validate quantitative STN detection algorithm (QD) derived from the multi-unit activity in a prospective setting.
Limbic and Motor Function Comparison of Deep Brain Stimulation of the Zona Incerta and Subthalamic Nucleus
BACKGROUND:: Psychiatric and neuropsychological side effects of STN stimulation have been increasingly recognized. Most programming regimens focus on contacts 0 and 1 while contact 3, which often times is located near or in the ZI, is usually not employed. The question of whether ZI stimulation may limit limbic effects has not been answered. OBJECTIVE: : Using standard trajectories and targeting, we examine the effects of acute stimulation near or in the ZI (contact 3) as compared to stimulation of the STN as measured by limbic and motor functions. METHODS:: Motor and limbic function of 11 patients with STN DBS were assessed using UPDRS 3, structured gait video analysis, VAS mood scales, task testing of impulsivity and facial recognition under routine STN programming and under stimulation in or near the ZI. Post-operative MRI confirmed location of contact 3 near or in the ZI. RESULTS:: Data analysis using repeated measures ANOVA revealed that motor scores remained stable with both stimulation settings, with specific improvements in finger taps (P=0.024) and rapid alternating movements (P=0.025) in ZI stimulation. Stimulation near or in ZI led to a decrease in self reported anxiety and depression (P = 0.031, 0.033 respectively) and improvement in fear recognition (P = 0.024). CONCLUSION:: We provide preliminary evidence that stimulation in or near the ZI results in maintained motor function while improving self-reported depression and anxiety in patients with bilateral STN DBS. Stimulation in or near the ZI may provide a useful programming setting for patients prone to psychiatric side effects.
Adhesion Molecules, Altered Vasoreactivity, and Brain Atrophy in Type 2 Diabetes
To investigate the effects of inflammation on perfusion regulation and brain volumes in type 2 diabetes.
