• 대한의용생체공학회:의공학회지
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• 제36권4호
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• pp.95-102
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• 2015

Epilepsy is a chronic neurological disease which produces repeated seizures. Over 30% of epileptic patients cannot be treated with anti-epileptic drugs, and surgical resection may cause loss of brain functions. Seizure suppression by electrical stimulation is currently being investigated as a new treatment method as clinical evidence has shown that electrical stimulation to brain could suppress seizure activity. In this paper, design of a real-time closed-loop neurostimulation system for epileptic seizure suppression is presented. The system records neural signals, detects seizures and delivers electrical stimulation. The system consists of a 6-channel electrode, front-end amplifiers, a data acquisition board by National Instruments, and a neurostimulator and Generic Osorio-Frei algorithm was applied for seizure detection. The algorithm was verified through simulation using electroencephalogram data, and the operation of whole system was verified through simulation and in- vivo test.

• The Journal of Korean Physical Therapy
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• 제22권6호
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• pp.91-98
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• 2010

Neurostimulation approaches have been developed and explored to modulate neuroplastic changes of cortical function in human brain. As one of the most primary noninvasive tools, transcranial direct current stimulation (tDCS) was extensively studied in the field of neuroscience. The alternation of cortical neurons depending on the polarity of the tDCS has been used for improving cognitive processing including working memory, learning, and language in normal individuals, as well as in patients with neurological or psychiatric diseases. In addition, tDCS has great advantages: it is a non-invasive, painless, safe, and cost-effective approach to enhance brain function in normal subjects and patients with neurological disorders. Numerous previous studies have confirmed the efficacy of tDCS. However, tDCS has not been considered for clinical applications and research in the field of physical therapy. Therefore, this review will focus on the general principles of tDCS and its related application parameters, and provide consideration of motor behavioral research and clinical applications in physical therapy.

• The Korean Journal of Pain
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• 제21권2호
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• pp.155-158
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• 2008

This report presents the application of occipital nerve stimulation in two patients with severe and disabling bilateral occipital neuralgia. Pain persisted despite the use of several procedures and the administration of medication in the patients. The patients underwent peripheral nerve stimulation for the treatment of headache. Peripheral nerve stimulation was accomplished via implantation of a subcutaneous electrode to stimulate the peripheral nerve in the occipital area. The patients reported a 90% improvement in overall pain. These cases illustrate the possible utilization of peripheral nerve stimulation for the treatment of occipital neuralgia.

• The Journal of Korean Physical Therapy
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• 제21권4호
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• pp.73-79
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• 2009

Purpose: Recently, neurostimulation studies involving manipulation of cortical excitability of the human brain have been increasingly attempted. We investigated whether transcranial direct current stimulation (tDCS) applied to the underlying cerebral cortex, directly induces cortical activation during fMRI scanning. Methods: We recently recruited five healthy subjects without a neurological or psychiatric history and who were right-handed, as verified by the modified Edinburg Handedness Inventory. fMRI was done while constant anodal tDCS was delivered to the underlying SM1 area?? immediately after the pre-stimulation for eighteen minutes. Results: Group analysis yielded an averaged map that showed that the SM1 area and the superior parietal cortex in the ipsilateral hemisphere were activated. The voxel size and peak intensity were, respectively, 82 and 5.22 in the SM1, and 85 and 5.77 in the superior parietal cortex. Conclusion: Cortical activation can be induced by constant anodal tDCS of the underlying motor cortex. This suggests that tDCS may be an effective therapeutic device for enhancing? physical motor function by modulating neural excitability of the motor cortex.

• Annals of Clinical Neurophysiology
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• 제14권2호
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• pp.59-63
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• 2012

Epilepsy has continued to provide challenges to epileptologists, as a significant proportion of patients continue to suffer from seizures despite medical and surgical treatments. Deep brain stimulation (DBS) has emerged as a new therapeutic modality that has the potential to improve quality of life and occasionally be curative for patients with medically refractory epilepsy who are not surgical candidates. Several groups have used DBS in drug-resistant epilepsy cases for which resective surgery cannot be applied. The promising subcortical brain structures are anterior and centromedian nucleus of the thalamus, subthalamic nucleus, and other nuclei to treat epilepsy in light of previous clinical and experimental data. Recently two randomized trials of neurostimulation for controlling refractory epilepsy employed the strategies to stimulate electrodes placed on both anterior thalamic nuclei or near seizure foci in response to electroencephalographically detected epileptiform activity. However, the more large-scale, long-term clinical trials which elucidates optimal stimulation parameters, ideal selection criteria for epilepsy DBS should be performed before long. In order to continue to advance the frontier of this field, it is imperative to have a good grasp of the current body of knowledge.

• 구강회복응용과학지
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• 제35권4호
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• pp.199-205
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• 2019

흔한 중증 원발 두통 질환 중 하나인 편두통의 치료법에는 두통 일기 작성, 생활습관 개선, 운동 및 이완요법, 인지행동요법, 신경자극 등을 비롯한 비약물치료와 약물치료 등 다양한 전략이 있다. 본 종설은 이 중 약물 치료를 두통의 강도와 빈도에 기반하여 급성기치료와 예방치료로 나누어 고찰하고, 약물 치료의 효과를 극대화 시키기 위한 방법 및 편두통 치료의 최신 지견을 소개하고자 한다.

• Journal of Korean Neurosurgical Society
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• 제62권3호
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• pp.361-365
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• 2019

Epilepsy has been known to humankind since antiquity. The surgical treatment of epilepsy began in the early days of neurosurgery and has developed greatly. Many surgical procedures have stood the test of time. However, clinicians treating epilepsy patients are now witnessing a huge tide of change. In 2017, the classification system for seizure and epilepsy types was revised nearly 36 years after the previous scheme was released. The actual difference between these systems may not be large, but there have been many conceptual changes, and clinicians must bid farewell to old terminology. Paradigms in drug discovery are changing, and novel anti-seizure drugs have been introduced for clinical use. In particular, drugs that target genetic changes harbor greater therapeutic potential than previous screening-based compounds. The concept of focal epilepsy has been challenged, and now epilepsy is regarded as a network disorder. With this novel concept, stereotactic electroencephalography (SEEG) is becoming increasingly popular for the evaluation of dysfunctioning neuronal networks. Minimally invasive ablative therapies using SEEG electrodes and neuromodulatory therapies such as deep brain stimulation and vagus nerve stimulation are widely applied to remedy dysfunctional epilepsy networks. The use of responsive neurostimulation is currently off-label in children with intractable epilepsy.

• 생물정신의학
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• 제24권4호
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• pp.167-174
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• 2017

Based on advances in biotechnology and neuroscience, neuromodulation is poised to gain clinical importance as a treatment modality for psychiatric disorders. In addition to old-established electroconvulsive therapy (ECT), clinicians are expected to understand newer forms of neurostimulation, such as deep brain stimulation (DBS), vagus nerve stimulation (VNS), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS). Given the growing interest in non-invasive neuromodulation technologies, clinicians may seek sufficient information about neuromodulation to inform their clinical practice. A growing literature suggests that applications of non-invasive neuromodulation have evidence particularly for indications where treatments are currently insufficient, such as drug-resistant depression. However, positive neuromodulation studies require replication, and the precise interactions among stimulation, antidepressant medication, and psychotherapy are unknown. Further studies of long-term safety and the impact on the developing brain are needed. Non-invasive neuromodulatory devices could enable more individualized treatment. However, do-it-yourself (DIY) stimulation kits require a better understanding of the effects of more frequent patterns of stimulation and raise concerns about clinical supervision, regulation, and reimbursement. Wide spread enthusiasm for therapeutic potential of neuromodulation in clinical practice settings should be mitigated by the fact that there are still research gaps and challenges associated with non-invasive neuromodulatory devices.

• The Korean Journal of Pain
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• 제29권2호
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• pp.123-128
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• 2016

Phantom limb pain is a phenomenon in which patients experience pain in a part of the body that no longer exists. In several treatment modalities, spinal cord stimulation (SCS) has been introduced for the management of intractable post-amputation pain. A 46-year-old male patient complained of severe ankle and foot pain, following above-the-knee amputation surgery on the right side amputation surgery three years earlier. Despite undergoing treatment with multiple modalities for pain management involving numerous oral and intravenous medications, nerve blocks, and pulsed radiofrequency (RF) treatment, the effect duration was temporary and the decreases in the patient's pain score were not acceptable. Even the use of SCS did not provide completely satisfactory pain management. However, the trial lead positioning in the cauda equina was able to stimulate the site of the severe pain, and the patient's pain score was dramatically decreased. We report a case of successful pain management with spinal cauda equina stimulation following the failure of SCS in the treatment of intractable phantom limb pain.