Updated on 2024/04/11

写真a

 
ISHIZAKI Tomotaka
 
Organization
Nagoya University Hospital Neurosurgery Assistant professor of hospital
Title
Assistant professor of hospital
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Degree 2

  1. Doctor of Philosophy (Medical science) ( 2020.7   Nagoya University ) 

  2. Bachelor (Medical Doctor) ( 2011.3   Nagoya University ) 

Research Areas 1

  1. Life Science / Neurosurgery  / Epilepsy surgery

Current Research Project and SDGs 1

  1. Subcortical network revealed by stereotactic neurosurgery

Awards 2

  1. America Epilepsy Society 2019 Suzanne and Peter Berry International Travel Award

    2019.12   America Epilepsy Society  

    Tomotaka Ishizaki

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    Award type:Award from international society, conference, symposium, etc.  Country:United States

  2. 2019 Japanese Epilepsy Society Sponsored Award UCB & Otsuka Award

    2019.3   Japan Epilepsy Society  

    Tomotaka Ishizaki

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    Country:Japan

 

Papers 18

  1. Cerebellar and thalamic connector hubs facilitate the involvement of visual and cognitive networks in essential tremor

    Bagarinao E., Maesawa S., Kato S., Mutoh M., Ito Y., Ishizaki T., Tanei T., Tsuboi T., Suzuki M., Watanabe H., Hoshiyama M., Isoda H., Katsuno M., Sobue G., Saito R.

    Parkinsonism and Related Disorders   Vol. 121   page: 106034   2024.4

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    Language:English   Publisher:Parkinsonism and Related Disorders  

    Introduction: Connector hubs are specialized brain regions that connect multiple brain networks and therefore have the potential to affect the functions of multiple systems. This study aims to examine the involvement of connector hub regions in essential tremor. Methods: We examined whole-brain functional connectivity alterations across multiple brain networks in 27 patients with essential tremor and 27 age- and sex-matched healthy controls to identify affected hub regions using a network metric called functional connectivity overlap ratio estimated from resting-state functional MRI. We also evaluated the relationships of affected hubs with cognitive and tremor scores in all patients and with motor function improvement scores in 15 patients who underwent postoperative follow-up evaluations after focused ultrasound thalamotomy. Results: We have identified affected connector hubs in the cerebellum and thalamus. Specifically, the dentate nucleus in the cerebellum and the dorsomedial thalamus exhibited more extensive connections with the sensorimotor network in patients. Moreover, the connections of the thalamic pulvinar with the visual network were also significantly widespread in the patient group. The connections of these connector hub regions with cognitive networks were negatively associated (FDR q < 0.05) with cognitive, tremor, and motor function improvement scores. Conclusion: In patients with essential tremor, connector hub regions within the cerebellum and thalamus exhibited widespread functional connections with sensorimotor and visual networks, leading to alternative pathways outside the classical tremor axis. Their connections with cognitive networks also affect patients’ cognitive function.

    DOI: 10.1016/j.parkreldis.2024.106034

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  2. Characteristics of deceased subjects transported to a postmortem imaging center due to unusual death related to epilepsy

    Ito, Y; Hata, N; Maesawa, S; Tanei, T; Ishizaki, T; Mutoh, M; Hashida, M; Kobayashi, Y; Saito, R

    EPILEPSIA OPEN   Vol. 9 ( 2 ) page: 592 - 601   2024.4

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    Language:English   Publisher:Epilepsia Open  

    Objective: Patients with epilepsy have high risk of experiencing uncommon causes of death. This study aimed to evaluate patients who underwent unusual deaths related to epilepsy and identify factors that may contribute to these deaths and may also include sudden unexpected death in epilepsy (SUDEP). Methods: We analyzed 5291 cases in which a postmortem imaging (PMI) study was performed using plane CT, because of an unexplained death. A rapid troponin T assay was performed using peripheral blood samples. Clinical information including the cause of death suspected by the attending physician, body position, place of death, medical history, and antiseizure medications was evaluated. Results: A total of 132 (2.6%) patients had an obvious history of epilepsy, while 5159 individuals had no history of epilepsy (97.4%). Cerebrovascular disease was the cause of death in 1.6% of patients in the group with epilepsy, and this was significantly lower than that in the non-epilepsy group. However, drowning was significantly higher (9.1% vs. 4.4%). Unspecified cause of death was significantly more frequent in the epilepsy group (78.0% vs. 57.8%). Furthermore, the proportion of patients who demonstrated elevation of troponin T levels without prior cardiac disease was significantly higher in the epilepsy group (37.9% vs. 31.1%). At discovery of death, prone position was dominant (30.3%), with deaths occurring most commonly in the bedroom (49.2%). No antiseizure medication had been prescribed in 12% of cases, while 29.5% of patients were taking multiple antiseizure medications. Significance: The prevalence of epilepsy in individuals experiencing unusual death was higher than in the general population. Despite PMI studies, no definitive cause of death was identified in a significant proportion of cases. The high troponin T levels may be explained by long intervals between death and examination or by higher incidence of myocardial damage at the time of death. Plain Language Summary: This study investigated unusual deaths in epilepsy patients, analyzing 5291 postmortem imaging cases. The results showed that 132 cases (2.6%) had a clear history of epilepsy. In these cases, only 22% cases were explained after postmortem examination, which is less than in non-epilepsy group (42.2%). Cerebrovascular disease was less common in the epilepsy group, while drowning was more common. Elevated troponin T levels, which suggest possibility of myocardial damage or long intervals between death and examination, were also more frequent in the epilepsy group compared to non-epilepsy group.

    DOI: 10.1002/epi4.12891

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  3. Boltless nylon-suture technique for stereotactic electroencephalography as a safe, effective alternative when the anchor bolt is inappropriate

    Mutoh, M; Maesawa, S; Nakatsubo, D; Ishizaki, T; Tanei, T; Torii, J; Ito, Y; Hashida, M; Saito, R

    ACTA NEUROCHIRURGICA   Vol. 166 ( 1 ) page: 18   2024.1

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    Language:English   Publisher:Acta Neurochirurgica  

    Background: The use of anchor bolts to secure electrodes to the skull can be difficult in some clinical situations. Herein, we present the boltless technique to secure electrodes to the scalp using nylon sutures to overcome the problems associated with anchor bolts. We investigated the safety, accuracy errors, and patient-related and operative factors affecting errors in the boltless technique. Methods: This single-institution retrospective series analyzed 103 electrodes placed in 12 patients. The target-point localization error (TPLE), entry-point localization error (EPLE), radial error (RE), and depth error (DE) of the electrodes were calculated. Results: The median of the mean operative time per electrode was 9.3 min. The median TPLE, EPLE, RE, and absolute DE value were 4.1 mm, 1.6 mm, 2.7 mm, and 1.9 mm, respectively. Positive correlations were observed between the preoperative scalp thickness, mean operative time per electrode, EPLE, RE, and the absolute value of DE versus TPLE (r =.228, p =.02; r =.678, p =.015; r =.228, p =.02; r =.445, p <.01; r =.630, p <.01, respectively), and electrode approach angle versus EPLE (r =.213, p =.031). Multivariate analysis revealed that the absolute value of DE had the strongest influence on the TPLE, followed by RE and preoperative scalp thickness, respectively (β =.938,.544,.060, respectively, p <.001). No complications related to SEEG insertion and monitoring were encountered. Conclusion: The boltless technique using our unique planning and technical method is a safe, effective, and low-cost alternative in cases where anchor bolts are contraindicated.

    DOI: 10.1007/s00701-024-05889-3

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  4. Hemodynamic and electrophysiological responses of the human amygdala during face imitation-a study using functional MRI and intracranial EEG

    Iidaka, T; Maesawa, S; Kanayama, N; Miyakoshi, M; Ishizaki, T; Saito, R

    CEREBRAL CORTEX   Vol. 34 ( 1 )   2024.1

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    The involvement of the human amygdala in facial mimicry remains a matter of debate. We investigated neural activity in the human amygdala during a task in which an imitation task was separated in time from an observation task involving facial expressions. Neural activity in the amygdala was measured using functional magnetic resonance imaging in 18 healthy individuals and using intracranial electroencephalogram in six medically refractory patients with epilepsy. The results of functional magnetic resonance imaging experiment showed that mimicry of negative and positive expressions activated the amygdala more than mimicry of non-emotional facial movements. In intracranial electroencephalogram experiment and time-frequency analysis, emotion-related activity of the amygdala during mimicry was observed as a significant neural oscillation in the high gamma band range. Furthermore, spectral event analysis of individual trial intracranial electroencephalogram data revealed that sustained oscillation of gamma band activity originated from an increased number and longer duration of neural events in the amygdala. Based on these findings, we conclude that during facial mimicry, visual information of expressions and feedback from facial movements are combined in the amygdalar nuclei. Considering the time difference of information approaching the amygdala, responses to facial movements are likely to modulate rather than initiate affective processing in human participants.

    DOI: 10.1093/cercor/bhad488

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  5. Outcomes and Prognostic Factors of Magnetic Resonance-guided Focused Ultrasound Thalamotomy for Essential Tremor at 2-year Follow-up

    HASHIDA Miki, MAESAWA Satoshi, KATO Sachiko, NAKATSUBO Daisuke, TSUGAWA Takahiko, TORII Jun, TANEI Takafumi, ISHIZAKI Tomotaka, MUTOH Manabu, ITO Yoshiki, TSUBOI Takashi, MIZUNO Satomi, SUZUKI Masashi, WAKABAYASHI Toshihiko, KATSUNO Masahisa, SAITO Ryuta

    Neurologia medico-chirurgica   Vol. advpub ( 0 )   2024

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    <p>Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is an effective treatment for essential tremor (ET). However, its long-term outcomes and prognostic factors remain unclear. This study aimed to retrospectively investigate 38 patients with ET who underwent MRgFUS thalamotomy and were followed up for >2 years. The improvement in tremor was evaluated using the Clinical Rating Scale for Tremor (CRST). Adverse events were documented, and correlations with factors, such as skull density ratio (SDR), maximum mean temperature (T-max), and lesion size, were examined. Furthermore, the outcomes were compared between two groups, one that met the cutoff values, which was previously reported (preoperative CRST-B ≤ 25, T-max ≥ 52.5°C, anterior-posterior size of lesion ≥ 3.9 mm, superior-inferior [SI] size of lesion > 5.5 mm), and the other that did not. The improvement rate was 59.4% on average at the 2-year follow-up. Adverse events, such as numbness (15.8%), dysarthria (10.5%), and lower extremity weakness (2.6%), were observed even after 2 years, although these were mild. The factors correlated with tremor improvement were the T-max and SI size of the lesion (p < 0.05), whereas the SDR showed no significance. Patients who met the aforementioned cutoff values demonstrated a 69.8% improvement at the 2-year follow-up, whereas others showed a 43.6% improvement (p < 0.05). In conclusion, MRgFUS is effective even after 2 years. The higher the T-max and the larger the lesion size, the better the tremor control. Previously reported cutoff values clearly predict the 2-year prognosis, indicating the usefulness of MRgFUS.</p>

    DOI: 10.2176/jns-nmc.2023-0202

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  6. Relief of Central Poststroke Pain Affecting Both the Arm and Leg on One Side by Double-independent Dual-lead Spinal Cord Stimulation Using Fast-acting Subperception Therapy Stimulation: A Case Report

    TANEI Takafumi, MAESAWA Satoshi, NISHIMURA Yusuke, NAGASHIMA Yoshitaka, ISHIZAKI Tomotaka, MUTOH Manabu, ITO Yoshiki, SAITO Ryuta

    NMC Case Report Journal   Vol. 10 ( 0 ) page: 15 - 20   2023.12

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    <p>Central poststroke pain is a chronic, intractable, central neuropathic pain. Spinal cord stimulation is a neuromodulation therapy for chronic neuropathic pain. The conventional stimulation method induces a sense of paresthesia. Fast-acting subperception therapy is one of the latest new stimulation methods without paresthesia. A case of achieving pain relief of central poststroke pain affecting both the arm and leg on one side by double-independent dual-lead spinal cord stimulation using fast-acting subperception therapy stimulation is presented. A 67-year-old woman had central poststroke pain due to a right thalamic hemorrhage. The numerical rating scale scores of the left arm and leg were 6 and 7, respectively. Using dual-lead stimulation at the Th 9-11 levels, a spinal cord stimulation trial was performed. Fast-acting subperception therapy stimulation achieved pain reduction in the left leg from 7 to 3. Therefore, a pulse generator was implanted, and the pain relief continued for 6 months. Then, two additional leads were implanted at the C 3-5 levels, and pain in the arm decreased from 6 to 4. Independent setting and adjustments of the dual-lead stimulation were required because the thresholds of paresthesia perception were significantly different. To achieve pain relief in both the arm and leg, double-independent dual-lead stimulation placed at cervical and thoracic levels is an effective treatment. Fast-acting subperception therapy stimulation may be effective for central poststroke pain, especially in cases where the paresthesia is perceived as uncomfortable or the conventional stimulation itself is ineffective.</p>

    DOI: 10.2176/jns-nmc.2022-0336

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  7. Epileptogenic zone in Broca's area is resectable under awake surgery in accordance with the hodotopic framework: A case report

    Suzuki, T; Ishizaki, T; Maesawa, S; Hashida, M; Mutoh, M; Ito, Y; Tanei, T; Saito, R

    SEIZURE-EUROPEAN JOURNAL OF EPILEPSY   Vol. 112   page: 84 - 87   2023.11

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    DOI: 10.1016/j.seizure.2023.09.018

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  8. Microscale mapping of thermal contact resistance using lock-in thermography

    Ishizaki, T; Nagano, H

    INTERNATIONAL JOURNAL OF THERMAL SCIENCES   Vol. 193   2023.11

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    This paper proposes a new thermal contact resistance distribution measurement method using lock-in thermography. This method was used to evaluate a two-dimensional local thermal contact resistance distribution. To be able to measure the distribution, a uniform intensity laser heating system was developed. The developed system has a top-hat intensity distribution with a diameter of 30 mm. By combining this heat source and the lock-in thermography, a new measurement instrument was developed, which can evaluate local temperature behavior in the frequency domain, including the information of the contact interface in high spatial resolution of about 70 μm. Additionally, a new thermal contact resistance measurement principle was constructed based on a one-dimensional heat transfer equation that considers the reflected and transmitted temperature waves at the boundary and contact interface. The thermal contact resistance was acquired as a solution to the inverse problem of the temperature response done by fitting analyses. The validation of this method was performed quantitatively with two samples made of two bonded isotropic graphite plates. The one sample has an intentional defect area that has a slightly higher thermal resistance. The other sample has the known thermal contact resistance value measured with a validated method. Based on the results, the measurement value agreed with the referenced value. Also, the defect area was quantitatively detected clearly as a high thermal resistance region. Furthermore, as a practical example, the measurement method was applied for two different contact interface roughness samples consisting of aluminum alloys and thermal grease. Consequently, it was revealed and visualized that the contact interface with a rough surface has a high thermal resistance spot.

    DOI: 10.1016/j.ijthermalsci.2023.108475

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  9. Focus disconnection of the SEEG-identified epileptic network by radiofrequency thermal coagulation

    Ishizaki, T; Maesawa, S; Yamamoto, H; Hashida, M; Mutoh, M; Ito, Y; Tanei, T; Natsume, J; Saito, R

    SEIZURE-EUROPEAN JOURNAL OF EPILEPSY   Vol. 111   page: 17 - 20   2023.10

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    DOI: 10.1016/j.seizure.2023.07.007

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  10. Efficacy of the latest new stimulation patterns of spinal cord stimulation for intractable neuropathic pain compared to conventional stimulation: study protocol for a clinical trial

    Tanei, T; Maesawa, S; Nishimura, Y; Nagashima, Y; Ishizaki, T; Ando, M; Kuwatsuka, Y; Hashizume, A; Kurasawa, S; Saito, R

    TRIALS   Vol. 24 ( 1 ) page: 604   2023.9

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    Background: Spinal cord stimulation (SCS) is one of the neuromodulation therapies for chronic neuropathic pain. The conventional paresthesia-based SCS involves the application of tonic stimulation that induces a sense of paresthesia. Recently, new SCS stimulation patterns without paresthesia have been developed. Differential target multiplexed (DTM) stimulation and fast-acting subperception therapy (FAST) stimulation are the latest paresthesia-free SCS patterns. Methods: A single-center, open-label, crossover, randomized clinical trial to investigate the superiority of SCS using the latest new stimulation patterns over conventional tonic stimulation for neuropathic pain is planned. This study consists of two steps: SCS trial (first step) and SCS system implantation (second step). In the SCS trial, participants will be randomly assigned to 4 groups receiving stimulation, including tonic, DTM, and FAST. Each stimulation will then be performed for 2 days, and a visual analog scale (VAS) for pain will be evaluated before and after each stimulation pattern. A stimulation-off period for 1 day is set between each stimulation pattern to wash out the residual previous stimulation effects. Pain improvement is defined as more than 33% reduction in the pain VAS. The primary analysis will compare pain improvement between the new stimulation patterns and the conventional tonic stimulation pattern in the SCS trial. The secondary outcomes will be evaluated as follows: (1) the relationships between causative disease and improvement rate by each stimulation pattern; (2) comparison of pain improvement between the DTM and FAST stimulation patterns in all cases and by causative disease; (3) changes in assessment items preoperatively to 24 months after the implantation; (4) preoperative factors associated with long-term effects defined as continuing for more than 12 months; and (5) adverse events related to this study 3 months after the implantation. Discussion: This study aims to clarify the effectiveness of the latest new stimulation patterns compared to the conventional tonic stimulation. In addition, which stimulation pattern is most effective for which kind of causative disease will be clarified. Trial registration: Japan Registry of Clinical Trials (jRCT) 1,042,220,094. Registered on 21 November 2022, and last modified on 6 January 2023. jRCT is an approved member of the Primary Registry Network of WHO ICTRP.

    DOI: 10.1186/s13063-023-07637-x

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  11. Connectivity alteration in thalamic nuclei and default mode network-related area in memory processes in mesial temporal lobe epilepsy using magnetoencephalography

    Ishizaki, T; Maesawa, S; Nakatsubo, D; Yamamoto, H; Torii, J; Mutoh, M; Natsume, J; Hoshiyama, M; Saito, R

    SCIENTIFIC REPORTS   Vol. 13 ( 1 ) page: 10632   2023.6

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    This work aimed to investigate the involvement of the thalamic nuclei in mesial temporal lobe epilepsy (MTLE) and identify the influence of interictal epileptic discharges on the neural basis of memory processing by evaluating the functional connectivity (FC) between the thalamic nuclei and default mode network-related area (DMNRA) using magnetoencephalography. Preoperative datasets of nine patients with MTLE with seizure-free status after surgery and those of nine healthy controls were analyzed. The FC between the thalamic nuclei (anterior nucleus [ANT], mediodorsal nucleus [MD], intralaminar nuclei [IL]), hippocampus, and DMNRA was examined for each of the resting, pre-spike, spike, and post-spike periods in the delta to ripple bands using magnetoencephalography. The FC between the ANT, MD, hippocampus, and medial prefrontal cortex increased in the gamma to ripple bands, whereas the FC between the ANT, IL, and DMNRA decreased in the delta to beta bands, compared with that of the healthy controls at rest. Compared with the rest period, the pre-spike period had significantly decreased FC between the ANT, MD, and DMNRA in the ripple band. Different FC changes between the thalamic nuclei, hippocampus, and DMNRA of specific connections in a particular band may reflect impairment or compensation in the memory processes.

    DOI: 10.1038/s41598-023-37834-2

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  12. Differential target multiplexed spinal cord stimulation using a paddle-type lead placed at the appropriate site for neuropathic pain after spinal cord injury in patients with past spinal surgical histories: study protocol for an exploratory clinical trial

    Tanei, T; Maesawa, S; Nishimura, Y; Nagashima, Y; Ishizaki, T; Ando, M; Kuwatsuka, Y; Hashizume, A; Kurasawa, S; Saito, R

    TRIALS   Vol. 24 ( 1 ) page: 395   2023.6

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    Background: Neuropathic pain after spinal cord injury (SCI), both traumatic and non-traumatic, is refractory to various treatments. Spinal cord stimulation (SCS) is one of the neuromodulation therapies for neuropathic pain, although SCS has insufficient efficacy for neuropathic pain after SCI. The reasons are presumed to be inappropriate locations of SCS leads and conventional tonic stimulation itself does not have a sufficient analgesic effect for the pain. In patients with past spinal surgical histories, the cylinder-type leads are likely to be placed on the caudal side of the SCI because of surgical adhesions. Differential target multiplexed (DTM) stimulation is one of the latest new stimulation patterns that is superior to conventional stimulation. Methods: A single-center, open-label, randomized, two-way crossover trial is planned to investigate the efficacy of SCS using DTM stimulation placing a paddle lead at the appropriate site for neuropathic pain after SCI in patients with spinal surgical histories. The paddle-type lead delivers energy more efficiently than a cylinder-type lead. This study consists of two steps: SCS trial (first step) and SCS system implantation (second step). The primary outcome is rates of achieving pain improvement with more than 33% reduction 3 months after SCS system implantation. The secondary outcomes are to be evaluated as follows: (1) effectiveness of DTM and tonic stimulations during the SCS trial; (2) changes of assessment items from 1 to 24 months; (3) relationships between the result of the SCS trial and the effects 3 months after SCS system implantation; (4) preoperative factors associated with a long-term effect, defined as continuing for more than 12 months; and (5) whether gait function improves from 1 to 24 months. Discussion: A paddle-type lead placed on the rostral side of SCI and using DTM stimulation may provide significant pain relief for patients with intractable neuropathic pain after SCI in patients with past spinal surgical histories. Trial registration: Japan Registry of Clinical Trials (jRCT) jRCT 1042220093. Registered on 21 November 2022, and last modified on 6 January 2023. jRCT is approved as a member of the Primary Registry Network of WHO ICTRP.

    DOI: 10.1186/s13063-023-07433-7

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  13. Clinical Impacts of Stereotactic Electroencephalography on Epilepsy Surgery and Associated Issues in the Current Situation in Japan

    MAESAWA Satoshi, ISHIZAKI Tomotaka, MUTOH Manabu, ITO Yoshiki, TORII Jun, TANEI Takafumi, NAKATSUBO Daisuke, SAITO Ryuta

    Neurologia medico-chirurgica   Vol. 63 ( 5 ) page: 179 - 190   2023.5

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    <p>Stereotactic electroencephalography (SEEG) is receiving increasing attention as a safe and effective technique in the invasive evaluation for epileptogenic zone (EZ) detection. The main clinical question is whether the use of SEEG truly improves outcomes. Herein, we compared outcomes in our patients after three types of intracranial EEG (iEEG): SEEG, the subdural electrode (SDE), and a combined method using depth and strip electrodes. We present here our preliminary results from two demonstrative cases. Several international reports from large epilepsy centers found the following clinical advantages of SEEG: 1) three-dimensional analysis of structures, including bilateral and multilobar structures; 2) low rate of complications; 3) less pneumoencephalopathy and less patient burden during postoperative course, which allows the initiation of video-EEG monitoring immediately after implantation and does not require resection to be performed in the same hospitalization; and 4) a higher rate of good seizure control after resection. In other words, SEEG more accurately identified the EZ than the SDE method. We obtained similar results in our preliminary experiences under limited conditions. In Japan, as of August 2022, dedicated electrodes and SEEG accessories have not been approved and the use of the robot arm is not widespread. The Japanese medical community is hopeful that these issues will soon be resolved and that the experience with SEEG in Japan will align with that of large epilepsy centers internationally.</p>

    DOI: 10.2176/jns-nmc.2022-0271

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  14. 特集 脳神経外科医が知っておきたい-てんかんのすべて Ⅰ 脳神経外科医が知っておきたいてんかんの診断と検査 てんかん発作症候学と大脳皮質の機能解剖

    前澤 聡, 石﨑 友崇, 齋藤 竜太

    Neurological Surgery 脳神経外科   Vol. 51 ( 1 ) page: 17 - 28   2023.1

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    DOI: 10.11477/mf.1436204711

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  15. Cutoff values for the best management strategy for magnetic resonance-guided focused ultrasound ablation for essential tremor

    Torii, J; Maesawa, S; Nakatsubo, D; Tsugawa, T; Kato, S; Ishizaki, T; Takai, S; Shibata, M; Wakabayashi, T; Tsuboi, T; Suzuki, M; Saito, R

    JOURNAL OF NEUROSURGERY   Vol. 138 ( 1 ) page: 38 - 49   2023.1

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    OBJECTIVE The efficacy of magnetic resonance–guided focused ultrasound (MRgFUS) ablation for essential tremor (ET) is well known; however, no prognostic factors have been established. The authors aimed to retrospectively investigate MRgFUS ablation outcomes and associated factors and to define the cutoff values for each prognostic factor. METHODS Sixty-four Japanese patients who underwent unilateral ventral intermediate nucleus thalamotomy with MRgFUS for ET were included. Follow-up evaluations were performed at 1 week and 1, 3, 6, 12, and 24 months postoperatively. Tremor suppression was evaluated using the Clinical Rating Scale for Tremor (CRST), and adverse effects were recorded postoperatively. Outcome-associated factors were examined preoperatively, intraoperatively, and postoperatively using multivariate analyses. The cutoff values for the prognostic factors were calculated using receiver operating characteristics. RESULTS Percentage improvements in the CRST scores of the affected upper limb were 82.4%, 72.2%, 68.6%, and 65.9% at 1, 3, 6, and 12 months, respectively. Preoperatively, a high skull density ratio (SDR) (p ≤ 0.047), low CRST part B score (used to assess tremors during several tasks) (cutoff value 25, p ≤ 0.041), and nonoccurrence of resting tremors (p = 0.027) were significantly associated with improved tremor control. An intraoperatively high maximum mean temperature (cutoff value 52.5°C, p ≤ 0.047), postoperatively large lesion (cutoff value 3.9 mm in the anterior-posterior direction, p ≤ 0.002; cutoff value 5.0–5.55 mm in the superior-inferior direction, p ≤ 0.026), and small transducer focus correction (p ≤ 0.015) were also associated with improved tremor control. No valid cutoff value was found for SDR. Adverse effects (limb weakness, sensory disturbance, ataxia/walking disturbance, dysgeusia, dysarthria, and facial swelling) occurred transiently and were associated with high SDR, high temperature, high number of sonication sessions, large lesion, and occurrence of resting tremor. Patients who developed leg weakness experienced greater percentage improvement in tremors at 3 months postoperatively than those who did not. CONCLUSIONS MRgFUS ablation could be used to achieve good tremor control with acceptable adverse effects in Japanese patients with ET. The relatively low SDR in Asian ethnic groups as compared with that of Western populations makes treatment difficult; however, the cutoff values obtained in this study may be useful for achieving good treatment outcomes even in such patients.

    DOI: 10.3171/2022.3.JNS212460

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  16. A case report: Dual-lead deep brain stimulation of the posterior subthalamic area and the thalamus was effective for Holmes tremor after unsuccessful focused ultrasound thalamotomy

    Maesawa, S; Torii, J; Nakatsubo, D; Noda, H; Mutoh, M; Ito, Y; Ishizaki, T; Tsuboi, T; Suzuki, M; Tanei, T; Katsuno, M; Saito, R

    FRONTIERS IN HUMAN NEUROSCIENCE   Vol. 16   page: 1065459   2022.12

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    Holmes tremor is a symptomatic tremor that develops secondary to central nervous system disorders. Stereotactic neuromodulation is considered when the tremors are intractable. Targeting the ventral intermediate nucleus (Vim) is common; however, the outcome is often unsatisfactory, and the posterior subthalamic area (PSA) is expected as alternative target. In this study, we report the case of a patient with intractable Holmes tremor who underwent dual-lead deep brain stimulation (DBS) to stimulate multiple locations in the PSA and thalamus. The patient was a 77-year-old female who complained of severe tremor in her left upper extremity that developed one year after her right thalamic infarction. Vim-thalamotomy using focused ultrasound therapy (FUS) was initially performed but failed to control tremor. Subsequently, we performed DBS using two leads to stimulate four different structures. Accordingly, one lead was implanted with the aim of targeting the ventral oralis nucleus (Vo)/zona incerta (Zi), and the other with the aim of targeting the Vim/prelemniscal radiation (Raprl). Electrode stimulation revealed that Raprl and Zi had obvious effects. Postoperatively, the patient achieved good tremor control without any side effects, which was maintained for two years. Considering that she demonstrated resting, postural, and intention/action tremor, and Vim-thalamotomy by FUS was insufficient for tremor control, complicated pathogenesis was presumed in her symptoms including both the cerebellothalamic and the pallidothalamic pathways. Using the dual-lead DBS technique, we have more choices to adjust the stimulation at multiple sites, where different functional networks are connected. Intractable tremors, such as Holmes tremor, may have complicated pathology, therefore, modulating multiple pathological networks is necessary. We suggest that the dual-lead DBS (Vo/Raprl and Vim/Zi) presented here is safe, technically feasible, and possibly effective for the control of Holmes tremor.

    DOI: 10.3389/fnhum.2022.1065459

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  17. Magnetic resonance-guided focused ultrasound thalamotomy restored distinctive resting-state networks in patients with essential tremor

    Kato, S; Maesawa, S; Bagarinao, E; Nakatsubo, D; Tsugawa, T; Mizuno, S; Kawabata, K; Tsuboi, T; Suzuki, M; Shibata, M; Takai, S; Ishizaki, T; Torii, J; Mutoh, M; Saito, R; Wakabayashi, T; Katsuno, M; Ozaki, N; Watanabe, H; Sobue, G

    JOURNAL OF NEUROSURGERY   Vol. 138 ( 2 ) page: 306 - 317   2022.2

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    Language:English   Publisher:Journal of Neurosurgery  

    OBJECTIVE Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy ameliorates symptoms in patients with essential tremor (ET). How this treatment affects canonical brain networks has not been elucidated. The purpose of this study was to clarify changes of brain networks after MRgFUS thalamotomy in ET patients by analyzing resting-state networks (RSNs). METHODS Fifteen patients with ET were included in this study. Left MRgFUS thalamotomy was performed in all cases, and MR images, including resting-state functional MRI (rsfMRI), were taken before and after surgery. MR images of 15 age- and sex-matched healthy controls (HCs) were also used for analysis. Using rsfMRI data, canonical RSNs were extracted by performing dual regression analysis, and the functional connectivity (FC) within respective networks was compared among pre-MRgFUS patients, post-MRgFUS patients, and HCs. The severity of tremor was evaluated using the Clinical Rating Scale for Tremor (CRST) score pre- and postoperatively, and its correlation with RSNs was examined. RESULTS Preoperatively, ET patients showed a significant decrease in FC in the sensorimotor network (SMN), primary visual network (VN), and visuospatial network (VSN) compared with HCs. The decrease in FC in the SMN correlated with the severity of tremor. After MRgFUS thalamotomy, ET patients still exhibited a significant decrease in FC in a small area of the SMN, but they exhibited an increase in the cerebellar network (CN). In comparison between pre- and post- MRgFUS patients, the FC in the SMN and the VSN significantly increased after treatment. Quantitative evaluation of the FCs in these three groups showed that the SMN and VSN increased postoperatively and demonstrated a trend toward those of HCs. CONCLUSIONS The SMN and CN, which are considered to be associated with the cerebello-thalamo-cortical loop, exhibited increased connectivity after MRgFUS thalamotomy. In addition, the FC of the visual network, which declined in ET patients compared with HCs, tended to normalize postoperatively. This could be related to the hypothesis that visual feedback is involved in tremor severity in ET patients. Overall, the analysis of the RSNs by rsfMRI reflected the patho-physiology with the intervention of MRgFUS thalamotomy in ET patients and demonstrated a possibility of a biomarker for successful treatment.

    DOI: 10.3171/2022.5.JNS22411

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  18. Multitier Network Analysis Using Resting-state Functional MRI for Epilepsy Surgery

    MAESAWA Satoshi, BAGARINAO Epifanio, NAKATSUBO Daisuke, ISHIZAKI Tomotaka, TAKAI Sou, TORII Jun, KATO Sachiko, SHIBATA Masashi, WAKABAYASHI Toshihiko, SAITO Ryuta

    Neurologia medico-chirurgica   Vol. 62 ( 1 ) page: 45 - 55   2022

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    Language:English   Publisher:The Japan Neurosurgical Society  

    <p>Resting-state functional MRI (rs-fMRI) has been utilized to visualize large-scale brain networks. We evaluated the usefulness of multitier network analysis using rs-fMRI in patients with focal epilepsy. Structural and rs-fMRI data were retrospectively evaluated in 20 cases with medically refractory focal epilepsy, who subsequently underwent surgery. First, structural changes were examined using voxel-based morphometry analysis. Second, alterations in large-scale networks were evaluated using dual-regression analysis. Third, changes in cortical hubs were analyzed and the relationship between aberrant hubs and the epileptogenic zone (EZ) was evaluated. Finally, the relationship between the hubs and the default mode network (DMN) was examined using spectral dynamic causal modeling (spDCM). Dual-regression analysis revealed significant decrease in functional connectivity in several networks including DMN in patients, although no structural difference was seen between groups. Aberrant cortical hubs were observed in and around the EZ (EZ hubs) in 85% of the patients, and a strong degree of EZ hubs correlated to good seizure outcomes postoperatively. In spDCM analysis, facilitation was often seen from the EZ hub to the contralateral side, while inhibition was seen from the EZ hub to nodes of the DMN. Some cognition-related networks were impaired in patients with focal epilepsy. The EZ hub appeared in the vicinity of EZ facilitating connections to distant regions in the early phase, which may eventually generate secondary focus, while inhibiting connections to the DMN, which may cause cognitive deterioration. Our results demonstrate pathological network alterations in epilepsy and suggest that earlier surgical intervention may be more effective.</p>

    DOI: 10.2176/nmc.oa.2021-0173

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Books 1

  1. Superhydrophobic Anticorrosion Coating

    Ishizaki T., Furukawa T., Kamiyama N., Saito N., Takai O.

    Handbook of Self-Cleaning Surfaces and Materials: From Fundamentals to Applications: Volumes 1 and 2  2023.1  ( ISBN:9783527351367

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    In this chapter, we introduce two types of superhydrophobic films formed on AZ31 magnesium alloy. One was fabricated by plasma chemical vapor deposition (CVD), and the other was prepared by two-step immersion processes. These film surfaces showed a static water contact angle of more than 150°. The hydrophobicity and root mean square roughness of the film surface increased with an increase in deposition or immersion time. The durability of these superhydrophobic surfaces in corrosive 5 wt% NaCl aqueous solution was elucidated. The anticorrosion resistance of these films was estimated by potentiodynamic polarization curve and electrochemical impedance spectroscopy (EIS) measurements. The EIS measurements and appropriate equivalent circuit models revealed that these superhydrophobic films considerably improved the anticorrosion-resistant performance of magnesium alloy AZ31. The anticorrosion mechanism of these superhydrophobic films was also proposed.

    DOI: 10.1002/9783527690688.ch28

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