Isolation, Culture and Long-Term Maintenance of Primary Mesencephalic Dopaminergic Neurons From Embryonic Rodent Brains

Degeneration of mesencephalic dopaminergic (mesDA) neurons is the pathological hallmark of Parkinson&#8217;s diseae. Study of the biological processes ...

Brigham and Women's Hospital, Harvard Medical School

A reduction in the local availability of nitric oxide (NO) may play a role in the etiology of chronic cerebral vasospasm after subarachnoid hemorrhage (SAH). We investigated the toxicity and efficacy of a locally delivered NO donor from a controlled-release polymer in preventing experimental cerebral vasospasm in rats and rabbits, respectively.

Prevention of experimental cerebral vasospasm by intracranial delivery of a nitric oxide donor from a controlled-release polymer: toxicity and efficacy studies in rabbits and rats.

Diethylenetriamine/nitric oxide (DETA/NO) has been shown to be an effective treatment for delayed posthemorrhagic vasospasm when released abluminally from ethylene-vinyl acetate copolymer (EVAc). However, the observed mortality associated with this drug warrants further investigation. To establish a maximum tolerable dose, this study evaluated the toxicity of DETA/NO released from EVAc in a dose-escalation series in cynomolgus monkeys (Macaca fascicularis).

Intracranial delivery of the nitric oxide donor diethylenetriamine/nitric oxide from a controlled-release polymer: toxicity in cynomolgus monkeys.

Most injuries to the neonatal brachial plexus occur acutely at birth, and are iatrogenic in origin. However, when weakness is accompanied by atrophy, nontraumatic etiologies should be considered. The differential diagnosis of chronic congenital brachial plexopathy includes cervical bone malformations, humeral osteomyelitis, varicella, and compression from various types of infantile tumors. An illustrative male infant delivered at 37 weeks of gestation with wasted musculature of the left upper arm, ipsilateral Horner's syndrome, and a hemidiaphragm is presented. On further examination, this patient manifested an underlying cervical tumor compressing the brachial plexus. Diagnostic steps leading to the pathologic identification of a solitary cervical myofibroma included physical examination, electromyography, radiographic imaging, and open biopsy. This report emphasizes the importance of differentiating acute from chronic congenital plexus palsy and of recognizing the possibility that infection or neoplasm may underlie the latter.

Infantile myofibromatosis: a nontraumatic cause of neonatal brachial plexus palsy.

&#x867D;&#x7136;&#x51E0;&#x4E2A;&#x4E34;&#x5E8A;&#x8BD5;&#x9A8C;&#x5229;&#x7528; 2 &#x578B;&#x817A;&#x76F8;&#x5173;&#x75C5;&#x6BD2; (&#x817A;&#x76F8;&#x5173;&#x75C5;&#x6BD2;&#xFF09; &#x8840;&#x6E05;&#x578B; 2 (2/2&#xFF09; &#x73B0;&#x6B63;&#x8FDB;&#x884C;&#xFF0C;&#x76EE;&#x524D;&#x5C1A;&#x4E0D;&#x6E05;&#x695A;&#xFF0C;&#x662F;&#x5426;&#x6B64;&#x7279;&#x5B9A;&#x8840;&#x6E05;&#x578B;&#x63D0;&#x4F9B;&#x4EFB;&#x4F55;&#x5B89;&#x5168;&#x6216;&#x6548;&#x7387;&#x65F6;&#x76F4;&#x63A5;&#x4F20;&#x9012;&#x5230;&#x4E2D;&#x67A2;&#x795E;&#x7ECF;&#x7CFB;&#x7EDF;&#x65B9;&#x9762;&#x6BD4;&#x522B;&#x4EBA;&#x6709;&#x4F18;&#x52BF;&#x3002;

&#x91CD;&#x7EC4;&#x817A;&#x76F8;&#x5173;&#x75C5;&#x6BD2; 2 &#x578B; pseudotypes&#xFF1A; &#x6BD4;&#x8F83;&#x5B89;&#x5168;&#x3001; &#x7279;&#x5F02;&#x6027;&#x3001; &#x548C;&#x8F6C;&#x5BFC;&#x6548;&#x7387;&#x5728;&#x7075;&#x957F;&#x7C7B;&#x52A8;&#x7269;&#x7EB9;&#x72B6;&#x4F53;&#x4E2D;&#x7684;&#x3002;&#x5B9E;&#x9A8C;&#x5BA4;&#x8C03;&#x67E5;&#x3002;

Although several clinical trials utilizing the adeno-associated virus (AAV) type 2 serotype 2 (2/2) are now underway, it is unclear whether this particular serotype offers any advantage over others in terms of safety or efficiency when delivered directly to the CNS.

Recombinant adeno-associated virus type 2 pseudotypes: comparing safety, specificity, and transduction efficiency in the primate striatum. Laboratory investigation.

Bien que plusieurs essais cliniques utilisant le type adeno-associated virus (AAV) 2 s&eacute;rotype 2 (2/2) sont maintenant en cours, on ne sait pas si ce s&eacute;rotype particulier offre un avantage sur les autres en termes de s&eacute;curit&eacute; ou d&#39;efficacit&eacute; lorsque livr&eacute; directement &agrave; la CNS.

Pseudotypes type 2 recombinante adeno-associated virus : comparant l&#39;efficacit&eacute; de s&eacute;curit&eacute;, la sp&eacute;cificit&eacute; et la transduction dans le striatum de primate. &Eacute;tude en laboratoire.

Obwohl mehrere klinische Studien, die unter Verwendung des Adeno-assoziierte Virus (AAV) Typs 2 2 Serotyp (2/2) sind jetzt im Gange, es ist unklar, ob diese bestimmten Serotyp keinen Vorteil gegen&uuml;ber anderen in Bezug auf Sicherheit und Effizienz beim direkt an die CNS bietet.

Rekombinante Adeno-assoziierte Virus Typ 2 Pseudotypes: Sicherheit, Spezifit&auml;t und Transduktion Effizienz im Striatum Primas vergleichen. Laboruntersuchung.

Sebbene diversi studi clinici che utilizzano il tipo di virus adeno-associati (AAV) 2 sierotipo 2 (2/2) sono ora in corso, non &egrave; chiaro se questo particolare sierotipo offre alcun vantaggio rispetto ad altri in termini di sicurezza o di efficienza quando consegnato direttamente al sistema nervoso centrale.

Pseudotypes tipo 2 recombinant virus adeno-associati: confrontando l&#39;efficienza di trasduzione, la specificit&agrave; e la sicurezza nello striato primate. Indagini di laboratorio.

&#x30A2;&#x30C7;&#x30CE;&#x968F;&#x4F34;&#x30A6;&#x30A4;&#x30EB;&#x30B9; (AAV) &#x30BF;&#x30A4;&#x30D7; 2 &#x3092;&#x5229;&#x7528;&#x3057;&#x305F;&#x3044;&#x304F;&#x3064;&#x304B;&#x306E;&#x81E8;&#x5E8A;&#x8A66;&#x9A13; 2 &#x8840;&#x6E05;&#x578B;&#x304C; (2/2) &#x4ECA;&#x9032;&#x884C;&#x4E2D;&#x3067;&#x3001;&#x305D;&#x308C;&#x306F;&#x4E0D;&#x660E;&#x304B;&#x3069;&#x3046;&#x304B;&#x3053;&#x306E;&#x7279;&#x5B9A;&#x306E;&#x8840;&#x6E05;&#x578B;&#x4EFB;&#x610F;&#x4ED6;&#x4E0A;&#x5B89;&#x5168;&#x3084; CNS &#x306B;&#x76F4;&#x63A5;&#x914D;&#x4FE1;&#x3059;&#x308B;&#x3068;&#x304D;&#x306E;&#x52B9;&#x7387;&#x306E;&#x9762;&#x3067;&#x5229;&#x70B9;&#x304C;&#x3042;&#x308A;&#x307E;&#x3059;&#x3002;

&#x7D44;&#x63DB;&#x3048;&#x306E;&#x30A2;&#x30C7;&#x30CE;&#x968F;&#x4F34;&#x30A6;&#x30A4;&#x30EB;&#x30B9; 2 &#x578B;&#x306E;&#x7591;&#x4F3C;&#x578B;: &#x970A;&#x9577;&#x985E;&#x306E;&#x7DDA;&#x6761;&#x4F53;&#x306B;&#x304A;&#x3051;&#x308B;&#x5B89;&#x5168;&#x6027;&#x3001;&#x7279;&#x7570;&#x6027;&#x3001;&#x4F1D;&#x9054;&#x52B9;&#x7387;&#x3092;&#x6BD4;&#x8F03;&#x3057;&#x307E;&#x3059;&#x3002;&#x7814;&#x7A76;&#x5BA4;&#x306E;&#x8ABF;&#x67FB;&#x3002;

&#xBE44;&#xB85D; adeno &#xC81C;&#xD734;&#xD574; &#xBC14;&#xC774;&#xB7EC;&#xC2A4; (AAV) &#xD0C0;&#xC785; 2&#xB97C; &#xD65C;&#xC6A9; &#xD558; &#xC5EC; &#xC5EC;&#xB7EC; &#xC784;&#xC0C1; &#xC2DC;&#xD5D8; serotype 2 (2/2)&#xB294; &#xC9C0;&#xAE08; &#xC9C4;&#xD589; &#xB418; &#xACE0;,&#xC774; &#xD2B9;&#xC815; serotype &#xC548;&#xC804; &#xB610;&#xB294; CNS&#xC5D0; &#xC9C1;&#xC811; &#xC804;&#xB2EC; &#xD558;&#xB294; &#xACBD;&#xC6B0; &#xD6A8;&#xC728;&#xC131; &#xCE21;&#xBA74;&#xC5D0;&#xC11C; &#xB2E4;&#xB978; &#xC5B4;&#xB5A4; &#xC6B0;&#xC704;&#xB97C; &#xC81C;&#xACF5; &#xD558;&#xB294; &#xC5EC;&#xBD80;&#xB97C; &#xBA85;&#xD655; &#xD558;&#xC9C0; &#xC54A;&#xB2E4;.

&#xC7AC;&#xC870;&#xD569; adeno &#xC81C;&#xD734;&#xD574; &#xBC14;&#xC774;&#xB7EC;&#xC2A4; 2 &#xD615; pseudotypes: &#xC601;&#xC7A5;&#xB958;&#xAC00; &#xB0B4;&#xC5D0;&#xC11C; &#xC548;&#xC804;, &#xD2B9;&#xC774;&#xC131;, &#xADF8;&#xB9AC;&#xACE0; &#xBCC0;&#xD658; &#xD6A8;&#xC728; &#xBE44;&#xAD50;. &#xC2E4;&#xD5D8;&#xC2E4; &#xC870;&#xC0AC;&#xC785;&#xB2C8;&#xB2E4;.

Aunque varios ensayos cl&iacute;nicos utilizando el tipo de virus adeno-asociado (AAV) 2 serotipo 2 (2/2) est&aacute;n ahora en marcha, no est&aacute; claro si este serotipo particular ofrece alguna ventaja sobre los dem&aacute;s en cuanto a la seguridad o eficacia cuando entregado directamente al SNC.

Pseudotypes de tipo 2 recombinante virus adeno-asociado: Comparar la eficacia de transducci&oacute;n, especificidad y seguridad en el estriado de primate. Investigaci&oacute;n del laboratorio.

There are a number of emerging surgical indications for deep brain stimulation. We have shown that modulation of activity within motor, mood, and cognitive circuits has beneficial effects in patients with Parkinson's disease, treatment-resistant depression, and perhaps Alzheimer's type dementia. We review the rationale, safety, and efficacy for each of these indications, focusing on disease mechanisms and relevant data that are necessary to document therapeutic value in each case. The review closes with some thoughts on possible future directions for deep brain stimulation. It is likely that applications for deep brain stimulation will continue to expand as accumulating data establish its safety and efficacy profile in these and other conditions.

Deep brain stimulation emerging indications.

&#x6709;&#x4E00;&#x5927;&#x6279;&#x65B0;&#x5174;&#x7684;&#x624B;&#x672F;&#x6307;&#x5F81;&#x4E3A;&#x8111;&#x6DF1;&#x90E8;&#x523A;&#x6FC0;&#x3002;&#x6211;&#x4EEC;&#x5DF2;&#x7ECF;&#x8868;&#x660E;&#x7535;&#x673A;&#x3001; &#x60C5;&#x7EEA;&#x548C;&#x8BA4;&#x77E5;&#x7535;&#x8DEF;&#x5185;&#x6D3B;&#x52A8;&#x7684;&#x8C03;&#x8282;&#x3001; &#x5E15;&#x91D1;&#x68EE;&#x75C5;&#x3001; &#x6CBB;&#x7597;&#x96BE;&#x6CBB;&#x6027;&#x6291;&#x90C1;&#x75C7;&#x548C;&#x4E5F;&#x8BB8;&#x963F;&#x5C14;&#x8328;&#x6D77;&#x9ED8;&#x578B;&#x75F4;&#x5446;&#x60A3;&#x8005;&#x4EA7;&#x751F;&#x6709;&#x76CA;&#x5F71;&#x54CD;&#x3002;&#x6211;&#x4EEC;&#x68C0;&#x8BA8;&#x7684;&#x7406;&#x7531;&#x3001; &#x5B89;&#x5168;&#x548C;&#x7597;&#x6548;&#x7684;&#x8FD9;&#x4E9B;&#x8FF9;&#x8C61;&#x8868;&#x660E;&#xFF0C;&#x6BCF;&#x4E2A;&#x91CD;&#x70B9;&#x75BE;&#x75C5;&#x53D1;&#x75C5;&#x673A;&#x5236;&#x548C;&#x76F8;&#x5173;&#x7684;&#x6570;&#x636E;&#x6240;&#x9700;&#x6587;&#x6863;&#x5728;&#x6BCF;&#x5B97;&#x4E2A;&#x6848;&#x7684;&#x6CBB;&#x7597;&#x4EF7;&#x503C;&#x3002;&#x68C0;&#x8BA8;&#x5173;&#x95ED;&#x4E0E;&#x6DF1;&#x90E8;&#x8111;&#x523A;&#x6FC0;&#x53EF;&#x80FD;&#x7684;&#x672A;&#x6765;&#x65B9;&#x5411;&#x7684;&#x51E0;&#x70B9;&#x601D;&#x8003;&#x3002;&#x5F88;&#x6709;&#x53EF;&#x80FD;&#x4E3A;&#x8111;&#x6DF1;&#x90E8;&#x523A;&#x6FC0;&#x7684;&#x5E94;&#x7528;&#x7A0B;&#x5E8F;&#x5C06;&#x7EE7;&#x7EED;&#x6269;&#x5927;&#x79EF;&#x7D2F;&#x6570;&#x636E;&#x5728;&#x8FD9;&#x4E9B;&#x548C;&#x5176;&#x4ED6;&#x6761;&#x4EF6;&#x5EFA;&#x7ACB;&#x5176;&#x7597;&#x6548;&#x548C;&#x5B89;&#x5168;&#x6027;&#x7684;&#x914D;&#x7F6E;&#x6587;&#x4EF6;&#x3002;

&#x8111;&#x6DF1;&#x90E8;&#x523A;&#x6FC0;&#x65B0;&#x5174;&#x8FF9;&#x8C61;&#x3002;

Il y a un certain nombre de nouvelles indications chirurgicales pour la stimulation c&eacute;r&eacute;brale profonde. Nous avons d&eacute;montr&eacute; que la modulation de l&#39;activit&eacute; dans le moteur, l&#39;humeur et des circuits cognitives a des effets b&eacute;n&eacute;fiques chez les patients atteints de la maladie de Parkinson, d&eacute;pression r&eacute;sistante aux traitement et peut-&ecirc;tre d&eacute;mence de type Alzheimer. Nous passons en revue la raison d&#39;&ecirc;tre, la s&eacute;curit&eacute; et l&#39;efficacit&eacute; de chacune de ces indications, mettant l&#39;accent sur les m&eacute;canismes des maladies et des donn&eacute;es pertinentes qui sont n&eacute;cessaires pour la valeur th&eacute;rapeutique de document dans chaque cas. L&#39;examen se termine par quelques r&eacute;flexions sur les orientations futures possibles pour la stimulation c&eacute;r&eacute;brale profonde. Il est probable que les demandes de la stimulation c&eacute;r&eacute;brale profonde continuera d&#39;&eacute;largir en accumul&eacute;e des donn&eacute;es &eacute;tablissent son profil d&#39;innocuit&eacute; et d&#39;efficacit&eacute; dans ces et d&#39;autres conditions.

Indications &eacute;mergentes de la stimulation c&eacute;r&eacute;brale profonde.

Es gibt eine Reihe von neuen chirurgischen Indikationen f&uuml;r Tiefe Hirnstimulation. Wir haben gezeigt, dass die Modulation der Aktivit&auml;t im Motor, Stimmung und kognitive Schaltungen wohltuende Wirkung bei Patienten mit Morbus Parkinson, Behandlung-resistente Depressionen und vielleicht Alzheimer Typ Demenz hat. Wir &uuml;berpr&uuml;fen die Begr&uuml;ndung, die Sicherheit und die Wirksamkeit f&uuml;r jede dieser Angaben Krankheitsmechanismen und relevanten Daten, die zum Dokument therapeutischen Wert in jedem Fall im Mittelpunkt. Die &Uuml;berpr&uuml;fung schlie&szlig;t mit einigen Gedanken &uuml;ber m&ouml;gliche Zukunftsperspektiven f&uuml;r Tiefe Hirnstimulation. Es ist wahrscheinlich, dass Anwendungen f&uuml;r Tiefe Hirnstimulation weiterhin anfallende Daten in diesen und anderen Bedingungen seine Sicherheit und Wirksamkeit Profil einrichten zu erweitern.

Deep Brain Stimulation aufstrebenden Indikationen.

Ci sono un certo numero di indicazioni chirurgiche emergenti per la stimolazione cerebrale profonda. Abbiamo dimostrato che la modulazione dell&#39;attivit&agrave; all&#39;interno del motore, umore e circuiti cognitivi ha effetti benefici nei pazienti con malattia di Parkinson, la depressione resistente al trattamento e forse demenza di tipo Alzheimer. Passiamo in rassegna la logica, la sicurezza e l&#39;efficacia per ciascuna di queste indicazioni, concentrandosi sui meccanismi di malattia e i dati rilevanti che sono necessari al valore terapeutico del documento in ogni caso. La rassegna si chiude con alcune riflessioni sui possibili direzioni future per la stimolazione cerebrale profonda. &Egrave; probabile che le applicazioni per la stimolazione cerebrale profonda continuer&agrave; ad espandersi come accumulando dati stabilire il profilo di sicurezza ed efficacia in queste e in altre condizioni.

Indicazioni emergenti del stimolazione cerebrale profonda.

&#x8133;&#x6DF1;&#x90E8;&#x523A;&#x6FC0;&#x7642;&#x6CD5;&#x306E;&#x305F;&#x3081;&#x306E;&#x65B0;&#x8208;&#x306E;&#x624B;&#x8853;&#x9069;&#x5FDC;&#x306E;&#x6570;&#x3067;&#x3059;&#x3002;&#x6211;&#x3005; &#x306F;&#x30E2;&#x30FC;&#x30BF;&#x30FC;&#x3001;&#x6C17;&#x5206;&#x3001;&#x304A;&#x3088;&#x3073;&#x8A8D;&#x77E5;&#x56DE;&#x8DEF;&#x5185;&#x306E;&#x30A2;&#x30AF;&#x30C6;&#x30A3;&#x30D3;&#x30C6;&#x30A3;&#x306E;&#x5909;&#x8ABF;&#x304C;&#x30D1;&#x30FC;&#x30AD;&#x30F3;&#x30BD;&#x30F3;&#x75C5;&#x3001;&#x6CBB;&#x7642;&#x62B5;&#x6297;&#x6027;&#x3046;&#x3064;&#x75C5;&#x3001;&#x304A;&#x305D;&#x3089;&#x304F;&#x30A2;&#x30EB;&#x30C4;&#x30CF;&#x30A4;&#x30DE;&#x30FC;&#x578B;&#x75F4;&#x5446;&#x60A3;&#x8005;&#x306B;&#x304A;&#x3051;&#x308B;&#x6709;&#x76CA;&#x306A;&#x52B9;&#x679C;&#x3092;&#x6301;&#x3063;&#x3066;&#x3044;&#x308B;&#x3053;&#x3068;&#x3092;&#x793A;&#x3057;&#x3066;&#x3044;&#x307E;&#x3059;&#x3002;&#x6211;&#x3005; &#x306E;&#x7406;&#x8AD6;&#x7684;&#x6839;&#x62E0;&#x3001;&#x5B89;&#x5168;&#x304A;&#x3088;&#x3073;&#x52B9;&#x529B;&#x3053;&#x308C;&#x3089;&#x306E;&#x5146;&#x5019;&#x306E;&#x5404;&#x75BE;&#x60A3;&#x306E;&#x30E1;&#x30AB;&#x30CB;&#x30BA;&#x30E0;&#x3084;&#x30C9;&#x30AD;&#x30E5;&#x30E1;&#x30F3;&#x30C8;&#x6CBB;&#x7642;&#x306E;&#x5024;&#x305D;&#x308C;&#x305E;&#x308C;&#x306E;&#x30B1;&#x30FC;&#x30B9;&#x306B;&#x3059;&#x308B;&#x305F;&#x3081;&#x306B;&#x5FC5;&#x8981;&#x306A;&#x95A2;&#x9023;&#x30C7;&#x30FC;&#x30BF;&#x306B;&#x7126;&#x70B9;&#x3092;&#x5F53;&#x3066;&#x3066;&#x78BA;&#x8A8D;&#x3057;&#x307E;&#x3059;&#x3002;&#x898B;&#x76F4;&#x3057;&#x304C;&#x53EF;&#x80FD;&#x306A;&#x5C06;&#x6765;&#x306E;&#x65B9;&#x5411;&#x6027;&#x8133;&#x6DF1;&#x90E8;&#x523A;&#x6FC0;&#x7642;&#x6CD5;&#x306E;&#x305F;&#x3081;&#x306E;&#x3044;&#x304F;&#x3064;&#x304B;&#x306E;&#x8003;&#x3048;&#x3092;&#x9589;&#x3058;&#x307E;&#x3059;&#x3002;&#x8133;&#x6DF1;&#x90E8;&#x523A;&#x6FC0;&#x7642;&#x6CD5;&#x306E;&#x305F;&#x3081;&#x306E;&#x30A2;&#x30D7;&#x30EA;&#x30B1;&#x30FC;&#x30B7;&#x30E7;&#x30F3;&#x306F;&#x3053;&#x308C;&#x3089;&#x304A;&#x3088;&#x3073;&#x305D;&#x306E;&#x4ED6;&#x306E;&#x6761;&#x4EF6;&#x3067;&#x305D;&#x306E;&#x5B89;&#x5168;&#x6027;&#x3068;&#x6709;&#x52B9;&#x6027;&#x306E;&#x30D7;&#x30ED;&#x30D5;&#x30A1;&#x30A4;&#x30EB; &#x30C7;&#x30FC;&#x30BF;&#x84C4;&#x7A4D;&#x3092;&#x78BA;&#x7ACB;&#x3059;&#x308B;&#x3088;&#x3046;&#x5C55;&#x958B;&#x3057;&#x7D9A;&#x3051;&#x308B;&#x3053;&#x3068;&#x306F;&#x672C;&#x5F53;&#x3089;&#x3057;&#x3044;&#x3002;

&#x8133;&#x6DF1;&#x90E8;&#x523A;&#x6FC0;&#x306E;&#x65B0;&#x305F;&#x306A;&#x5146;&#x5019;&#x3002;

&#xAE4A;&#xC740; &#xB450;&#xB1CC; &#xC790;&#xADF9;&#xC5D0; &#xB300; &#xD55C; &#xC2E0;&#xD765; &#xC218;&#xC220; &#xB2E4; &#xC218;&#xAC00; &#xC788;&#xC2B5;&#xB2C8;&#xB2E4;. &#xC6B0;&#xB9AC;&#xB294; &#xBAA8;&#xD130;, &#xAE30;&#xBD84;&#xACFC; &#xC778;&#xC9C0; &#xD68C;&#xB85C; &#xB0B4;&#xC5D0;&#xC11C; &#xD65C;&#xB3D9;&#xC758; &#xBCC0;&#xC870; &#xD30C; &#xD0A8; &#xC2A8; &#xBCD1;, &#xCE58;&#xB8CC; &#xB0B4;&#xC131; &#xC6B0;&#xC6B8;&#xC99D;&#xACFC; &#xC544;&#xB9C8;&#xB3C4; Alzheimer &#xC720;&#xD615; &#xCE58; &#xB9E4; &#xD658;&#xC790;&#xC5D0; &#xC720;&#xC775;&#xD55C; &#xD6A8;&#xACFC;&#xAC00;&#xC9C0;&#xACE0; &#xB098;&#xD0C0;&#xB0AC;&#xC2B5;&#xB2C8;&#xB2E4;. &#xC6B0;&#xB9AC;&#xB294; &#xAC80;&#xD1A0; &#xADFC;&#xAC70; &#xC548;&#xC804;&#xACFC; &#xD6A8;&#xB2A5; &#xAC01; &#xC774;&#xB7EC;&#xD55C; &#xC9D5;&#xD6C4;&#xC5D0; &#xB300; &#xD55C; &#xC9C8;&#xBCD1; &#xBA54;&#xCEE4;&#xB2C8;&#xC998; &#xBC0F; &#xAC01;&#xAC01;&#xC758; &#xACBD;&#xC6B0;&#xC5D0;&#xC11C; &#xBB38;&#xC11C; &#xCE58;&#xB8CC; &#xAC00;&#xCE58; &#xD558;&#xB294; &#xB370; &#xD544;&#xC694;&#xD55C; &#xAD00;&#xB828; &#xB370;&#xC774;&#xD130;&#xC5D0; &#xCD08;&#xC810;&#xC744; &#xB9DE;&#xCD94;&#xACE0;. &#xAE4A;&#xC740; &#xB450;&#xB1CC; &#xC790;&#xADF9;&#xC5D0; &#xB300; &#xD55C; &#xAC00;&#xB2A5;&#xD55C; &#xBBF8;&#xB798;&#xC758; &#xBC29;&#xD5A5;&#xC5D0; &#xB300; &#xD55C; &#xBA87; &#xAC00;&#xC9C0; &#xC0DD;&#xAC01; &#xAC80;&#xD1A0;&#xB97C; &#xB2EB;&#xC2B5;&#xB2C8;&#xB2E4;. &#xAE4A;&#xC740; &#xB450;&#xB1CC; &#xC790;&#xADF9;&#xC5D0; &#xB300; &#xD55C; &#xC751;&#xC6A9; &#xD504;&#xB85C;&#xADF8;&#xB7A8; &#xACC4;&#xC18D; &#xCD95;&#xC801; &#xB370;&#xC774;&#xD130; &#xC774;&#xAC83;&#xACFC; &#xB2E4;&#xB978; &#xC870;&#xAC74;&#xC5D0;&#xC11C;&#xC758; &#xC548;&#xC804;&#xACFC; &#xD6A8;&#xB2A5; &#xD504;&#xB85C;&#xD544; &#xC124;&#xC815;&#xC73C;&#xB85C; &#xD655;&#xC7A5;&#xD560; &#xAC83;&#xC785;&#xB2C8;&#xB2E4; &#xAC00;&#xB2A5;&#xC131;&#xC774; &#xB192;&#xC2B5;&#xB2C8;&#xB2E4;.

&#xAE4A;&#xC740; &#xB450;&#xB1CC; &#xC790;&#xADF9; &#xC2E0;&#xD765; &#xD45C;&#xC2DC;&#xC785;&#xB2C8;&#xB2E4;.

Hay una serie de nuevas indicaciones quir&uacute;rgicas para la estimulaci&oacute;n cerebral profunda. Hemos demostrado que la modulaci&oacute;n de la actividad dentro de motor, estado de &aacute;nimo y circuitos cognitivos tiene efectos beneficiosos en pacientes con enfermedad de Parkinson, depresi&oacute;n resistente al tratamiento y tal vez demencia de tipo Alzheimer. Repasamos los fundamentos, seguridad y eficacia para cada una de estas indicaciones, centr&aacute;ndose en los mecanismos de la enfermedad y los datos pertinentes que sean necesarios para el valor terap&eacute;utico de documento en cada caso. La revisi&oacute;n se cierra con algunas reflexiones sobre posibles direcciones futuras para la estimulaci&oacute;n cerebral profunda. Es probable que soliciten la estimulaci&oacute;n cerebral profunda continuar&aacute; ampliando como acumuladas datos establecen su perfil de seguridad y eficacia en estas y otras condiciones.

Indicaciones emergentes del est&iacute;mulo profundo del cerebro.

Presentation to publication.

To examine whether multiple aneurysms located in the anterior cerebral artery (ACA), middle cerebral artery (MCA), or internal carotid artery (ICA) could be treated through single-stage, ipsilateral dual craniotomies.

Dual ipsilateral craniotomies through a single incision for the surgical management of multiple intracranial aneurysms.

The success of deep brain stimulation (DBS) surgery in treating medically refractory symptoms of some movement disorders has inspired further investigation into a wide variety of other treatment-resistant conditions. These range from disorders of gait, mood, and memory to problems as diverse as obesity, consciousness, and addiction. We review the emerging indications, rationale, and outcomes for some of the most promising new applications of DBS in the treatment of postural instability associated with Parkinson's disease, depression, obsessive-compulsive disorder, obesity, substance abuse, epilepsy, Alzheimer's-type dementia, and traumatic brain injury. These studies reveal some of the excitement in a field at the edge of a rapidly expanding frontier. Much work still remains to be done on basic mechanism of DBS, optimal target and patient selection, and long-term durability of this technology in treating new indications.

Novel applications of deep brain stimulation.

Surgical therapy for the secondary dystonias is generally perceived to be less effective than for primary disease. However, a number of case reports and small open series have recently appeared describing quite favorable outcomes following surgery for some nonprimary dystonias. We discuss surgical treatment options for this group of diverse conditions, including tardive dystonia, dystonic cerebral palsy, and certain heredodegenerative diseases in which deep brain stimulation and ablative lesions of the posteroventral pallidum have been shown to be effective. Other types of secondary dystonia respond less well to pallidal surgery, particularly when anatomical lesions of the basal ganglia are prominent on preoperative imaging. For these conditions, central baclofen delivery and botulinum toxin denervation may be considered. With optimal medical and surgical care, some patients with secondary dystonia have achieved reductions in disability and pain that approach those documented for primary dystonia.

Surgical treatment for secondary dystonia.

Pharmacological therapy has had limited success in the treatment of most major neurological diseases. This has motivated the development of a number of novel surgical approaches designed to ameliorate drug-induced side effects or pharmacoresistant symptoms. Deep brain stimulation (DBS) has been quite successful in controlling both the cardinal motor manifestation of Parkinson's disease and the side effects of prolonged levodopa therapy. This has encouraged the application of DBS technology to treat a number of other neurodegenerative conditions, including secondary dystonia associated with pantothenate kinase-associated neurodegeneration (PKAN, formerly Hallervorden-Spatz syndrome), chorea associated with Huntington's disease, and most recently, cognitive decline associated with Alzheimer's type dementia. We review the rationale, indications and outcomes of neuromodulation for selected neurodegenerative conditions. In addition to DBS, we discuss select small molecule and gene-based neuromodulatory approaches. Ongoing study of basic pathophysiological mechanisms may eventually allow directed primary prevention of some of these diseases, but until then, invasive neuromoduation will likely continue to play an ever-increasing role in the delivery of the most advanced care for patients with these debilitating conditions.

Neuromodulation for neurodegenerative conditions.

The field of functional neurosurgery has developed a number of recent innovative neuromodulatory approaches to treat disease that remains resistant to the best medical therapy. These include novel surgical techniques to intervene in motor and cognitive sequelae of refractory epilepsy, neurodegenerative disease, and certain psychiatric conditions. To a large extent, much of the innovation in our field continues to be driven by a systems-level understanding of the impact of disease on the brain. For example, several groups have exploited findings from neuroimaging work to identify a number of new potential neuromodulatory targets for the treatment of refractory depression. Ongoing discoveries at the cellular and molecular level promise targeted gene or drug delivery aimed at curing disease. Neurosurgeons will certainly remain at the forefront of translating these strategies into practical clinical applications. Several randomized trials are now underway to assess the safety and efficacy of a number of new approaches, and we will continue to acquire better knowledge of optimal patient selection, identification of the most effective neuromodulatory targets, and recognition of adverse effects as these studies progress.

Some recent trends and further promising directions in functional neurosurgery.

Surgical therapy for treatment-resistant obsessive compulsive disorder (OCD) remains an effective option for well-selected patients managed within a multidisciplinary setting. Historically, lesions within the limbic system have been used to control both obsessive thoughts and repetitive compulsions associated with this disease. We discuss classical targets as well as contemporary neuromodulatory approaches that have been shown to provide symptomatic relief. Recently, deep brain stimulation (DBS) of the anterior limb of the internal capsule/ventral striatum received Conformité Européene (CE) mark and Food and Drug Administration (FDA) approvals for treatment of intractable OCD. Remarkably, this is the first such approval for neurosurgical intervention in a strictly psychiatric indication in modern times. This target is discussed in detail along with alternative targets currently being proposed. We close with a discussion of gamma knife capsulotomy, a modality with deep historical roots. Further directions in the surgical treatment of OCD will require better preoperative predictors of postoperative responses, optimal selection of individualized targets, and rigorous reporting of adverse events and standardized outcomes. To meet these challenges, centers must be equipped with a multidisciplinary team and patient-centered approach to ensure adequate screening and follow up of patients with this difficult-to-treat condition.

Deep brain stimulation and ablation for obsessive compulsive disorder: evolution of contemporary indications, targets and techniques.

Specific vulnerability and degeneration of the dopaminergic neurons in the substantia nigra pars compacta of the midbrain is the pathological hallmark of Parkinson's disease. A number of transcription factors regulate the birth and development of this set of neurons and some remain constitutively expressed throughout life. These maintenance transcription factors are closely associated with essential neurophysiological functions and are required ultimately for the long-term survival of the midbrain dopaminergic neurons. The current review describes the role of two such factors, Nurr1 and engrailed, in differentiation, maturation, and in normal physiological functions including acquisition of neurotransmitter identity. The review will also elucidate the relationship of these factors with life, vulnerability, degeneration and death of mesencephalic dopaminergic neurons in the context of Parkinson's disease.

The lifelong maintenance of mesencephalic dopaminergic neurons by Nurr1 and engrailed.

Learning novel sequences constitutes an example of declarative memory formation, involving conscious recall of temporal events. Performance in sequence learning tasks improves with repetition and involves forming temporal associations over scales of seconds to minutes. To further understand the neural circuits underlying declarative sequence learning over trials, we tracked changes in intracranial field potentials (IFPs) recorded from 1142 electrodes implanted throughout temporal and frontal cortical areas in 14 human subjects, while they learned the temporal-order of multiple sequences of images over trials through repeated recall. We observed an increase in power in the gamma frequency band (30-100 Hz) in the recall phase, particularly in areas within the temporal lobe including the parahippocampal gyrus. The degree of this gamma power enhancement decreased over trials with improved sequence recall. Modulation of gamma power was directly correlated with the improvement in recall performance. When presenting new sequences, gamma power was reset to high values and decreased again after learning. These observations suggest that signals in the gamma frequency band may play a more prominent role during the early steps of the learning process rather than during the maintenance of memory traces.

Travis S. Tierney

Department of Neurosurgery

Brigham and Women's Hospital, Harvard Medical School

Isolation, Culture and Long-Term Maintenance of Primary Mesencephalic Dopaminergic Neurons From Embryonic Rodent Brains

Travis S. Tierney

.css-o250i3{font-size:18px;font-family:Open Sans,sans-serif;line-height:21.6px;}Department of Neurosurgery

Brigham and Women's Hospital, Harvard Medical School

Isolation, Culture and Long-Term Maintenance of Primary Mesencephalic Dopaminergic Neurons From Embryonic Rodent Brains

Department of Neurosurgery