To determine the medium-term maternal impact of open fetal spina bifida repair.
Prospective cohort study.
University Hospitals Leuven, Belgium.
Mothers who had open maternal-fetal spina bifida repair ...between March 2012 and December 2021.
A patient-reported survey on subsequent fertility, pregnancy, and gynaecological and psychological outcomes.
Complications during subsequent pregnancies, and gynaecological and psychological problems.
Seventy-two out of 100 invited women completed the questionnaire (72%). Despite being advised not to, seven of 13 women attempting to conceive became pregnant within 2 years after fetal surgery and one woman delivered vaginally. Two of the 16 subsequent pregnancies were complicated by an open neural tube defect. One pregnancy was complicated by a placenta accreta and one pregnancy was complicated by a uterine rupture, both with good neonatal outcomes. Nearly half of respondents who did not attempt to conceive reported that this was because of their experience of the index pregnancy and caring for the index child. Three out of four respondents reported medium-term psychological problems, mostly anxiety for the health of the index child, fear for recurrence in subsequent pregnancies and feelings of guilt.
Open maternal-fetal surgery for spina bifida did not appear to affect fertility in our cohort. Half of the attempts to conceive took place within 2 years. One uterine rupture and one placenta accreta occurred in 16 subsequent pregnancies. Most respondents reported psychological problems linked to the index pregnancy, which reinforces the need for long-term psychological support.
Abstract
INTRODUCTION
Treatment-resistant obsessive-compulsive disorder can be treated with a number of different surgical procedures targeting the limbic circuitry; however, within this circuit, ...there are unexplored targets. The objective of this study is to determine the safety and initial efficacy of inferior thalamic peduncle deep brain stimulation in patients with severe obsessive-compulsive disorder.
METHODS
We performed an open-label, unblinded phase 1 pilot study examining the effects of bilateral inferior thalamic peduncle deep brain stimulation for severe treatment-refractory obsessive-compulsive disorder. The primary outcome was safety, as reported in intraoperative and postoperative visits. The initial efficacy was determined by Y-BOCs scores. Component Y-BOCs scores, Hamilton Depression Severity Scale, Quality of Life Assessment (SF-36), Oxford Happiness Questionnaire, Warwick-Edinburgh Mental Well-Being Scale, and Sheehan Disability Scale were also analyzed for a minimum of 2 yr after implantation.
RESULTS
Five patients (2 males, 3 females; age range: 25-48 yr) were implanted with bilateral inferior thalamic peduncle deep brain stimulation. At 2 yr follow-up, there were no mortalities; however, there were 3 adverse events. One patient had the DBS system removed after 1 yr due to the device becoming part of the obsession. The other 2 adverse events occurred in 1 patient and were not related to the device. All 5 patients were considered responders (52% improvement in Y-BOCs scores compared to baseline (range: 39-73%), P < .01).
CONCLUSION
Inferior thalamic peduncle deep brain stimulation is a safe and potentially efficacious treatment for severe obsessive-compulsive disorder. Further studies are necessary to determine efficacy.
Central poststroke pain (CPSP) is a severe type of neuropathic pain that can develop after stroke and is difficult to treat. Research into its underlying mechanisms and treatment options could ...benefit from a valid CPSP animal model. Nine different CPSP animal models have been published, but there are relatively few reports on successful reproductions of these models and so far only little advances in the understanding or the management of CPSP have been made relying on these models. In general, the construct validity (similarity in underlying mechanisms) of these CPSP animal models is relatively high, although this cannot be evaluated into depth because of lack of understanding the mechanisms through which thalamic stroke can lead to CPSP. The face validity (symptom similarity) is relatively low, mainly because pain in these models is tested almost exclusively through evoked mechanical/thermal hypersensitivity assessed by reflexive measures and given the conflicting results with similar tests in patients with CPSP. The predictive validity (similarity in treatment efficacy) has not been evaluated in most models and incorporates difficulties that are specific to CPSP. We compare the different models regarding these types of validity and discuss the robustness, reproducibility, and problems regarding the design and reporting of the articles establishing these models. We conclude with various proposals on how to improve the validity and reproducibility of CPSP animal models. Until further improvements are achieved, prudence is called for in interpreting results obtained through these models.
Central poststroke pain (CPSP) is a debilitating and often treatment-refractory condition that affects numerous stroke patients. The location of lesions most likely to cause pain and the identity of ...the functional brain networks that they impinge upon remain incompletely understood. We aimed to (1) elucidate which lesion locations are most frequently accompanied by pain; (2) explore CPSP-associated functional networks; and (3) examine how neuromodulation interacts with these networks. This multisite study investigated 17 CPSP patients who received deep brain stimulation (DBS; n = 12) or motor cortex stimulation (MCS; n = 5). Pain-causing lesions were manually segmented and normalized to standard space. To identify areas linked to high risk of pain, the locations of CPSP lesions and 220 control lesions were compared using voxelwise odds ratio mapping. The functional connectivity of pain-causing lesions was obtained using a large (n = 1000) normative resting-state functional MRI connectome and compared to that of control lesions and therapeutic DBS activation volumes. Brain regions most associated with CPSP risk (highest value = 63 times) were located along the ascending somatosensory pathways. These areas and the majority of individual CPSP lesions were functionally connected to anterior/middle cingulate cortex, insula, thalamus, and inferior parietal lobule (PBonferroni < 0.05). The extent of connectivity to the thalamus, inferior parietal lobule, and precuneus also differed between CPSP and control lesions (PBonferroni < 0.05). Posterior insula and thalamus shared connectivity with both CPSP lesions and pain-alleviating DBS activation volumes (PBonferroni < 0.05). These findings further clarify the topography and functional connectivity of pain-causing brain lesions, and provide new insights into the network-level mechanism of CPSP neuromodulation.
The authors report the case of an elderly male in his 60s who, after 5 months of efficacious treatment with chronic deep brain stimulation of the subthalamic nucleus (STN-DBS), developed a ...hardware-related erosion necessitating removal of the complete DBS system. One and a half years following the first implantation, a new STN-DBS system was implanted along an immediately adjacent trajectory, and reproduction of clinical efficacy was reported. Additionally, 2 microstimulation protocols were compared between the 2 surgeries, i.e., one to assess the stimulation frequency response of STN neurons and another to assess inhibitory synaptic plasticity in the substantia nigra pars reticulata (SNr). The spontaneous neuronal firing rates of STN neurons in each hemisphere were also compared between the 2 surgeries. The results suggest that the frequency-sensitivity of STN neurons may have been reduced (i.e., more resistant to neuronal suppression), while the spontaneous baseline firing rates of STN neurons and the plasticity measured in the SNr remained unchanged (2 factors that may be indicative of neurodegenerative processes).
•Normal-range electrical impedances can be measured from fractured DBS electrodes.•Only combining impedance measurements and imaging can rule out electrode fractures.•This is probably the first ...reported open DBS electrode fracture resulting from a fall.
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