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Papers - ENATSU Rei

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越智さと子, 菅野彩, 平野司, 江夏怜, 三國信啓

てんかんをめぐって ( 日本てんかん学会-北海道地方会 ) 38 23 - 33 2020.12

てんかんに対して自己調整と発作自動制御機構を持つ器材、迷走神経刺激療法(VNS)-Aspire SR(VNS-SR)の有効性について検討した。当院で施行したVNS-SR留置術を、VNS-SRから開始した新規群16例(男性9例、女性7例)と迷走神経刺激療法(VNS)の治療歴を有する交換群32例(男性18例、女性14例)に分類した。VNS-SRは交換群で前器材と比較して発作減少治療効果を上げることが示され、80%以上の発作抑制が得られたのは被験者のうち11%であり、VNS単独では6%程度にとどまっていた。また、合理的な多段階治療の検討では、VNSを先行して調整後十分な効果が得られない場合、臨床所見と脳波所見の精査後に開頭術を追加する方針によって発作抑制効果と行動拡大等のQOL改善が得られた。また、VNS-SRが有用な患者として、Lennox-Gastaut症候群等のてんかん症候群、疼痛を伴う発作例、CYPs系薬剤の副作用が強い例、発作時心負荷が大きい重積例等が考えられた。

振戦再発例におけるサイクリング刺激の振戦抑制効果

江夏怜, 北川まゆみ, 森下登史, 笹川彩佳, 栗原伴佳, 平野司, 在原正泰, 三上毅, 三國信啓

日本定位・機能神経外科学会プログラム・抄録集 ( (一社)日本定位・機能神経外科学会 ) 60回 130 - 130 2020.12

Directional leadを用いたパーキンソン病におけるSTN、cZI、PSAの刺激効果の比較

北川まゆみ, 江夏怜, 三國信啓

臨床神経学 ( (一社)日本神経学会 ) 60 ( Suppl. ) S379 - S379 2020.11

在原正泰, 江夏怜, 栗原伴佳, 笹川彩佳, 平野司, 香城章麿, 越智さと子, 福村忍, 三國信啓

小児の脳神経 ( (一社)日本小児神経外科学会 ) 45 ( 3 ) 262 - 262 2020.10

Negative motor networks: Electric cortical stimulation and diffusion tensor imaging.

R Yokoyama, R Enatsu, A Kanno, H Suzuki, Y Suzuki, A Sasagawa, T Hirano, M Arihara, T Kuribara, S Ochi, N Mikuni

Revue neurologique 176 ( 7-8 ) 592 - 600 2020.09 [International journal]

INTRODUCTION: This study investigated the networks of Negative motor areas (NMAs) using electric cortical stimulation and diffusion tensor imaging (DTI). METHODS: Twelve patients with intractable focal epilepsy, in which NMAs were identified by electrical cortical stimulation, were enrolled in this study. Electric stimulation at 50Hz was applied to the electrodes during motor tasks to identify the NMAs. DTI was used to identify the subcortical fibers originating from the NMAs found by electrical stimulation. RESULTS: NMAs were found in lateral frontal areas (premotor area (PM) and precentral gyrus) in all 12 patients, in pre-supplementary motor areas (pre-SMAs) in four patients, and in posterior parietal cortices (PPCs) in four. DTI detected fibers connecting to the ipsilateral PMs, PPCs and temporal regions via U-fibers, superior longitudinal fasciculus (SLF), and arcuate fasciculus (AF) from the lateral frontal NMAs. Pre-SMA-NMAs had connections with ipsilateral PMs and contralateral pre-SMAs via the frontal aslant tract and transcallosal commissural fibers, and PPC-NMAs with ipsilateral PMs via SLF and AF. CONCLUSION: This study found the characteristic cortical network of each NMA, and especially revealed new insight of pre-SMA-NMA and PPC NMA. These NMAs might be associated with different mechanism of negative motor response.

DOI PubMed

Anatomical and functional distribution of functional MRI language mapping.

Tsukasa Hirano, Rei Enatsu, Ayaka Sasagawa, Masayasu Arihara, Tomoyoshi Kuribara, Rintaro Yokoyama, Hime Suzuki, Satoko Ochi, Nobuhiro Mikuni

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 77 116 - 122 2020.07 [International journal]

OBJECTIVE: The aim of the present study was to compare localization of the language cortex using electrical cortical stimulation (ECS) and functional magnetic resonance imaging (fMRI) to establish the relevance of fMRI language mapping. METHODS: Language mapping with fMRI and functional ECS mapping were retrospectively compared in ten patients with refractory epilepsy who underwent fMRI language mapping and functional ECS mapping between June 2012 and April 2019. A shiritori task, a popular Japanese word chain game, was used for fMRI language mapping. RESULTS: BOLD signal activation was observed in the left inferior frontal gyrus (including the pars opecularis and the pars triangularis), and superior temporal gyrus, which is a language-related area, as well as in the left superior and middle frontal gyri, the intraparietal sulcus, and fusiform gyrus. These results were compared with ECS to elucidate the functional role of the activated areas during fMRI language tasks. These activated areas included language areas, negative motor areas, supplementary motor areas (SMAs), and non-functional areas. CONCLUSION: The activated areas of fMRI language mapping include language-related areas, the negative motor area, and SMAs. These findings suggest the involvement of language and higher order motor networks in verbal expression.

DOI PubMed

Ischemic Tolerance Evaluated by Computed Tomography Perfusion during Balloon Test Occlusion.

Tomoyoshi Kuribara, Takeshi Mikami, Satoshi Iihoshi, Kei Miyata, Sangnyon Kim, Yuka Kawata, Katsuya Komatsu, Yusuke Kimura, Rei Enatsu, Yukinori Akiyama, Toru Hirano, Nobuhiro Mikuni

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 29 ( 6 ) 104807 - 104807 2020.06 [International journal]

OBJECTIVES: Balloon test occlusion (BTO) is performed to evaluate ischemic tolerance for large and giant cerebral aneurysms and head and neck tumors that may require parent artery occlusion. However, ischemic tolerance for the temporary test occlusion does not always guarantee a tolerance for permanent occlusion. In this study, we evaluated the utility of computed tomography (CT) perfusion during BTO to quantify ischemic tolerance for detecting delayed ischemic stroke. MATERIALS AND METHODS: Forty-one patients who underwent BTO for the internal carotid artery were included. The correlations between the parameters of CT perfusion and collateral angiographic appearance or stump pressure during BTO were evaluated. The cerebral blood flow (CBF), cerebral blood volume, mean transit time (MTT), and time to peak (TTP) were obtained through CT perfusion, and the asymmetry ratios were determined. Collateral angiographic appearances were categorized into 5 grades (0-4). RESULTS: The collateral angiographic appearance showed moderate correlations with CBF, MTT, and TTP that was significant. Of these, the absolute value of the correlation coefficient was the highest for MTT. MTT also showed a moderate correlation with stump pressure. CBF and MTT were significantly different between the poor collateral group (grades 2 and 3) and the good collateral group (grade 4). Based on the MTT, the good collateral group was identified with high sensitivity (75.0%) and specificity (81.2%). CONCLUSIONS: In BTO, the MTT obtained through CT perfusion showed a correlation with collateral angiographic appearance and stump pressure. Thus, the MTT might be useful to quantify ischemic tolerance for detecting delayed ischemic stroke.

DOI PubMed

The Immediate Effects of Vagus Nerve Stimulation in Intractable Epilepsy: An Intra-operative Electrocorticographic Analysis.

Rintaro Yokoyama, Yukinori Akiyama, Rei Enatsu, Hime Suzuki, Yuto Suzuki, Aya Kanno, Satoko Ochi, Nobuhiro Mikuni

Neurologia medico-chirurgica 60 ( 5 ) 244 - 251 2020.05 [Domestic journal]

The purpose of this study was to investigate whether and how vagus nerve stimulation (VNS) reduces the epileptogenic activity in the bilateral cerebral cortex in patients with intractable epilepsy. We analyzed the electrocorticograms (ECoGs) of five patients who underwent callosotomy due to intractable epilepsy even after VNS implantation. We recorded ECoGs and analyzed power spectrum in both VNS OFF and ON phases. We counted the number of spikes and electrodes with epileptic spikes, distinguishing unilaterally and bilaterally hemispherically spread spikes as synchronousness of the epileptic spikes in both VNS OFF and ON phases. There were 24.80 ± 35.55 and 7.20 ± 9.93 unilaterally spread spikes in the VNS OFF and ON phases, respectively (P = 0.157), and 35.8 ± 29.21 and 10.6 ± 13.50 bilaterally spread spikes in the VNS OFF and ON phases, respectively (P = 0.027). The number of electrodes with unilaterally and bilaterally spread spikes in the VNS OFF and ON phases was 3.84 ± 2.13 and 3.59 ± 1.82 (P = 0.415), and 8.20 ± 3.56 and 6.89 ± 2.89 (P = 0.026), respectively. The ECoG background power spectra recordings in the VNS OFF and ON phases were also analyzed. The spectral power tended to be greater in the high-frequency band at VNS ON phase than OFF phase. This study showed the reduction of epileptogenic spikes and spread areas of the spikes by VNS as immediate effects, electrophysiologically.

DOI PubMed

Combined deep brain stimulation and thalamotomy for tremor-dominant Parkinson's disease.

Akimaro Kojoh, Rei Enatsu, Mayumi Kitagawa, Takeshi Mikami, Ayaka Sasagawa, Tomoyoshi Kuribara, Tsukasa Hirano, Masayasu Arihara, Nobuhiro Mikuni

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 74 244 - 247 2020.04 [International journal]

Although deep brain stimulation (DBS) is an established treatment for Parkinson's disease, the long-term suppression of tremor is still a challenging issue. We report two patients with tremor-dominant Parkinson's disease (PD) treated with unilateral thalamotomy of the ventralis intermedius nucleus (Vim) combined with the subthalamic nucleus (STN)-DBS or the posterior subthalamic area (PSA)-DBS. One year after the surgery, thalamotomy of the area from the Vim to the PSA showed improvement not only in tremor but also in rigidity and akinesia. PSA- or STN-DBS with low intensity stimulation eliminated residual PD symptoms. Combined DBS and thalamotomy may provide long-term improvement of the majority of PD symptoms using lower therapeutic stimulation voltages.

DOI PubMed

Neuroimaging and neurophysiological evaluation of severity of Parkinson's disease.

Tomoyoshi Kuribara, Rei Enatsu, Mayumi Kitagawa, Masayasu Arihara, Ayaka Sasagawa, Tsukasa Hirano, Hime Suzuki, Rintaro Yokoyama, Takeshi Mikami, Nobuhiro Mikuni

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 74 135 - 140 2020.04 [International journal]

OBJECTIVES: Parkinson's disease (PD) is a neurodegenerative disease presenting characteristic motor features. Severity is usually assessed by clinical symptoms; however, few objective indicators are available. In this study, we evaluated the utility of dopamine transporter (DAT) imaging and subthalamic nucleus (STN) activities as indicators of PD severity. MATERIALS AND METHODS: Twelve hemispheres of ten patients with PD who underwent deep brain stimulation (DBS) were included in this study. Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part 3 scores were used to evaluate clinical severity. The relationship between specific binding ratio (SBR) of DAT imaging and the root mean square (RMS) of STN micro-electrode recording (MER) was evaluated. RESULTS: A negative correlation was detected between the MDS-UPDRS part 3 scores and SBR (N = 20, R2 = 0.418; P = 0.002). With respect to subscores, rigidity (R2 = 0.582; P < 0.001) and bradykinesia (R2 = 0.378; P = 0.004) showed negative correlation with SBR, whereas tremor showed no correlation (R2 = 0.054; P = 0.324) (N = 20). On the other hand, no correlation was found between MER and the MDS-UPDRS part 3 scores in ten hemispheres of six patients. CONCLUSION: DAT findings may be useful in evaluating PD severity, especially rigidity and bradykinesia.

DOI PubMed

Molecular Aberrations Associated with Seizure Control in Diffuse Astrocytic and Oligodendroglial Tumors.

Hime Suzuki, Nobuhiro Mikuni, Shintaro Sugita, Tomoyuki Aoyama, Rintaro Yokoyama, Yuto Suzuki, Rei Enatsu, Yukinori Akiyama, Takeshi Mikami, Masahiko Wanibuchi, Tadashi Hasegawa

Neurologia medico-chirurgica 60 ( 3 ) 147 - 155 2020.03 [Domestic journal]

Diffuse astrocytic and oligodendroglial tumors are frequently associated with symptomatic epilepsy, and predictive seizure control is important for the improvement of patient quality of life. To elucidate the factors related to drug resistance of brain tumor-associated epilepsy from a pathological perspective. From January 2012 to October 2017, 36 patients diagnosed with diffuse astrocytic or oligodendroglial tumors were included. Assessment for seizure control was performed according to the Engel classification of seizures. Patient clinical, radiological, and pathological data were stratified based on the following 16 variables: age, sex, location of tumor, existence of the preoperative seizure, extent of resection, administration of temozolomide, radiation therapy, recurrence, Karnofsky performance scale, isocitrate dehydrogenase 1, 1p/19q co-deletion, Olig2, platelet-derived growth factor receptor alpha, p53, ATRX, and Ki67. These factors were compared between the well-controlled group and drug-resistant seizure group. Twenty-seven patients experienced seizures; of these, 14 cases were well-controlled, and 13 cases were drug-resistant. Neither clinical nor radiological characteristics were significantly different between these two groups, though p53 immunodetection levels were significantly higher, and the frequency of 1p/19q co-deletion was significantly lower in the group with drug-resistant seizures than in the well-controlled group. In the multivariate analysis, only one item was selected according to stepwise methods, and a significant difference was observed for p53 (OR, 21.600; 95% CI, 2.135-218.579; P = 0.009). Upregulation of p53 may be a molecular mechanism underlying drug resistant epilepsy associated with diffuse astrocytic and oligodendroglial tumors.

DOI PubMed

Misleading non-epileptic epileptiform activities on intracranial recordings.

Ayaka Sasagawa, Rei Enatsu, Hime Suzuki, Rintaro Yokoyama, Tsukasa Hirano, Masayasu Arihara, Tomoyoshi Kuribara, Satoko Ochi, Nobuhiro Mikuni

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 71 158 - 163 2020.01 [International journal]

Numerous non-epileptic physiological electroencephalographic (EEG) patterns morphologically mimic epileptiform activity. However, misleading non-epileptic findings of electrocorticography (ECoG) have not yet been examined in detail. The aim of the present study was to identify non-epileptic epileptiform ECoG findings. We retrospectively reviewed the intracranial recordings of 21 patients with intractable focal epilepsy who became seizure-free after a presurgical evaluation with subdural electrodes following resective surgeries at Sapporo Medical University between January 2014 and December 2018. Morphological epileptiform findings outside epileptogenic areas were judged as non-epileptic and analyzed. Seventeen areas in nine patients exhibited non-epileptic epileptiform activities. These areas were identified in the lateral temporal cortices, basal temporal areas, rolandic areas, and frontal lobe. Morphological patterns were classified into three types: 1) spiky oscillations, 2) isolated spiky activity, and 3) isolated fast activity. The normal cortex may exhibit non-epileptic epileptiform activities. These activities need to be carefully differentiated from real epileptic abnormalities to prevent the mislocalization of epileptogenic areas.

DOI PubMed

Directional leadを用いて、STN、PSA、Vimの刺激効果を評価した振戦型パーキンソン病の2例

北川まゆみ, 江夏怜, 三國信啓

臨床神経学 ( (一社)日本神経学会 ) 60 ( 1 ) 95 - 95 2020.01

Forgetting to take antiseizure medications is associated with focal to bilateral tonic-clonic seizures, as revealed by a cross-sectional study.

Hime Suzuki, Nobuhiro Mikuni, Hirofumi Ohnishi, Rintaro Yokoyama, Rei Enatsu, Satoko Ochi

PloS one 15 ( 10 ) e0240082 2020 [International journal]

OBJECTIVES: To evaluate the effects of nonadherence to antiseizure medications (ASMs) and clinical characteristics on seizure control, we employed a prospective cohort cross-sectional study using self-reports and medical records of patients with epilepsy (PWEs). METHODS: Eight hundred and fifty-five PWEs taking ASMs were enrolled from fourteen collaborative outpatient clinics from January 2018 to March 2019. Questions from the Morisky Medication Adherence Scale were used as adherence self-reports. If a PWE's questionnaire indicated that they had missed doses of their ASMs, outpatient physicians asked them directly about the details of their compliance, including the timing of intentionally or unintentionally missed doses. The association between lack of seizure control and utilization outcomes, such as missed doses, demographics, and clinical characteristics of the PWEs, were assessed by univariate and multivariate analyses. RESULTS: Multivariate analysis revealed that forgetting to take ASMs was associated with lack of seizure control and the existence of focal to bilateral tonic-clonic seizures. Dementia, younger age, use of three or more antiepileptic agents, and living in a one-person household were associated with the risk of forgetting to take ASMs. SIGNIFICANCE: For PWEs with poor drug management or a high incidence of missed doses of ASMs, efforts to improve adherence could facilitate better seizure control and decrease focal to bilateral tonic-clonic propagation.

DOI PubMed

Moyamoya disease with epileptic nystagmus: A case report.

Chie Nakayama, Takeshi Mikami, Ryo Ukai, Ryohei Chiba, Rei Enatsu, Hime Suzuki, Toru Hirano, Nobuhiro Mikuni

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 70 251 - 254 2019.12 [International journal]

Epileptic nystagmus is a quick, repetitive, jerky movement of the eyeball caused by seizure activity, which is unaccompanied by other ictal phenomena. We report a case of moyamoya disease with epileptic nystagmus. A 23-year-old woman presented with a headache and transient hemiparesis on her left side. Magnetic resonance imaging showed no ischemic or hemorrhagic stroke lesions. Digital subtraction angiography confirmed stenosis of the terminal portion of the right internal carotid artery and the formation of moyamoya vessels on the right side. 123I-N-isopropyl-iodoamphetamine (123I-IMP) single photon emission computed tomography (SPECT) showed decreased uptake in the right basal ganglia, frontal, and parietal regions. After electroencephalography (EEG) and a hyperventilation test were performed, nystagmus appeared and was accompanied with a declining level of consciousness. Ictal EEG during an attack showed no epileptiform discharge. Moreover, the patient sometimes experienced simultaneous upper limb-shaking and gelastic attacks. After superficial temporal artery to middle cerebral artery bypass surgery was performed on the right side, symptom frequency and duration gradually decreased. Decreased 123I-IMP SPECT blood flow in the right frontal region is considered a mechanism that causes the onset of epileptic nystagmus. It is presumed that the attack was caused by an ischemic abnormality in the saccade region of the frontal eye field. Moreover, revascularization can effectively treat the symptoms of moyamoya disease.

DOI PubMed

Directional leadを用いてSTN、PSA、Vimの刺激効果を評価したパーキンソン病2例

笹川彩佳, 江夏怜, 北川まゆみ, 栗原伴佳, 在原正泰, 平野司, 三國信啓

日本定位・機能神経外科学会プログラム・抄録集 ( (一社)日本定位・機能神経外科学会 ) 59回 113 - 113 2019.12

北海道でのてんかん診療と研究

三國信啓, 鈴木比女, 横山林太郎, 鈴木脩斗, 菅野彩, 江夏怜, 越智さと子

てんかんをめぐって ( 日本てんかん学会-北海道地方会 ) 37 11 - 20 2019.12

パーキンソン病・不随意運動治療における新知見I(画像、手術) パーキンソン病におけるDAT scan、MERの症状との相関

栗原伴佳, 江夏怜, 北川まゆみ, 在原正泰, 笹川彩佳, 平野司, 鈴木比女, 横山林太郎, 三上毅, 三國信啓

日本定位・機能神経外科学会プログラム・抄録集 ( (一社)日本定位・機能神経外科学会 ) 59回 84 - 84 2019.12

Intraoperative Monitoring for Vagus Nerve Stimulation.

Ryohei Chiba, Rei Enatsu, Satoko Ochi, Shoto Yamada, Ayaka Sasagawa, Hime Suzuki, Rintaro Yokoyama, Tsukasa Hirano, Masayasu Arihara, Tomoyoshi Kuribara, Nobuhiro Mikuni

World neurosurgery 131 191 - 193 2019.11 [International journal]

BACKGROUND: Vagus nerve stimulation is a palliative treatment for patients with refractory epilepsy; however, the misplacement of electrodes may cause complications and thus needs to be avoided. METHODS: We herein report an intraoperative monitoring technique to prevent the misplacement of electrodes. Endotracheal tube electrodes were inserted to record electromyographic activity from the vocal cords and identify the vagus nerve. Electromyography electrodes were placed on the sternomastoid muscle, sternohyoid muscle, geniohyoid muscle, and trapezius muscle to record muscle activities innervated by the ansa cervicalis. The vagus nerve and ansa cervicalis were electrically stimulated during surgery, and electromyography of the vocal cords and muscles innervated by the ansa cervicalis was recorded. The threshold of vagus nerve activation ranged between 0.05 and 0.75 mA. RESULTS: The vagus nerve was successfully identified and differentiated from the nerve root of the ansa cervicalis using this technique. CONCLUSIONS: Intraoperative monitoring of the vagus nerve and ansa cervicalis is useful for safe and effective vagus nerve stimulation.

DOI PubMed

言語タスク中のFunctional MRI賦活部位の機能的意義

江夏怜, 平野司, 笹川彩佳, 在原正泰, 栗原伴佳, 横山林太郎, 鈴木比女, 越智さと子, 三國信啓

臨床神経生理学 ( (一社)日本臨床神経生理学会 ) 47 ( 5 ) 458 - 458 2019.10

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Papers - ENATSU Rei