Extradural Cortical Stimulation Research Articles

Day/night difference in extradural cortical stimulation for motor relearning in a subacute stroke rat model

The aim of this study was to assess the proper timing of extradural cortical stimulation (ECS) on the motor relearning in a rat model of subacute photothrombotic stroke. Photothrombotic infarction was induced on the dominant sensorimotor cortex in male Sprague-Dawley rats after training in a single-pellet reaching task (SPRT). Rats were randomly divided into three groups after stroke: ECS during the inactive period (Day-ECS group), ECS during the active period (Night-ECS group) and no ECS (Non-stimulated group). Six sham-operated rats were assigned to the control group. The Day- and Night-ECS group received continuous ECS for 12 hours during the day or night for 2 weeks from day 4 after the stroke. Behavioral assessment with SPRT was performed daily. SPRT showed a significantly faster and greater improvement in the Day and Night-ECS groups than in the Non-stimulated group. In the Day- and Night-ECS groups, the success rate of SPRT differed significantly from Non-stimulated group on day 11 and day 8, respectively. In addition, the Night-ECS group showed a significantly higher SPRT success rate than the Day-ECS group from days 10 to 13. ECS during the active period might be more effective for motor relearning in the subacute stroke rat model.

Effects of extradural cortical stimulation on motor recovery in a rat model of subacute stroke.

Previous studies demonstrated that administering extradural cortical stimulation (ECS) to rats during the acute phase of a photothrombotic infarct enhances motor recovery. However, the effect of ECS during the subacute phase was unknown. We aimed to evaluate the effects of ECS on motor recovery in a rat model of subacute photothrombotic stroke. Photothrombotic ischemic injury to the left sensorimotor cortex (SMC) was induced in 41 male Sprague-Dawley rats using Rose-bengal dye (20 mg/kg) and cold light. The rats were randomly divided into two groups: ECS on infarcted SMC (ECS group) and no ECS on infarcted SMC (non-stimulated group). The ECS group received continuous ECS for 14 days starting from day 5 after the stroke onset. Behavioral training with the single-pellet reaching task (SPRT) was performed daily for all of the rats from the fifth day after stroke onset. After 19 days, brain sections were immunostained to allow the quantification of infarct volumes and the evaluation of the neuronal markers. The SPRT scores showed significantly faster and greater improvement in the ECS group than in the non-stimulated group. There were no significant differences in infarct size. However, in the ECS group, significantly more doublecortin-labeled cells were identified close to the penumbra region of the cerebral cortex. ECS in the subacute phase improved the behavior motor function in the stroke rat model, and induced a significant axonal sprouting in the peri-infarct area.

Extradural cortical stimulation for neural network recovery in stroke patients

Extradural cortical stimulation for neural network recovery in stroke patients

Complementary methods of diagnosis and treatment in movement disorders

The cortical and subcortical regions are functionally connected, and normal well-coordinated movement results from their interaction. Abnormal movements are the consequence of a lesion or malfunction in the basal ganglia (BG) and their interconnections. Movement disorders are usually corrected by medication, but there are some techniques not-included into regular medical practice, which improve the symptoms by their neuromodulatory effects. In this review we discuss the uses of Single Photon Emission Computed Tomography (SPECT), Positron Emission Tomography (PET ), Magnetic Resonance Imaging (MRI), Transcranial Sonography (TCS), Transcranial Magnetic Stimulation (TMS) and Electrooculography (EOG) in paraclinical diagnosis, and the potential of Deep Brain Stimulation (DBS), Extradural Cortical Stimulation (ECS), transcranial Direct Current Stimulation (tTDS), repetitive Transcranial Magnetic Stimulation (rTMS) and Functional Electrical Stimulation (FES) as a therapeutic tool in patients with movement disorders.

Therapeutic extradural cortical stimulation for Parkinson's Disease: Report of six cases and review of the literature

Objectives We report our experience and results with extradural cortical stimulation (ECS) in the surgical treatment of Parkinson's Disease (PD). Besides, we review the literature supporting the use of this technique. Materials and methods Six patients with advanced PD and exclusion criteria for Deep Brain Stimulation (DBS) were included in our ECS protocol. With the aid of functional MRI and somato-sensory evoked potentials monitoring, the motor cortex projection over the scalp was drawn. Finally, under local anesthesia a stimulation lead was placed in the epidural space overlying the central sulcus. Results Patients showed mild daily life activities improvement with a slightly lower levodopa equivalent dose, but UPDRS part III scores showed no significant modification. Conclusions Despite ECS is a minimally invasive surgical technique, our results only support its use in selected patients with advanced PD, in whom this therapy may be modestly effective. More experimental studies regarding the neuromodulation of the basal ganglia-cortex loops are required to optimize its clinical application.

Bifocal extradural cortical stimulation-induced recovery of consciousness in the permanent post-traumatic vegetative state

To the Editor: The chance of recovery from vegetative state (VS) 1 year after traumatic brain injury (TBI) is close to zero, i.e., it is permanent, PVS [5, 14]. Deep brain stimulation (DBS) of the midbrain or thalamus failed to improve awareness in PVS patients [15]. Yet, imaging studies suggest the potential for cognitive processing in a subset of patients and potentially recruitable cortical regions [6–9, 11]. Isolated thalamocortical ‘‘island’’ circuits may be working in PVS [6–9, 11]. We now find that bifocal, extradural cortical stimulation (b-ECS), a very safe minimally invasive surgical method [2–4], can restore conscious contents in the PVS. The present result differs from recent reports of an improvement of the minimally conscious state by DBS [13]: it is known that PVS and the MCS are different physiological entities, with large-scale ‘‘higher order’’ cortical activation on functional neuroimaging in MCS, normally not observed in PVS patients, a much better prognosis for the MCS even past 12 months, and sporadic, weak, inconsistent, but clearly intentional actions in MCS, but not PVS [9]. This female (born in 1988) was diagnosed as permanently vegetative following a car crash in January 2005. During the first week post-injury, her Glasgow Coma Scale was 5–6. She underwent right decompressive hemicraniectomy (with flap replaced at a later date) and went on to receive intensive neurorehabilitation for more than 1 year, to no avail. In August 2007, somatosensory evoked potentials (SSEPs) at the median nerve demonstrated absent N20/P25 components on both sides. Structural MRI showed a supratentorial right lateral ventricular enlargement due to scar retraction and signs of encephalomalacia on that side. On examination, the patient stared blankly in front of her, without any sign of visual pursuit. The defensive blink reflex was completely absent. Repeated verbal commands were not obeyed, even when given by familiar voices. Sporadic spontaneous movements of the four limbs were noted. Her head was often turned to the right, with the left arm flexed and her spastic left leg extended. Spastic retraction of the left arm was observed following nociceptive stimuli, with hyperextension of both legs. The patient was completely unable to localize external stimuli. She was scored 25 (category 9) on the Disability Rating Scale (DRS). This patient’s parents gave surrogate informed consent to surgery after Inner Review Board approval. After induction of general anesthesia, a double, parallel, sigmoid incision of the skin overlying the target areas was performed in August 2007. The left side was elected, i.e., the side contralateral to her previous hemicraniectomy. The sulcus between the left parietal gyri P1 and P2 and the middle frontal sulcus (F2), including Brodmann’s areas 8 and 46 (dorsolateral prefrontal cortex, DLPFC), were targeted under neuronavigation guidance. Four burr holes were fashioned, and two stimulating paddles were inserted extradurally (Lamitrode 4, ANS). The paddles were linked via a dual extension to a subclavearly pocketed pulse generator (IPG) (Genesis, ANS). One week post-surgery, stimulation was started simultaneously on both channels. Over the following 10 months, the patient was assessed by an independent third party who was totally blind to the procedure on nine occasions at 1-month intervals, after which parameters could be reset. S. Canavero B. Massa-Micon F. Cauda Turin Advanced Neuromodulation Group (TANG), Turin, Italy

Transcranial magnetic stimulation for central pain

Transcranial magnetic stimulation recently has emerged as a therapeutic tool in neurology and psychiatry, with contradictory results. Central pain, a major chronic pain syndrome affecting millions of people worldwide, has been the focus of a few studies. Although transcranial magnetic stimulation has no role in the chronic management of such pain, it has potential as a screening procedure for the much more effective extradural cortical stimulation, a minimally invasive neurosurgical procedure that has emerged as the technique of choice in treating these patients.

Transcranial Magnetic Cortical Stimulation Relieves Central Pain

Extradural cortical stimulation for neurogenic pain is a recent addition to the field of functional neurosurgery. About 50% of patients with central pain draw benefit in the long run. However, there is an urgent need for prognostic factors in order to cut the costs of the procedure. In this paper we report a statistically significant correlation between the subhypnotic propofol test, transcranial magnetic cortical stimulation (TMS) and the actual short-term outcome of extradural cortical stimulation in 9 patients. The propofol test and TMS appear to predict short-term effects of extradural cortical stimulation.

Therapeutic extradural cortical stimulation for movement disorders: A review

Extradural motor cortex stimulation was introduced in 1989 for control of central pain. In recent years this has been found useful in several patients with movement disorders. This paper attempts to bring together all the relevant literature, discuss mechanisms and lay out guidelines for future research and clinical applications.

Therapeutic Extradural Cortical Stimulation for Central and Neuropathic Pain: A Review

Therapeutic Extradural Cortical Stimulation for Central and Neuropathic Pain: A Review

Therapeutic extradural cortical stimulation for central and neuropathic pain: a review.

Extradural cortical stimulation is a recent addition to the armamentarium of functional neurosurgery. This article reviews results of treatment of chronic central and neuropathic pain. It is concluded that extradural cortical stimulation may be effective in several refractory cases.

Cortically Evoked Motor Action Potential in Spinal Cord Injury Research

Somatosensory evoked potentials (SEPs) have been used extensively in the neurophysiological assessment of spinal cord integrity. However, SEPs mainly reflect the function of the dorsal column. In an effort to find a reliable method of assessing the integrity of the motor tracts for experimental purposes, we studied cortically evoked motor action potentials (CEMAPs). Twenty white rats used were anesthetized with ketamine, and extradural cortical stimulation was carried out through a parasagittal craniectomy posterior to the coronal suture. A single stimulus of 325 mV for a duration of 0.1 to 0.5 ms was used to obtain a motor action potential from the contralateral lower extremity. Complete transsection of the spinal cord abolished the CEMAP. A progressive increase in pressure applied to the spinal cord with a progressive increase in duration produced loss of the CEMAP. The selective motor tract study made possible by cortical stimulation makes this a good technique for studying the motor tracts in experimental work.

SEQUENCE OF EVENTS FOLLOWING SYNAPTIC AND ELECTRICAL EXCITATION OF PYRAMIDAL NEURONS OF THE MOTOR CORTEX.

ArticlesSEQUENCE OF EVENTS FOLLOWING SYNAPTIC AND ELECTRICAL EXCITATION OF PYRAMIDAL NEURONS OF THE MOTOR CORTEXJ. Schlag, and R. BalvinJ. Schlag, and R. BalvinPublished Online:01 May 1964https://doi.org/10.1152/jn.1964.27.3.334MoreSectionsPDF (4 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByTherapeutic extradural cortical stimulation for movement disorders: A review19 July 2013 | Neurological Research, Vol. 25, No. 2Development from primary to augmenting responses in the somatosensory systemBrain Research, Vol. 205, No. 1Processing of sensory informationProgress in Neurobiology, Vol. 9, No. 1-2Identification of possible inhibitory neurons in the pericruciate cortex of the catBrain Research, Vol. 79, No. 1Physiological identification of inhibitory interneurones in the feline pericruciate cortexNeuropharmacology, Vol. 13, No. 6Light microscopic analysis of the cortical projection of the thalamic ventrolateral nucleus in the catBrain Research, Vol. 55, No. 1Thalamo-caudate-cortical relationships in synchronized activity. II. Further differentiation between spindle systems by cooling and lesions in the mesencephalonBrain Research, Vol. 39, No. 1An elementary description of thalamocortical system dynamics in the catBrain Research, Vol. 31, No. 1Effects of medial thalamic lesions in the rat a review and an interpretationNeuropsychologia, Vol. 9, No. 2The thalamocortical system as a neuronal machine: The interaction of ventrolateral nucleus with sensorimotor cortex in the catBrain Research, Vol. 18, No. 2Modulation of pyramidal tract cell activity by ventrolateral thalamic regions. Its possible role in tremorogenic mechanismsBrain Research, Vol. 14, No. 2Callosal and non-callosal connexions between the sensory-motor cortices in cat and monkeyElectroencephalography and Clinical Neurophysiology, Vol. 26, No. 6A quantitative study of temporal and spatial response patterns in a thalamic cell population electrically stimulatedBrain Research, Vol. 8, No. 2The influence of thalamic stimulus parameters on primary and augmenting cortical intracellular potentialsBrain Research, Vol. 5, No. 3Convergence of fast and slow synaptic systems on pyramidal tract neurons in motor cortex following surface stimulationExperimental Neurology, Vol. 17, No. 3Activités évoquées chez le chat dans la région du nucleus ventralis lateralis par diverses stimulations sensorielles. II. étude micro-physiologiqueElectroencephalography and Clinical Neurophysiology, Vol. 19, No. 5 More from this issue > Volume 27Issue 3May 1964Pages 334-365 https://doi.org/10.1152/jn.1964.27.3.334PubMed14168197History Published online 1 May 1964 Published in print 1 May 1964 Metrics