• Clinical Psychopharmacology and Neuroscience
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• v.16 no.4
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• pp.494-496
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• 2018

No previous reports have described a case in which deep brain stimulation elicited an acute mood swing from a depressive to manic state simply by switching one side of the bilateral deep brain stimulation electrode on and off. The patient was a 68-year-old woman with a 10-year history of Parkinson's disease. She underwent bilateral subthalamic deep brain stimulation surgery. After undergoing surgery, the patient exhibited hyperthymia. She was scheduled for admission. On the first day of admission, it was clear that resting tremors in the right limbs had relapsed and her hyperthymia had reverted to depression. It was discovered that the left-side electrode of the deep brain stimulation device was found to be accidentally turned off. As soon as the electrode was turned on, motor impairment improved and her mood switched from depression to mania. The authors speculate that the lateral balance of stimulation plays an important role in mood regulation. The current report provides an intriguing insight into possible mechanisms of mood swing in mood disorders.

• Journal of Korean Neurosurgical Society
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• v.65 no.5
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• pp.640-651
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• 2022

Clinical studies on neuromodulation intervention for trigeminal neuralgia have not yet shown promising results. This might be due to the fact that the pathophysiology of chronic trigeminal neuropathy is not yet fully understood. Chronic trigeminal neuropathy includes trigeminal autonomic neuropathy, painful trigeminal neuropathy, and persistent idiopathic facial pain. This disorder is caused by complex abnormalities in the pain processing system, which is comprised of the affective, emotional, and sensory components, rather than mere abnormal sensation. Therefore, integrative understanding of the pain system is necessary for appropriate neuromodulation of chronic trigeminal neuropathy. The possible neuromodulation targets that participate in complex pain processing are as follows : the ventral posterior medial nucleus, periaqueductal gray, motor cortex, nucleus accumbens, subthalamic nucleus, globus pallidus internus, anterior cingulate cortex, hypothalamus, sphenopalatine ganglion, and occipital nerve. In conclusion, neuromodulation interventions for trigeminal neuralgia is yet to be elucidated; future advancements in this area are required.

• Annals of Clinical Neurophysiology
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• v.14 no.2
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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.

• Journal of Yeungnam Medical Science
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• v.19 no.2
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• pp.136-143
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• 2002

Even though the nonketotic hyperglycemia is a metabolic disorder, it complicates hemichorea-hemiballism rarely. Moreover, generalized chorea-ballism associated with nonketotic hyperglycemia in diabetes mellitus is very rare, so it has not been reported in Korean literature. Although the precise pathophysiologic mechanisms of these disorders are still poorly understood, deficiency of gamma aminobutyric acid (GABA) in nonketotic hyperglycemia or reduced GABAnergic inhibition by striatal lesion may increase inhibitory output to subthalamic nucleus. These result loss of pallidal inhibition and produce contralateral hemichorea-hemiballism. The striatal lesions, such as transient ischemia with reactive astrocytosis or small amount of petechial hemorrhage, are related with changes of magnetic resonance image (MRI) findings presumably. We report a diabetic old woman who developed generalized chorea-ballismus as a very rare complication of nonketotic hyperglycemia. Her brain MRI showed high signal intensity in left lentiform nucleus and right pallidum on T1 weighted images and low signal intensity in bilateral putamen on T2 weighted images with highly enhanced corresponding lesions on T1 weighted enhancement images.

• Animal cells and systems
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• v.2 no.1
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• pp.71-80
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• 1998

Glutamate dehydrogenase (GDH) is one of the main enzymes involved in the formation and metabolism of the neurotransmitter glutamate. In the present study, we investigated the distribution of the GDH-immunoreactive cells in the rat brain using monoclonal antibodies against bovine brain GDH isoprotein. GDH-immunoreactive cell were distributed in the basal ganglia, thalamus and the nuclei belong to substantia innominata, and its connecting area, subthalamic nucleus, zona incerta, and substantia niqra. We could see GDH-immunoreactive cells in the hippocampus, septal nuclei associated with the limbic system, the anterior thalamic nuclei connecting between the hypothalamus and limbic system, and its associated structures, amygdaloid nuclear complex, the dorsal raphe and median raphe nuclei and the reticular formation of the midbrain. The GDH-immunoreactive cells were shown in the pyramidal neurons of the cerebral cortex, the Purkinie cells of the cerebella cortex, their associated structures, ventral thalamic nuclei and the reticular thalamic nuclei that seem to function as neural conduction in the thalamus.

• Journal of Korean Neurosurgical Society
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• v.54 no.6
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• pp.453-460
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• 2013

Objective : There is a rich literature confirming the default mode network found compatible with task-induced deactivation regions in normal subjects, but few investigations of alterations of the motor deactivation in patients with intracranial lesions. Therefore, we hypothesized that an intracranial lesion results in abnormal changes in a task-induced deactivation region compared with default mode network, and these changes are associated with specific attributes of allocated regions. Methods : Blood oxygenation level dependent (BOLD) functional magnetic resonance imaging (fMRI) during a motor task were obtained from 27 intracranial lesion patients (mean age, 57.3 years; range 15-78 years) who had various kinds of brain tumors. The BOLD fMRI data for each patient were evaluated to obtain activation or deactivation regions. The distinctive deactivation regions from intracranial lesion patients were evaluated by comparing to the literature reports. Results : There were additive deactivated regions according to intracranial lesions : fusiform gyrus in cavernous hemangioma; lateral occipital gyrus in meningioma; crus cerebri in hemangiopericytoma; globus pallidus, lateral occipital gyrus, caudate nucleus, fusiform gyrus, lingual gyrus, claustrum, substantia nigra, subthalamic nucleus in GBM; fusiform gyrus in metastatic brain tumors. Conclusion : There is increasing interest in human brain function using fMRI. The authors report the brain function migrations and changes that occur in patients with intracranial lesions.

• Journal of the Korean Society for Precision Engineering
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• v.29 no.9
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• pp.1035-1040
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• 2012

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been found to be effective treatment of Parkinson's disease (PD). This study aims to evaluate the effect of DBS for rigidity during DBS surgery. Six Parkinsonian patients who received STN-DBS surgery participated in this study. The examiner imposed flexion and extension of a patient's wrist randomly. Resistance to passive movement was quantified by viscoelastic properties (two damping constants for each of flexion and extension phase and one spring constant throughout both phases). All Viscoelastic constants decreased by DBS (p<0.01). Specifically, reduction in damping constant during flexion ($B_f$) was greater than those of damping constant during extension ($B_e$) and of spring constant (p<0.05). $B_f$ would be appropriate for evaluation of effect of DBS for rigidity during DBS surgery.

• Korean Journal of Clinical Laboratory Science
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• v.51 no.4
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• pp.468-474
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• 2019

Deep brain stimulation (DBS) is an effective surgical procedure for treating drug refractory movement disorders, and DBS involves delivering high frequency electrical stimulation to deep brain nuclei. Microelectrode recording (MER) is a complementary test that can precisely identify the location of deep brain nuclei, along with MRI correlation, during DBS surgery to improve the surgical outcome and minimize side effects. The purpose of this paper is to analyze the neuro-physiological waveforms and identify the usefulness of MER by analyzing the MER performed during DBS surgery for treating movement disorders. We retrospectively reviewed 28 patients who underwent MER during DBS surgery for movement disorders from January to December 2018. Of the 28 patients, 38 MERs for the subthalamic nucleus (STN), 10 MERs for the globuspallidusinternus (Gpi), and 4 MERs for the ventral intermediate thalamic nucleus (VIM) were performed. In all the cases, the target sites were found and micro-stimulations were used to check for side effects and to readjust the target sites. The clinical symptoms of all 28 patients improved after surgery. In conclusion, MER is a useful test that employs neuro-physiological waveforms to accurately identify the deep brain nuclei, along with MRI correlation, to improve the DBS surgical outcomes for movement disorders and to minimize side effects.

• Journal of Korean Neurosurgical Society
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• v.44 no.1
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• pp.26-35
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• 2008

Objective : In the evaluation of patients with Parkinson's disease (PD), most neurologists only see their patients during a limited period of their fluctuating 24-hour-a-day lives. This study aimed to assess the short-term outcome of STN stimulation for patients with advanced PD evaluated in a 24-hour monitoring unit for movement disorder (MUMD) using a prospective protocol. Methods : Forty-two patients with advanced PD consecutively treated with bilateral STN stimulation using multi-channel microelectrode recording were included in this study. All patients were evaluated using a 24-hour MUMD with a video recording/editing system and were evaluated with a prospective protocol of the Unified Parkinson's Disease Rating Scale, Hoehn and Yahr Staging, Schwab and England Activities of Daily Living, levodopa equivalent daily dose (LEDD), Short Form-36 Health Survey, and neuropsychological tests. Magnetic resonance (MR) images of the brain were performed prior to and six months after surgery. Results : All patients were evaluated at three and six months after surgery. There was a rapid and significant improvement of the motor symptoms, especially in tremor and rigidity, after STN stimulation with low morbidity. Dyskinesia was markedly decreased with much lowered LEDD values by 50% after STN stimulation. 1.5T MR images were safely taken according to the manufacturer's guidelines at six months after surgery without any adverse effects in 41 patients treated with STN stimulations. Conclusion : Evaluations in a 24-hour monitoring unit could reduce the dose of medication efficiently to an optimal level with patients' comfort and improve the clinical symptoms in harmony with STN stimulation.