研究者詳細 - 江夏　怜

論文 - 江夏　怜

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焦点刺激によるCCEP(cortico-cortical evoked potential)を用いた発作伝播ネットワークの解明

菅野彩, 大瀧隼也, 能代将平, 鈴木健吾, 江夏怜, 越智さと子, 松橋眞生, 矢澤省吾, 長峯隆, 三國信啓

てんかん研究 ( (一社)日本てんかん学会 ) 33 ( 2 ) 467 - 467 2015年09月

治療に難渋した反射てんかんの一例

江夏怜, 菅野彩, 越智さと子, 村原貴史, 井上周子, 矢澤省吾, 長峯隆, 白石秀明, 三國信啓

てんかん研究 ( (一社)日本てんかん学会 ) 33 ( 2 ) 434 - 435 2015年09月

血中PRL値測定は、術後発作コントロールの指標となりうるか? 治療関与前後での対比

越智さと子, 菅野彩, 江夏怜, 秋山幸功, 三上毅, 三國信啓

てんかん研究 ( (一社)日本てんかん学会 ) 33 ( 2 ) 628 - 628 2015年09月

【てんかん医療の多様な展開-基礎から臨床まで-】てんかん外科の現状と展望

江夏怜, 三國信啓

最新医学 ( (株)最新医学社 ) 70 ( 6 ) 1097 - 1101 2015年06月

てんかんの外科治療は,薬剤難治性てんかん症例が対象となり,QOLを著明に改善させる可能性があるが,術後の発作再発も認められ,正確なてんかん原性領域の同定・切除が術後発作消失の鍵となる.今後は,より正確なてんかん原性領域と脳機能領域の同定による安全で有効な切除術の発展とともに,合併症が少なく,より低侵襲な手術法の開発が求められる.(著者抄録)

難治性てんかんへの迷走神経刺激療法(VNS)後Comorbidityの変化小児と成人の治療副次効果の差異

越智さと子, 江夏怜, 白石秀明, 若井周治, 三國信啓

小児の脳神経 ( (一社)日本小児神経外科学会 ) 40 ( 1 ) 70 - 70 2015年04月

Connections of the limbic network: a corticocortical evoked potentials study.

Rei Enatsu, Jorge Gonzalez-Martinez, Juan Bulacio, Yuichi Kubota, John Mosher, Richard C Burgess, Imad Najm, Dileep R Nair

Cortex; a journal devoted to the study of the nervous system and behavior 62 20 - 33 2015年01月 [国際誌]

Papez proposed a network for higher brain function, which is termed the limbic network. However, the in vivo human limbic network has not been established. We investigated the connectivity of the human limbic system using corticocortical evoked potential (CCEP). This retrospective analysis included 28 patients with medically intractable focal epilepsy who underwent stereoelectroencephalography (SEEG) and CCEP. Alternating 1 Hz electrical stimuli were delivered to parts of the limbic system [anterior and posterior hippocampus, temporal pole, parahippocampal gyrus (PHG), amygdala, anterior (ACG) and posterior cingulate gyrus (PCG), medial and lateral orbitofrontal cortex (OF)]. A total of 40-60 stimuli were averaged in each trial to obtain CCEP responses. CCEP distributions were evaluated by calculating the root mean square (RMS) of CCEP responses. Anterior hippocampal stimulation elicited prominent CCEP responses in medial and lateral temporal structures, PCG, medial OF and insula over the ipsilateral hemisphere. Posterior hippocampal stimulation induced CCEP responses in the ipsilateral medial and lateral temporal structures and PCG. The findings also revealed connections from temporal pole to the ipsilateral medial temporal structures, and connections from PHG to the ipsilateral hippocampus and PCG. The amygdala projected to broad areas including the ipsilateral medial and lateral temporal structures, medial and lateral frontal areas, the cingulate gyrus, insula and inferior parietal lobule. ACG and PCG showed connections to the ipsilateral medial fronto-parietal areas and connections to bilateral medial temporo-parieto-occipital and lateral parieto-occipital areas, respectively. Medial and lateral OF stimulation induced responses in the adjacent cortices. This study revealed that various regions within the limbic network are intimately connected in reverberating circuits and are linked to specific ipsilateral and contralateral regions, which may reflect distinct functional roles.

DOI PubMed

Multiple extra-ischemic hemorrhages following intravenous thrombolysis in a patient with Trousseau syndrome: case study.

Hiroyuki Ikeda, Rei Enatsu, Norikazu Yamana, Masaki Nishimura, Masaaki Saiki

SpringerPlus 4 141 - 141 2015年 [国際誌]

BACKGROUND: Intracerebral hemorrhage is the most feared complication of intravenous thrombolysis for acute ischemic stroke. Such hemorrhage usually occurs within or at the margin of ischemic or manifestly infarcted brain tissue. A patient with Trousseau syndrome who developed multiple extra-ischemic hemorrhages following intravenous thrombolysis is described. CASE DESCRIPTION: An 80-year-old Japanese man with no other underlying disease was diagnosed with unresectable advanced lung cancer (stage IV) without brain metastasis and had not yet been treated. The patient suddenly presented with disturbance of consciousness, right hemiplegia, and total aphasia, and was admitted to our hospital. Magnetic resonance imaging revealed acute cerebral infarction extending from the basal ganglia to the corona radiata of the left cerebrum and multiple small areas of bilateral cerebral cortices. Cardiogenic cerebral embolism was considered among the differential diagnoses, but the brain natriuretic peptide level was within the normal range, and no arrhythmias such as atrial fibrillation were observed. With no other causes, the patient was diagnosed with Trousseau syndrome due to hypercoagulability associated with the advanced lung cancer. The patient received intravenous tissue plasminogen activator (t-PA) at 96 minutes after onset of symptoms. His symptoms partially improved, but they suddenly deteriorated at 84 minutes after the thrombolysis. A computed tomography (CT) scan immediately after the neurological deterioration revealed a subcortical hemorrhage in the left occipital lobe. A repeat CT scan the day after onset showed enlargement of the left occipital hemorrhage and two new subcortical hemorrhages in the right frontal and right temporal lobes. These hemorrhages were located in areas remote from the acute ischemic lesions. CONCLUSION: To the best of our knowledge, this is the first reported case of multiple extra-ischemic hemorrhages following intravenous thrombolysis in a patient with Trousseau syndrome. The course of this case suggests that intravenous t-PA administration for acute ischemic stroke with Trousseau syndrome may be associated with a higher risk of intracranial hemorrhage.

DOI PubMed

Low-volume centerにおける急性期血栓回収療法の成績 device毎の再開通時間、再開通率の検討

小柳正臣, 小林環, 江夏怜, 織田雅, 齊木雅章

JNET: Journal of Neuroendovascular Therapy ( (NPO)日本脳神経血管内治療学会 ) 8 ( 6 ) 300 - 300 2014年12月

[Endovascular coil embolization for a ruptured distal anterior choroidal artery aneurysm showing definite short-term enlargement: a case report].

Hiroyuki Ikeda, Norikazu Yamana, Kosuke Hayashi, Taichi Ikedou, Yasuzumi Matsui, Tomofumi Hirose, Masaki Nishimura, Naoki Matsumoto, Rei Enatsu, Masaaki Saiki

No shinkei geka. Neurological surgery 42 ( 10 ) 951 - 9 2014年10月 [国内誌]

Distal anterior choroidal artery aneurysms are quite rare, and appropriate treatment timing and methods remain unclear. Direct surgery of these aneurysms is difficult due to their deep location, small size, and angioarchitecture;however, pseudoaneurysms might disappear spontaneously with conservative treatment. A 65-year-old man with a history of hypertension was admitted to our hospital with a 5-day history of sudden headache and nausea. Computed tomography revealed an intraventricular hematoma located mainly in the right lateral ventricle. Cerebral angiography 7 days after onset revealed a right distal anterior choroidal artery aneurysm and proximal right middle cerebral artery occlusion caused by atherosclerotic changes. Endovascular coil embolization was performed under general anesthesia 14 days after onset. Preoperative angiography demonstrated definite enlargement of the aneurysm and stasis of the contrast agent in the aneurysm in the venous phase. Detachable platinum coils were delivered into the aneurysm and parent artery. The patient was discharged neurologically intact after the procedure. Follow-up angiography 3 months after coil embolization showed complete occlusion of the aneurysm. In recent years, endovascular surgery has emerged as a less invasive treatment option. Early treatment should be considered for patients with ruptured distal anterior choroidal artery aneurysm because these aneurysms might grow and re-rupture in the short term.

DOI PubMed

短期間に増大しコイル塞栓術を行った前脈絡叢動脈末梢部に発生した破裂脳動脈瘤の1例

池田宏之, 山名則和, 林晃佑, 池堂太一, 松井恭澄, 廣瀬智史, 西村真樹, 松本直樹, 江夏怜, 齊木雅章

Neurological Surgery ( (株)医学書院 ) 42 ( 10 ) 951 - 959 2014年10月

65歳男。突発する頭痛、嘔気が出現し、発症5日目に受診した。精査の結果、中大脳動脈の動脈硬化性閉塞に起因して前脈絡叢動脈末梢部に発生した破裂脳動脈瘤と診断し、降圧療法による保存的治療を行った後、発症14日目に血管内塞栓術を行った。動脈瘤は発症7日目と比較すると増大していたが、瘤内までマイクロカテーテルを誘導し、瘤内からのコイル塞栓術をなし得た。術後3ヵ月の現在、経過は良好である。

皮質皮質間誘発電位を用いた前頭葉、島回のネットワークの解析(Connections of the frontal and insular network: A Corticocortical Evoked Potentials study)

江夏怜, Gonzalez-Martinez Jorge, Bulacio Juan, Kubota Yuichi, Mosher John, Burgess Richard, Najm Imad, Nair Dileep

てんかん研究 ( (一社)日本てんかん学会 ) 32 ( 2 ) 359 - 359 2014年09月

Stereoelectroencephalography in children and adolescents with difficult-to-localize refractory focal epilepsy.

Jorge Gonzalez-Martinez, Jeffrey Mullin, Juan Bulacio, Ajay Gupta, Rei Enatsu, Imad Najm, William Bingaman, Elaine Wyllie, Deepak Lachhwani

Neurosurgery 75 ( 3 ) 258 - 68 2014年09月 [国際誌]

BACKGROUND: Although stereoelectroencephalography (SEEG) has been shown to be a valuable tool for preoperative decision making in focal epilepsy, there are few reports addressing the utility and safety of SEEG methodology applied to children and adolescents. OBJECTIVE: To present the results of our early experience using SEEG in pediatric patients with difficult-to-localize epilepsy who were not considered candidates for subdural grid evaluation. METHODS: Thirty children and adolescents with the diagnosis of medically refractory focal epilepsy (not considered ideal candidates for subdural grids and strip placement) underwent SEEG implantation. Demographics, electrophysiological localization of the hypothetical epileptogenic zone, complications, and seizure outcome after resections were analyzed. RESULTS: Eighteen patients (60%) underwent resections after SEEG implantations. In patients who did not undergo resections (12 patients), reasons included failure to localize the epileptogenic zone (4 patients); multifocal epileptogenic zone (4 patients); epileptogenic zone located in eloquent cortex, preventing resection (3 patients); and improvement in seizures after the implantation (1 patient). In patients who subsequently underwent resections, 10 patients (55.5%) were seizure free (Engel class I) and 5 patients (27.7%) experienced seizure improvement (Engel class II or III) at the end of the follow-up period (mean, 25.9 months; range, 12 to 47 months). The complication rate in SEEG implantations was 3%. CONCLUSION: The SEEG methodology is safe and should be considered in children/adolescents with difficult-to-localize epilepsy. When applied to highly complex and difficult-to-localize pediatric patients, SEEG may provide an additional opportunity for seizure freedom in association with a low morbidity rate.

DOI PubMed

Cephalic aura after frontal lobe resection.

Yosuke Kakisaka, Lara Jehi, Rafeed Alkawadri, Zhong I Wang, Rei Enatsu, John C Mosher, Anne-Sophie Dubarry, Andreas V Alexopoulos, Richard C Burgess

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 21 ( 8 ) 1450 - 2 2014年08月 [国際誌]

A cephalic aura is a common sensory aura typically seen in frontal lobe epilepsy. The generation mechanism of cephalic aura is not fully understood. It is hypothesized that to generate a cephalic aura extensive cortical areas need to be excited. We report a patient who started to have cephalic aura after right frontal lobe resection. Magnetoencephalography (MEG) showed interictal spike and ictal change during cephalic aura, both of which were distributed in the right frontal region, and the latter involved much more widespread areas than the former on MEG sensors. The peculiar seizure onset pattern may indicate that surgical modification of the epileptic network was related to the appearance of cephalic aura. We hypothesize that generation of cephalic aura may be associated with more extensive cortical involvement of epileptic activity than that of interictal activity, in at least a subset of cases.

DOI PubMed

Combining stereo-electroencephalography and subdural electrodes in the diagnosis and treatment of medically intractable epilepsy.

Rei Enatsu, Juan Bulacio, Imad Najm, Elaine Wyllie, Norman K So, Dileep R Nair, Nancy Foldvary-Schaefer, William Bingaman, Jorge Gonzalez-Martinez

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 21 ( 8 ) 1441 - 5 2014年08月 [国際誌]

Stereo-electroencephalography (SEEG) has advantages for exploring deeper epileptic foci. Nevertheless, SEEG can only sample isolated cortical areas and its spatial limitation, with the inability to record contiguous cortical regions, may cause difficulties in interpretation. In light of these limitations, the authors describe the hybrid technique of SEEG and subdural strip electrode placement. The hybrid technique was used for a presurgical evaluation in four patients with intractable epilepsy. Initially, the depth electrodes were inserted with a robotic stereotactic system. Thereafter, a skin incision and a small craniectomy were performed at the entry point of the strip electrode trajectory. The dura was opened and, under live fluoroscopic guidance, strip electrodes were slid into the subdural space. In these patients, the additional subdural strip electrodes provided (1) information regarding the precise description of seizure spread in the cortical surface adjacent to the subdural space, (2) identification of epileptogenic zones located near the crown, (3) more precise definition of functional cortex and (4) a better delineation of the interface between epileptogenic zones and functional cortex. This hybrid technique provides additional data compared to either technique alone, offering superior understanding of the dynamics of the epileptic activity and its interaction with functional cortical areas.

DOI PubMed

Robot-assisted stereotactic laser ablation in medically intractable epilepsy: operative technique.

Jorge Gonzalez-Martinez, Sumeet Vadera, Jeffrey Mullin, Rei Enatsu, Andreas V Alexopoulos, Ravish Patwardhan, William Bingaman, Imad Najm

Neurosurgery 10 Suppl 2 167 - 72 2014年06月 [国際誌]

BACKGROUND: Stereotactic laser ablation offers an advantage over open surgical procedures for treatment of epileptic foci, tumors, and other brain pathology. Robot-assisted stereotactic laser ablation could offer an accurate, efficient, minimally invasive, and safe method for placement of an ablation catheter into the target. OBJECTIVE: To determine the feasibility of placement of a stereotactic laser ablation catheter into a brain lesion with the use of robotic assistance, via a safe, accurate, efficient, and minimally invasive manner. METHODS: A laser ablation catheter (Visualase, Inc) was placed by using robotic guidance (ROSA, Medtech Surgical, Inc) under general anesthesia into a localized epileptogenic periventricular heterotopic lesion in a 19-year-old woman with 10-year refractory focal seizure history. The laser applicator (1.65 mm diameter) position was confirmed by using magnetic resonance imaging (MRI). Ablation using the Visualase system was performed under multiplanar imaging with real-time thermal imaging and treatment estimates in each plane. A postablation MRI sequence (T1 postgadolinium contrast injection) was used to immediately confirm the ablation. RESULTS: MRI showed accurate skin entry point and trajectory, with the applicator advanced to the lesion's distal boundary. Ablation was accomplished in less than 3 minutes of heating. The overall procedure, from time of skin incision to end of last ablation, was approximately 90 minutes. After confirmation of proper lesioning by using a T1 contrast-enhanced MRI, the applicator was removed, and the incision was closed using a single stitch. No hemorrhage or other untoward complication was visualized. The patient awoke without any complication, was observed overnight after admitting to a regular floor bed, and was discharged to home the following day. CONCLUSION: This technique, using a combination of Visualase laser ablation, ROSA robot, and intraoperative MRI, facilitated a safe, efficacious, efficient, and minimally invasive approach that could be used for placement of 1 or multiple electrodes in the future.

DOI PubMed

Functional magnetic resonance imaging networks induced by intracranial stimulation may help defining the epileptogenic zone.

Stephen E Jones, Myron Zhang, Rafi Avitsian, Pallab Bhattacharyya, Juan Bulacio, Fernando Cendes, Rei Enatsu, Mark Lowe, Imad Najm, Dileep Nair, Michael Phillips, Jorge Gonzalez-Martinez

Brain connectivity 4 ( 4 ) 286 - 98 2014年05月 [国際誌]

Patients with medically intractable epilepsy often undergo invasive evaluation and surgery, with a 50% success rate. The low success rate is likely due to poor identification of the epileptogenic zone (EZ), the brain area causing seizures. This work introduces a new method using functional magnetic resonance imaging (fMRI) with simultaneous direct electrical stimulation of the brain that could help localize the EZ, performed in five patients with medically intractable epilepsy undergoing invasive evaluation with intracranial depth electrodes. Stimulation occurred in a location near the hypothesized EZ and a location away. Electrical recordings in response to stimulation were recorded and compared to fMRI. Multiple stimulation parameters were varied, like current and frequency. The brain areas showing fMRI response were compared with the areas resected and the success of surgery. Robust fMRI maps of activation networks were easily produced, which also showed a significant but weak positive correlation between quantitative measures of blood-oxygen-level-dependent (BOLD) activity and measures of electrical activity in response to direct electrical stimulation (mean correlation coefficient of 0.38 for all acquisitions that produced a strong BOLD response). For four patients with outcome data at 6 months, successful surgical outcome is consistent with the resection of brain areas containing high local fMRI activity. In conclusion, this method demonstrates the feasibility of simultaneous direct electrical stimulation and fMRI in humans, which allows the study of brain connectivity with high resolution and full spatial coverage. This innovative technique could be used to better define the localization and extension of the EZ in intractable epilepsies, as well as for other functional neurosurgical procedures.

DOI PubMed

Stereotactic placement of depth electrodes in medically intractable epilepsy.

Jorge Gonzalez-Martinez, Jeffrey Mullin, Sumeet Vadera, Juan Bulacio, Gwyneth Hughes, Stephen Jones, Rei Enatsu, Imad Najm

Journal of neurosurgery 120 ( 3 ) 639 - 44 2014年03月 [国際誌]

OBJECT: Despite its long-reported successful record, with almost 60 years of clinical use, the technical complexity regarding the placement of stereoelectroencephalography (SEEG) depth electrodes may have contributed to the limited widespread application of the technique in centers outside Europe. The authors report on a simplified and novel SEEG surgical technique in the extraoperative mapping of refractory focal epilepsy. METHODS: The proposed technique was applied in patients with medically refractory focal epilepsy. Data regarding general demographic information, method of electrode implantation, time of implantation, number of implanted electrodes, seizure outcome after SEEG-guided resections, and complications were prospectively collected. RESULTS: From March 2009 to April 2012, 122 patients underwent SEEG depth electrode implantation at the Cleveland Clinic Epilepsy Center in which the authors' technique was used. There were 65 male and 57 female patients whose mean age was 33 years (range 5-68 years). The group included 21 pediatric patients (younger than 18 years). Planning and implantations were performed in a single stage. The time for planning was, on average, 33 minutes (range 20-47 minutes), and the time for implantation was, on average, 107 minutes (range 47-150 minutes). Complications related to the SEEG technique were observed in 3 patients. The calculated risk of complications per electrode was 0.18%. The seizure-free rate after SEEG-guided resections was 62% in a mean follow-up period of 12 months. CONCLUSIONS: The authors report on a safe, simplified, and less time-consuming method of SEEG depth electrode implantation, using standard and widely available surgical tools, making the technique a reasonable option for extraoperative monitoring of patients with medically intractable epilepsy in centers lacking the Talairach stereotactic armamentarium.

DOI PubMed

The modulation of rolandic oscillation induced by digital nerve stimulation and self-paced movement of the finger: a MEG study.

Rei Enatsu, Takashi Nagamine, Jun Matsubayashi, Hitoshi Maezawa, Takayuki Kikuchi, Hidenao Fukuyama, Nobuhiro Mikuni, Susumu Miyamoto, Nobuo Hashimoto

Journal of the neurological sciences 337 ( 1-2 ) 201 - 11 2014年02月 [国際誌]

BACKGROUND: The rolandic cortex exhibits spontaneous rhythmic activity. This oscillation can be modulated by somatosensory stimulation and voluntary movement. The purpose of this study is to elucidate the influence of sensory input on the rolandic oscillation in comparison with movement-related oscillation. METHODS: Magnetic brain rhythms were recorded in nine healthy subjects in two sessions: electrical stimulation (STIM) of the digital nerve and self-paced movement (SPM) of the right index finger. Thereafter, 10 and 20 Hz oscillatory activities were compared between the two sessions with temporal spectral evolution analysis. RESULTS: Sensory input altered the rolandic oscillations even under no movement conditions. As for 10 Hz ERD in the STIM session, three subjects showed a contralateral dominant pattern, whereas the remaining subjects showed a bilateral pattern. In spite of this individual variability, ERD showed comparable amplitude in both sessions. However, ERSs in the SPM session were larger than that in the STIM session. These findings might reflect the activation of neural networks common to sensory and motor systems followed by the inhibition of the other surrounding cortical areas. CONCLUSIONS: Our results suggest that rolandic oscillations may reflect the coordination of sensory and motor systems in the neural networks including both sensory and motor systems.

DOI PubMed

Posterior cingulate epilepsy: clinical and neurophysiological analysis.

Rei Enatsu, Juan Bulacio, Dileep R Nair, William Bingaman, Imad Najm, Jorge Gonzalez-Martinez

Journal of neurology, neurosurgery, and psychiatry 85 ( 1 ) 44 - 50 2014年01月 [国際誌]

OBJECTIVE: Posterior cingulate epilepsy (PCE) is misleading because the seizure onset is located in an anatomically deep and semiologically silent area. This type of epilepsy is rare and has not been well described yet. Knowledge of the characteristics of PCE is important for the interpretation of presurgical evaluation and better surgical strategy. The purpose of this study was to better characterise the clinical and neurophysiological features of PCE. METHODS: This retrospective analysis included seven intractable PCE patients. Six patients had postcingulate ictal onset identified by stereotactic EEG (SEEG) evaluations. One patient had a postcingulate tumour. We analysed clinical semiology, the scalp EEG/SEEG findings and cortico-cortical evoked potential (CCEP). RESULTS: The classifications of scalp EEG were various, including non-localisible, lateralised to the seizure onset side, regional parieto-occipital, regional frontocentral and regional temporal. Three of seven patients showed motor manifestations, including bilateral asymmetric tonic seizures and hypermotor seizures. In these patients, ictal activities spread to frontal (lateral premotor area, orbitofrontal cortex, supplementary motor area, anteior cingulate gyrus) and parietal (precuneus, posterior cingulate gyrus, inferior parietal lobule (IPL), postcentral gyrus) areas. Four patients showed dialeptic seizures or automotor seizures, with seizure spread to medial temporal or IPL areas. CCEP was performed in four patients, suggesting electrophysiological connections from the posterior cingulate gyrus to parietal, temporal, mesial occipital and mesial frontal areas. CONCLUSIONS: This study revealed that the network from the posterior cingulate gyrus and the semiology of PCE (motor manifestation vs dialeptic/automotor seizure) varies depending upon the seizure spread patterns.

DOI PubMed

Localized motor manifestation due to a basilar trunk aneurysm.

Rei Enatsu, Masato Matsumoto, Minoru Asahi, Osamu Hirai

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 34 ( 11 ) 2067 - 8 2013年11月 [国際誌]

DOI PubMed

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