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Jeffrey G Ojemann

Publications and source records attributed to Jeffrey G Ojemann.

At least 19 recordsLinked to original sources
PubMed2007

Dexmedetomidine sedation during awake craniotomy for seizure resection: effects on electrocorticography.

Patients with refractory seizures may undergo awake craniotomy and cortical resection of the seizure area, using intraoperative functional mapping and electrocorticography (ECoG). We used dexmedetomidine in 6 patients, transitioning successively from the asleep-awake-asleep method, through a combined propofol/dexmedetomidine sedative infusion, to dexmedetomidine as the only sedation. Initial experience with the asleep-awake-asleep method in 2 patients was successful with the replacement of propofol/laryngeal mask anesthesia, 20 to 30 minutes before ECoG testing, by dexmedetomidine infusion, maintained at 0.2 mcg kg-1 h-1 throughout neurocognitive testing. Propofol anesthesia was reintroduced for resection. One patient received combined dexmedetomidine (0.2 mcg kg-1 h-1) and propofol (200 mcg kg-1 min-1) infusions for sedation. Both infusions were stopped 15 minutes before ECoG. Subsequently, they were restarted and the epileptic foci resected. Three patients received dexmedetomidine as the sole sedative agent, together with scalp block local anesthesia, and incremental boluses totaling 150 to 175 mcg of fentanyl per case. Dexmedetomidine was started with 0.3 mcg kg-1 boluses and maintained with 0.2 to 0.7 mcg kg-1 h-1for craniotomy, testing, and resection. The infusion was paused for 20 minutes in 1 patient to allow improvement in neurocognitive testing. This occurred within 10 minutes. All patients enjoyed good hemodynamic control, with blood pressure maintained within 20% of initial values, and made uneventful recoveries. The surgical conditions were all reported as favorable. Dexmedetomidine can be used singly for sedation in awake craniotomy requiring ECoG. Individual dose ranges vary, but a bolus of 0.3 mcg kg-1 with an infusion of 0.2 mcg kg-1 min-1 is a good starting point, allowing accurate mapping of epileptic foci and subsequent resection.

Adolescent↗
PubMed2006

Structured cueing on a semantic fluency task differentiates patients with temporal versus frontal lobe seizure onset.

Patients with frontal lobe dysfunction (e.g., Huntington's disease) reportedly benefit more from cueing on measures of semantic fluency than do patients with damage to temporal lobe structures (e.g., Alzheimer's disease). This differential benefit from cueing suggests that different neurocognitive functions are impaired in these two groups. Patients with frontal lobe dysfunction are presumed to have difficulty with the executive aspects of this generative fluency task, whereas patients with temporal lobe impairment are limited by deficits in semantic memory. We studied the performance of patients with complex partial seizures of frontal or temporal lobe onset, as determined by video/EEG monitoring, on standard and cued measures of semantic fluency administered in a counterbalanced sequence across groups. These groups did not differ significantly in terms of age, education, gender, age at seizure onset, total number of antiepileptic drugs, or IQ, and all patients subsequently underwent surgery for intractable epilepsy. Patients with frontal lobe dysfunction (FL group) performed significantly worse than patients with temporal lobe impairment (TL group) on the standard semantic fluency paradigm (TL group: M=18.4, SD=4.7; FL group: M=11.1, SD=5.3), t(27)=-3.75, P<0.001. Nevertheless, results of an ANCOVA demonstrated that the FL group showed significantly greater performance improvement than the TL group when provided with a cued semantic fluency format, even after controlling for baseline differences in ability on the standard semantic fluency task (TL group: M=0.45, SD=3.8; FL M=9.4, SD=5.1), F(1,29)=12.37, P=0.002. These findings support previous research suggesting that frontal and temporal structures contribute uniquely to semantic generative fluency and suggest that using a combination of standard and cued semantic fluency tasks may help confirm localization of seizure onset in partial epilepsy by localizing the associated cognitive dysfunction.

Adult↗
PubMed2006

Changing frontal contributions to memory before and after medial temporal lobectomy.

Frontal recruitment was characterized using functional magnetic resonance imaging (fMRI) during memory encoding in temporal lobe epilepsy (TLE) patients before and after unilateral medial temporal lobectomy. Twenty-four TLE patients and 12 healthy controls underwent a preoperative fMRI session consisting of verbal and nonverbal incidental memory-encoding tasks that typically lead to robust, lateralized frontal activity in controls. A similar postoperative fMRI session was performed in a subset of patients. Preoperatively, the verbal task resulted in significant additional recruitment of right frontal cortex in left TLE patients, compared with controls. Right TLE patients instead showed typically lateralized frontal activation. Bilateral frontal recruitment has been observed in older adults and in young adults in situations of difficult task demands. Typical right-lateralized patterns of frontal recruitment were found in both patient groups during the nonverbal task, indicating that the bilateral frontal recruitment pattern was engaged dynamically depending on the task. After surgery, left TLE patients regained more lateralized frontal activity. These results demonstrated differences in frontal recruitment in left and right TLE patients. Such differences emerged in specific task settings and were influenced by surgery, suggesting a dynamic mechanism of frontal recruitment that can be obtained in TLE patients, possibly as a response to presurgical dysfunction.

Adaptation, Physiological↗
PubMed2006

Vagus nerve stimulation for intractable seizures in children.

Forty-three children less than 12 years of age having intractable seizures were treated with vagus nerve stimulation. Five children were monitored for <12 months, 16 children for 12 to 17 months, and 22 children for > or =18 months with overall median seizure reduction of 55%. Thirty-seven percent had at least 90% reduction. Vagus nerve stimulation was effective in children with generalized, mixed, and partial medically refractory seizures.

Age Factors↗
PubMed2006

Electrocorticography-based brain computer interface--the Seattle experience.

Electrocorticography (ECoG) has been demonstrated to be an effective modality as a platform for brain-computer interfaces (BCIs). Through our experience with ten subjects, we further demonstrate evidence to support the power and flexibility of this signal for BCI usage. In a subset of four patients, closed-loop BCI experiments were attempted with the patient receiving online feedback that consisted of one-dimensional cursor movement controlled by ECoG features that had shown correlation with various real and imagined motor and speech tasks. All four achieved control, with final target accuracies between 73%-100%. We assess the methods for achieving control and the manner in which enhancing online control can be accomplished by rescreening during online tasks. Additionally, we assess the relevant issues of the current experimental paradigm in light of their clinical constraints.

Cerebral Cortex↗
PubMed2006

Use of dexmedetomidine in awake craniotomy in adolescents: report of two cases.

Awake craniotomy is a key tool in resection of lesions near critical functional regions, particularly the speech area. Craniotomy with an awake portion for mapping may be performed in carefully selected adolescents and preteenaged children. A number of different regimens may be used for sedation and anesthesia in these cases. We describe two adolescent patients in whom awake craniotomy was performed using an intravenous anesthesia technique with dexmedetomidine and without need for airway instrumentation.

Adolescent↗
PubMed2006

The emerging world of motor neuroprosthetics: a neurosurgical perspective.

A MOTOR NEUROPROSTHETIC device, or brain computer interface, is a machine that can take some type of signal from the brain and convert that information into overt device control such that it reflects the intentions of the user's brain. In essence, these constructs can decode the electrophysiological signals representing motor intent. With the parallel evolution of neuroscience, engineering, and rapid computing, the era of clinical neuroprosthetics is approaching as a practical reality for people with severe motor impairment. Patients with such diseases as spinal cord injury, stroke, limb loss, and neuromuscular disorders may benefit through the implantation of these brain computer interfaces that serve to augment their ability to communicate and interact with their environment. In the upcoming years, it will be important for the neurosurgeon to understand what a brain computer interface is, its fundamental principle of operation, and what the salient surgical issues are when considering implantation. We review the current state of the field of motor neuroprosthetics research, the early clinical applications, and the essential considerations from a neurosurgical perspective for the future.

Brain↗
PubMed2005

Primary hypothyroidism in a 12-year-old girl with a suprasellar pituitary mass: rapid regression after thyroid replacement therapy: case report.

The authors report on a 12-year-old girl with a suprasellar mass and primary hypothyroidism in whom the lesion promptly regressed following initiation of thyroid replacement therapy. Based on this experience, it is suggested that secondary pituitary hyperplasia be included in the differential diagnostic considerations of a suprasellar lesion in a child and that resolution of the hyperplasia may occur in a matter of weeks rather than months as previously reported.

Child↗
PubMed2004

Hand somatosensory cortex activity following selective dorsal rhizotomy: report of three cases with fMRI.

INTRODUCTION: Selective dorsal rhizotomy (SDR) is an effective treatment for lower extremity spasticity in cerebral palsy. Cortical organization in sensory cortex may be abnormal in cerebral palsy, and deafferentation is known to lead to cortical reorganization in many situations. METHODS: We used functional magnetic resonance imaging (fMRI) of hand sensory stimulation to determine if the partial deafferentation of the lower extremity sensory system, associated with SDR, led to any alterations in the cortical somatosensory representation for the upper limbs. Three patients with spastic diplegia were studied with blood oxygen level-dependent (BOLD)-fMRI before and after SDR. fMRI during tactile stimulation of the digits of the right hand was used to map hand somatosensory cortex. Comparison of the cortical maps devoted to the hand before and after SDR assessed for cortical reorganization following partial deafferentation of the lower extremity. RESULTS: In the one patient with upper extremity involvement, the hand sensory representation was markedly enhanced following SDR. In the other two patients, a normal pattern, but with diminished activity, was seen compared with preoperative findings. SDR for lower limb spastic diplegia does not lead to extensive reorganization of cortex dedicated to the representation of the upper limb. An essentially normal pattern of activation was seen both before and after SDR. CONCLUSION: The relief of attention demands associated with spasticity may explain the modulation in intensity seen after SDR in the patients who exhibited no upper extremity involvement despite lower limb spasticity.

Adolescent↗
PubMed2004

Functional reorganization of spatial transformations after a parietal lesion.

BACKGROUND: Mental spatial transformations are ubiquitous and necessary for everyday spatial cognition, such as packing luggage into a car or repairing a broken vase. The posterior parietal cortex is known to be involved in performing such transformations. OBJECTIVE: To measure reorganization after lesioning of posterior parietal cortex areas subserving spatial transformation. METHOD: Brain activity in a patient who underwent a resection of right parietal cortex to manage intractable epilepsy was measured using fMRI while he performed a set of spatial transformation tasks. These data were compared with data from a group of healthy control subjects. RESULTS: During spatial transformations, activity in the regions overlapping the resection was reduced in the patient compared with control subjects, but activity in the contralateral cortex was greater than that of control subjects. CONCLUSIONS: After a lesion the left hemisphere can adopt components of spatial reasoning normally subserved by the right hemisphere. This converges with evidence that components of language processing normally subserved by the left hemisphere can be taken over by the right hemisphere, suggesting that plasticity of function in the adult human cortex is a general characteristic.

Adult↗
PubMed2004

A brain-computer interface using electrocorticographic signals in humans.

Brain-computer interfaces (BCIs) enable users to control devices with electroencephalographic (EEG) activity from the scalp or with single-neuron activity from within the brain. Both methods have disadvantages: EEG has limited resolution and requires extensive training, while single-neuron recording entails significant clinical risks and has limited stability. We demonstrate here for the first time that electrocorticographic (ECoG) activity recorded from the surface of the brain can enable users to control a one-dimensional computer cursor rapidly and accurately. We first identified ECoG signals that were associated with different types of motor and speech imagery. Over brief training periods of 3-24 min, four patients then used these signals to master closed-loop control and to achieve success rates of 74-100% in a one-dimensional binary task. In additional open-loop experiments, we found that ECoG signals at frequencies up to 180 Hz encoded substantial information about the direction of two-dimensional joystick movements. Our results suggest that an ECoG-based BCI could provide for people with severe motor disabilities a non-muscular communication and control option that is more powerful than EEG-based BCIs and is potentially more stable and less traumatic than BCIs that use electrodes penetrating the brain.

Adult↗
PubMed2004

9p21 and 13q14 dosages in ependymomas. A clinicopathologic study of 101 cases.

Ependymomas are glial neoplasms whose clinical behavior is difficult to predict based on histology alone. Recently, a comparative genomic hybridization study identified frequent chromosome 9p and 13q losses in anaplastic ependymomas, suggesting that p16 and RB alterations may be involved in tumor progression. In order to test this hypothesis further, 101 myxopapillary, conventional, and anaplastic ependymomas (51 spinal and 50 intracranial tumors) were tested for RB and p16 deletions using fluorescence in situ hybridization. Clinical follow-up, ranging from 2 to 198 months (median 46 months), was obtained in 90 cases (91%). RB and p16 deletions were seen in 22 of 92 (24%) and 22 of 89 (25%) informative cases, respectively. Polysomies were more frequent in the grade I and II spinal tumors, consistent with prior reports of increased aneuploidy in such cases. No significant genetic associations were seen with tumor grade, recurrence, or death, suggesting that 9p and 13q deletions do not play a prominent role in the malignant progression of ependymomas, as has been implicated in other glioma subtypes.

Adolescent↗
PubMed2003

A procedure for identifying regions preferentially activated by attention to semantic and phonological relations using functional magnetic resonance imaging.

A procedure is introduced for using functional magnetic resonance imaging (fMRI) techniques to identify neural regions associated with attention to semantic and phonological aspects of written words within a single group of subjects. Short lists (16 words/list), consisting of visually-presented semantically-related words (bed, rest) or rhyming words (weep, beep) were presented rapidly to subjects, who were asked to attend to the relations among the words. Regions preferentially involved in attention to semantic relations appeared within left anterior/ventral inferior frontal gyrus (IFG, approximate Brodmann Area, BA47), left posterior/dorsal IFG (BA44/45), left superior/middle temporal cortex (BA22/21), left fusiform gyrus (BA37), and right cerebellum. Regions preferentially involved in attention to phonological relations appeared within left inferior frontal cortex (near BA6/44, posterior to the semantic regions within IFG described above) and within bilateral inferior parietal cortex (BA40) and precuneus (BA7). This method is notable in that a comparison of the two tasks within some of the individual subjects revealed activation patterns similar to the group average, especially within left inferior frontal and left superior/middle parietal cortices. This fact combined with the efficiency with which the data can be obtained (here, in about an hour of functional scanning) and the adaptability of the task for many different subject populations suggests a wide range of possibilities for this technique: it could be used to track language development (e.g. in children), compare language organization across subject populations (e.g. for dyslexic or blind subjects), and identify language regions within individuals (e.g. potentially to aid in surgical planning).

Adolescent↗
PubMed2003

Selective disturbance of mental rotation by cortical stimulation.

In order to plan activity, people must imagine the spatial consequences of potential actions. Two classes of mental spatial transformation can be distinguished: Object-based spatial transformations are imagined movements of objects, such as mental rotation. Egocentric perspective transformations are imagined changes in one's viewpoint, such as imagining one's self in the position of another person. Here we report a case in which electrical stimulation of the right parietal cortex selectively interfered with performance of a mental rotation task. Interference was selective to this stimulation site, and was task specific. Performance of the perspective transformation task, and a control for visual encoding and responding, were unimpaired by stimulation. This marks the first instance of the use of direct cortical stimulation to investigate mental spatial transformations.

Adult↗
PubMed2002

Intrathecal baclofen withdrawal: a case report and review of the literature.

INTRODUCTION: Spasticity is an endpoint of a variety of neurologic disorders with upper motor neuron damage. There have been several studies demonstrating improvement in spasticity through administration of intrathecal baclofen. Withdrawal from oral baclofen has been well described. Intrathecal baclofen withdrawal has been less frequently reported. We present a case of withdrawal after intrathecal baclofen pump catheter failure. PATIENT: A 14-year-old boy presented with fevers, which were thought to be related to recent spine surgery and possible pneumonia. Eventual workup revealed evidence of intrathecal baclofen withdrawal owing to pump catheter failure. His fevers, with temperatures of up to 40 degrees C, and painful muscle spasms resolved and his clinical condition improved after pump exploration and resumption of intrathecal delivery. CONCLUSIONS: Intrathecal baclofen withdrawal can be life threatening. Prompt recognition and restoration of an adequate intrathecal baclofen dose is essential for recovery.

Adolescent↗
PubMed2002

Intracranial infantile myofibromatosis with intraparenchymal involvement.

Infantile myofibromatosis is the most common fibrous disorder of infancy and early childhood. Intracranial involvement is rare, with the majority of lesions being localized to the skull or dura with variable intracranial extension. We present the case of a 19-month-old girl with infantile myofibromatosis and an incidentally discovered, enlarging, calcified, posterior fossa mass. The patient underwent suboccipital craniotomy and resection of the lesion. This is the first report of the surgical removal of an intraparenchymal infantile myofibroma.

Brain Neoplasms↗