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Papers - ENATSU Rei

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VNSの即時効果の評価

秋山幸功, 横山林太郎, 越智さと子, 江夏怜, 三國信啓

てんかん研究 ( (一社)日本てんかん学会 ) 37 ( 2 ) 621 - 621 2019.09

小児悪性脳腫瘍寛解後の遅発性薬剤抵抗性てんかん

越智さと子, 江夏怜, 三國信啓

てんかん研究 ( (一社)日本てんかん学会 ) 37 ( 2 ) 518 - 518 2019.09

脳機能の可視化とてんかんのSemiology CCEPとてんかん焦点・ネットワーク解析

江夏怜

てんかん研究 ( (一社)日本てんかん学会 ) 37 ( 2 ) 470 - 471 2019.09

Choreo-ballistic movement after thalamotomy in a patient with Lewy body dementia.

Takuro Saitoh, Rei Enatsu, Mayumi Kitagawa, Takashi Morishita, Yuto Suzuki, Takeshi Mikami, Nobuhiro Mikuni

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 66 264 - 266 2019.08 [International journal]

Thalamotomy is an established treatment for medically refractory tremor. Major complications of thalamotomy include cognitive disturbance, paralysis, dysphagia, sensory loss, and speech disturbance. Hemiballism is a rare complication after thalamotomy. We herein present a 74-year-old female patient who developed choreo-ballistic movement after thalamotomy. She was diagnosed with Lewy body dementia at the age of 70 years and exhibited worsening bilateral hand tremor. Her tremor was severe and pharmacoresistant. Left thalamotomy was planned with the trajectory passing through the ventralis intermedius (VIM) nucleus to the posterior subthalamic area (PSA). The right VIM nucleus and PSA were both coagulated with one trajectory, resulting in the immediate amelioration of right hand tremor. However, four days after surgery, choreo-ballistic movement appeared in the right leg and persisted for six months. Furthermore, tremor recurred after one month. Postoperative MRI showed a small coagulated lesion in the subthalamic nucleus. Although choreo-ballistic movement is a rare complication, it needs to be considered, particularly in patients in which the inferior border of the VIM nucleus is targeted.

DOI PubMed

A Case Report of Multitrack Recording of Posterior Subthalamic Nucleus, Caudal Zona Incerta, and Prelemniscal Radiation: Which Is Most Effective for Bradykinesia?

Rei Enatsu, Mayumi Kitagawa, Takeshi Mikami, Aya Kanno, Shoichi Komura, Nobuhiro Mikuni

NMC case report journal 6 ( 3 ) 91 - 93 2019.08 [Domestic journal]

Deep brain stimulation (DBS) of the posterior subthalamic nucleus (pSTN), caudal zona incerta (cZI), and prelemniscal radiation (Raprl) has been shown to improve Parkinsonian motor symptoms. We herein report neurophysiological and functional differences among the cZI, Raprl, and pSTN in a 68-year-old male patient with Parkinson's disease (PD). The stereotactic implantation of DBS electrodes in the right STN was performed. Thereafter, a transfrontal trajectory for the left cZI was planned for left side implantation, with the expectation that the electrode entered the pSTN in the case of a posterior brain shift. In the implantation of the DBS lead in the cZI, three microelectrodes were simultaneously placed in an array with the central, medial, and anterior positions placed 2 mm apart to delineate the cZI, Raprl, and pSTN, respectively. A maximal reduction in bradykinesia was obtained from the stimulation of the pSTN at the lowest voltage thresholds, and the voltage threshold for abolishing tremors was lower in the Raprl and cZI than in the pSTN. The left DBS lead was implanted in the pSTN because right-sided bradykinesia was more severe than tremor. The multitrack recording of cZI, Raprl, and pSTN might broaden target selection depending on patients' symptoms.

DOI PubMed

Psychogenic Pseudo-responses in an Electrical Cortical Stimulation.

Tomoaki Tamada, Rei Enatsu, Yuto Suzuki, Rintaro Yokoyama, Hime Suzuki, Satoko Ochi, Nobuhiro Mikuni

Neurologia medico-chirurgica 59 ( 7 ) 287 - 290 2019.07 [Domestic journal]

An electrical cortical stimulation provides important information for functional brain mapping. However, subjective responses (i.e. sensory, visual, and auditory symptoms) are purely detected by patients' descriptions, and may be affected by patients' awareness and intelligence levels. We experienced psychogenic responses in the electrical cortical stimulation of two patients with intractable epilepsy. A sham stimulation was useful for differentiating pseudo-responses from real responses in the electrical cortical stimulation. Inductive questions, long testing durations, and clear cues of stimulation onsets need to be avoided to prevent psychogenic pseudo-responses in the electrical cortical stimulation. Furthermore, a sham stimulation is applicable for detecting pseudo-responses the moment patients show atypical or inexplicable symptoms.

DOI PubMed

当院においてステレオ脳波を使用した2症例

玉田智晃, 江夏怜, 笹川彩佳, 鈴木脩斗, 越智さと子, 三國信啓

てんかん研究 ( (一社)日本てんかん学会 ) 37 ( 1 ) 85 - 85 2019.06

The Influence of Anesthesia on Corticocortical Evoked Potential Monitoring Network Between Frontal and Temporoparietal Cortices.

Yuto Suzuki, Rei Enatsu, Aya Kanno, Rintaro Yokoyama, Hime Suzuki, Shunsuke Tachibana, Yukinori Akiyama, Takeshi Mikami, Satoko Ochi, Michiaki Yamakage, Nobuhiro Mikuni

World neurosurgery 123 e685-e692 2019.03 [International journal]

BACKGROUND: Previous studies have reported the usefulness of intraoperative corticocortical evoked potentials (CCEPs) for preserving language function during brain surgery. OBJECTIVE: This study aimed to assess the influence of depth of anesthesia on CCEP to establish its clinical utility. METHODS: Twenty patients with brain tumors or epilepsy who underwent awake craniotomy were included in this study. Before resection, the electrode plates were placed on the frontal and temporoparietal cortices, and 1-Hz alternating electrical stimuli were delivered to the pars opercularis/pars triangularis in a bipolar fashion. Electrocorticograms from the temporoparietal cortices time-locked to stimuli were averaged to obtain CCEP responses from a state of deep anesthesia until the awake state. The correlation between CCEP waveforms and bispectral index (BIS) was evaluated. RESULTS: CCEP amplitude increased with the increase in the BIS level. CCEP latency decreased in 5 patients and increased in 15 patients under anesthesia compared with the awake state. CCEP amplitudes decreased by 11.3% to 75.2% (median 31.3%) under anesthesia with <65 BIS level. These differences were statistically significant (P < 0.01, Wilcoxon signed-rank test). With respect to CCEP latencies, there was no significant difference between the awake and anesthetic states. CONCLUSIONS: CCEP amplitudes were correlated with depth of anesthesia, whereas CCEP latencies were not affected by anesthesia. The influence of anesthesia should be considered when applying this technique to intraoperative monitoring.

DOI PubMed

Effects of Hemosiderosis on Epilepsy Following Subarachnoid Hemorrhage.

Tsukasa Hirano, Rei Enatsu, Satoshi Iihoshi, Takeshi Mikami, Toshimi Honma, Hirofumi Ohnishi, Nobuhiro Mikuni

Neurologia medico-chirurgica 59 ( 1 ) 27 - 32 2019.01 [Domestic journal]

Epilepsy after aneurysmal subarachnoid hemorrhage (post-SAH epilepsy) is a critical complication that influences clinical and social prognoses. However, the underlying mechanisms remain unclear. We investigated the relationship between hemosiderosis and the incidence of post-SAH epilepsy. About 50 patients with aneurysmal SAH who were admitted to Sapporo Medical University and Oji General Hospital between April 2010 and June 2016 were enrolled in this retrospective study. Hemosiderosis detected by T2*-weighted magnetic resonance imaging(MRI) and the incidence of post-SAH epilepsy were retrospectively analyzed. Post-SAH epilepsy was defined as an unprovoked seizures occurring more than 1 week after the onset of SAH. Six patients (12%) developed post-SAH epilepsy. In all patients, hemosiderosis in the cortex or cerebral parenchyma was detected by T2*-weighted MRI. Statistical analyses revealed that hemosiderosis and the co-existence of intracerebral hemorrhage (ICH) related with post-SAH epilepsy (Fisher's exact test, univariate exact logistic regression analysis: P < 0.05). Post-SAH epilepsy was predicted by hemosiderosis and the co-existence of ICH. The present results suggest that hemosiderin is the principal cause of post-SAH epilepsy and may be a predictor of this critical complication.

DOI PubMed

Peri-electrode edema after deep brain stimulation.

Takuro Saitoh, Rei Enatsu, Takeshi Mikami, Yuto Suzuki, Aya Kanno, Mayumi Kitagawa, Nobuhiro Mikuni

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 59 29 - 31 2019.01 [International journal]

Peri-electrode edema can occur after deep brain stimulation (DBS). The diagnosis and management of peri-electrode edema may be challenging. We herein report non-infectious peri-electrode edema after the placement of DBS electrodes in patients with Parkinson's disease (PD). Fifteen patients who underwent DBS surgery between 2010 and 2018 at Sapporo Medical University were included to identify post-operative peri-electrode edema. Pre- and post-operative CT and MRI were retrospectively analyzed. Six patients showed hyperintensity around the electrodes on FLAIR/T2 MRI without neurological deficits. Two patients showed limited FLAIR and DWI hyperintensities in deep white matter, and microvessels may have been occluded in these patients. In five patients, MRI revealed extensive FLAIR or T2 hyperintensity in surface white matter around the electrodes without vessel injury, whereas DWI showed no abnormal signals. The eosinophil count was increased in one of these five patients. Peri-electrode edema after DBS surgery is not an uncommon phenomenon, and includes two types: (1) limited edema in deep white matter and (2) extensive edema in surface white matter. Different mechanisms may be associated with these types of edemas.

DOI PubMed

後背側視床下核、不確帯、prelemniscal radiation、の微小電極記録による同定と刺激効果の比較

北川まゆみ, 江夏怜, 三上毅, 三國信啓

臨床神経学 ( (一社)日本神経学会 ) 59 ( 1 ) 49 - 49 2019.01

Interhemispheric Asymmetry of Network Connecting Between Frontal and Temporoparietal Cortices: A Corticocortical-Evoked Potential Study.

Aya Kanno, Rei Enatsu, Satoshi Ookawa, Shouhei Noshiro, Shunya Ohtaki, Kengo Suzuki, Yuto Suzuki, Rintaro Yokoyama, Satoko Ochi, Yukinori Akiyama, Takeshi Mikami, Takuro Nakae, Takayuki Kikuchi, Takeharu Kunieda, Susumu Miyamoto, Riki Matsumoto, Nobuhiro Mikuni

World neurosurgery 120 e628-e636 2018.12 [International journal]

BACKGROUND: The connection between the ventrolateral frontal and temporoparietal cortices has an important role in language function on the language-dominant side and spatial awareness on the nondominant side. However, the laterality of these pathways remains controversial. We investigated the laterality of this connection using corticocortical-evoked potentials (CCEPs). METHODS: From April 2014 to March 2016, 27 patients who had undergone frontotemporal craniotomy were enrolled. With the patients under general anesthesia, subdural electrodes were placed on both frontal and temporoparietal areas intraoperatively. Alternating 1-Hz electrical stimuli were delivered to the pars opercularis and pars triangularis with a stimulus intensity of 10 mA. CCEPs were obtained from temporoparietal areas by averaging the electrocorticogram time-locked to the stimulus onset. The amplitudes and latencies of the CCEP N1 components were compared between the dominant and nondominant sides. RESULTS: The median amplitudes of the CCEPs were 335.1 μV (range, 60.2-750) and 125.65 μV (range, 55.1-634) on the dominant and nondominant sides, respectively. The CCEP amplitudes were significantly larger on the dominant side than on the nondominant side (P = 0.013). In contrast, the median latency was 27.8 ms (range, 19.3-36.6) on the language-dominant side and 28.9 ms (range, 8.9-38.5) on the nondominant side. The latencies were not significantly different between the 2 sides (P = 0.604). CONCLUSIONS: The CCEP amplitudes were significantly larger in the dominant hemisphere. These findings can lead to better hypotheses regarding the relationship between language functions and the development of the network connecting the frontal and temporoparietal cortices.

DOI PubMed

Location and Threshold of Electrical Cortical Stimulation for Functional Brain Mapping.

Aya Kanno, Rei Enatsu, Satoshi Ookawa, Satoko Ochi, Nobuhiro Mikuni

World neurosurgery 119 e125-e130 2018.11 [International journal]

BACKGROUND AND OBJECTIVE: Although many studies have investigated functional localization by electrical stimulation, the threshold to identify each area remains controversial. The present study aimed to elucidate the threshold of a cortical stimulation for functional mapping. METHODS: We analyzed data from 17 patients with medically intractable epilepsy who underwent a 50-Hz electrical cortical stimulation for functional mapping between October 2013 and May 2017. The symptoms induced by the stimulation and the thresholds of the stimulation for these responses were evaluated. RESULTS: Motor responses were observed after the stimulation of the primary motor cortex, supplementary motor area, and frontal eye field, and sensory responses after the stimulation of the primary and secondary sensory cortex. Regarding negative responses, language impairment was observed after the stimulation of the anterior, posterior, and basal temporal language areas, negative motor responses after the stimulation of the premotor cortex, posterior parietal cortex, and the pre- supplementary motor area, and an impairment in spatial recognition after the stimulation of the right posterior parietal cortex. Negative or positive auditory symptoms were observed with the stimulation of the posterior superior temporal gyrus. The thresholds for positive phenomena were significantly lower than those for negative phenomena (Mann-Whitney U test, P < 0.01), and sensory responses were induced at significantly lower intensities than motor responses (P < 0.01). CONCLUSIONS: Positive and sensory effects are induced by lower intensities than negative and motor responses, respectively. The present results provide not only a practical guide for functional mapping, but also a hierarchal concept of processing in the brain.

DOI PubMed

The auditory cortex network in the posterior superior temporal area.

Yuto Suzuki, Rei Enatsu, Aya Kanno, Satoko Ochi, Nobuhiro Mikuni

Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology 129 ( 10 ) 2132 - 2136 2018.10 [International journal]

OBJECTIVE: This study investigated the function and networks of the auditory cortices in the posterior lateral superior temporal area (PLST) using a combination of electrical cortical stimulation and diffusion tensor imaging (DTI). METHODS: Seven patients with intractable focal epilepsy in which the PLST auditory cortices were identified during the electrical cortical stimulation were enrolled in this study (left side: four patients, right side: three patients). Electrical stimulation at 50 Hz was applied to the chronically implanted subdural electrodes to identify the PLST auditory cortices. DTI was used to identify the subcortical fibers originating from the PLST auditory cortices found by electrical stimulation. RESULTS: Electrical stimulation of the right PLST auditory cortices induced hearing impairment in three patients and left side stimulation elicited hearing illusory sounds in four patients. DTI detected the middle longitudinal fasciculus (MLF) in all patients, the superior longitudinal fasciculus (SLF) in six patients and the inferior fronto-occipital fasciculus (IFOF) in three patients, originating from the PLST auditory cortices. CONCLUSION: This study suggests different functional roles between the right and left PLST auditory cortices, and the networks originating from these areas. SIGNIFICANCE: MLF, SLF and IFOF might be associated with the auditory processing.

DOI PubMed

全身麻酔による皮質-皮質間誘発電位への影響

三國信啓, 鈴木脩斗, 江夏怜, 菅野彩

臨床神経生理学 ( (一社)日本臨床神経生理学会 ) 46 ( 5 ) 450 - 450 2018.10

もやもや病における脳表血管の幾何学的解析

小松克也, 三上毅, 秋山幸功, 江夏怜, 大川聡史, 鈴木比女, 鰐渕昌彦, 三國信啓

脳循環代謝 ( (一社)日本脳循環代謝学会 ) 30 ( 1 ) 107 - 107 2018.10

迷走神経刺激療法(VNS)の長期的効果術中迷走神経モニタリングの有用性と意義

越智さと子, 江夏怜, 三國信啓, 山田奨人, 菅野彩

臨床神経生理学 ( (一社)日本臨床神経生理学会 ) 46 ( 5 ) 511 - 511 2018.10

Threshold and distribution of afterdischarges with electrical cortical stimulation.

Hime Suzuki, Rei Enatsu, Aya Kanno, Yuto Suzuki, Rintaro Yokoyama, Satoshi Ookawa, Satoko Ochi, Nobuhiro Mikuni

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 55 71 - 75 2018.09 [International journal]

OBJECTIVE: The present study aimed to investigate the threshold and distribution of afterdischarges (ADs) with cortical electrical stimulation for functional brain mapping. METHOD: We retrospectively analyzed data from 11 patients with medically intractable epilepsy who underwent 50-Hz cortical electrical stimulation for functional mapping followed by resection. These patients became seizure free for more than six months. The threshold and distribution of ADs induced by the stimulation were evaluated. RESULTS: The median threshold was 6 mA (range: 2-15 mA) for the frontal lobe, 8 mA (3-15 mA) for the temporal lobe, 6 mA (2-15 mA) for the parietal lobe, and 6 mA (4-12 mA) for the occipital lobe. No significant interlobar differences were observed in AD thresholds. No significant differences were noted between within and outside epileptogenic zones. The distribution of ADs, remote spread was observed in all patients, reflecting fronto-parieto-temporal connections, as well as contiguous spread. The stimulation of premotor areas, the inferior parietal lobule, supplementary motor area, and basal temporal areas appeared to induce ADs in remote cortices. CONCLUSION: While no locational differences were observed in AD thresholds, each brain region showed a characteristic pattern for AD spread. Remote AD spread needs to be considered for safe functional mapping.

DOI PubMed

脳機能マッピングにみる上側頭回後方外側の聴覚皮質と後方言語野の位置関係

菅野彩, 鈴木脩斗, 大川聡史, 江夏怜, 越智さと子, 三國信啓

てんかん研究 ( (一社)日本てんかん学会 ) 36 ( 2 ) 437 - 437 2018.09

低悪性度脳腫瘍における症候性てんかんの病理学的検討

鈴木比女, 三國信啓, 杉田真太朗, 長谷川匡, 横山林太郎, 鈴木脩斗, 江夏怜, 秋山幸功, 三上毅, 越智さと子, 鰐渕昌彦

てんかん研究 ( (一社)日本てんかん学会 ) 36 ( 2 ) 424 - 424 2018.09

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Papers - ENATSU Rei