Hyper Smash

Central and Peripheral Nervous system


Special Editorial & Latest IONM topics

A new column and a Blog Special Editorial on Neuromonitoring was launched few days ago and it is Active now, did you visit, do you have your say or got questions, write to the emails of the author and blogger.

Thursday, January 16, 2014

Epilepsy: Drug Resistent Focal Epilepsy & Surgical Resection treatments, two Epilepsia Reports

Brain and Spine, 2014 Research Reports:
Full-size image (35 K)
Fig from-Link: Human Epilepsy Patterns, focal epilepsy,
The following two new research reports published in Epilepsia journal [quoted Epilepsy current]might be of interest to those Epilepsy doctors and professionals, ofcourse to Neurophysiologists and long term intraoperative monitoring field.

Quoted: Current Literature In Clinical Science
Are HFOs Still UFOs? The Known and Unknown About High Frequency Oscillations in Epilepsy Surgery

High-Frequency Oscillations, Extent of Surgical Resection, and Surgical Outcome in Drug-Resistant Focal Epilepsy.
Haegelen C, Perucca P, Chatillon CE, Andrade-Valenca L, Zelmann R, Jacobs J, Collins DL, Dubeau F, Olivier A, Gotman J.
Epilepsia 2013;54:848–857.
PURPOSE: Removal of areas generating high-frequency oscillations (HFOs) recorded from the intracerebral electroencephalography
(iEEG) of patients with medically intractable epilepsy has been found to be correlated with improved surgical outcome. However, whether differences exist according to the type of epilepsy is largely unknown. We performed a comparative assessment of the impact of removing HFO-generating tissue on surgical outcome between temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE). We also assessed the relationship between the extent of surgical resectionand surgical outcome.
Read the full abstract at: http://www.aesnet.org/files/dmfile/epcu_13.6_273_ClinicalCommentary_Jobst.pdf#!
And the Full article at Epilesia journal.

Ripple Classification Helps to Localize the Seizure-Onset Zone in Neocortical Epilepsy.
Wang S, Wang IZ, Bulacio JC, Mosher JC, Gonzalez-Martinez J, Alexopoulos AV, Najm IM, So NK.
 Epilepsia 2013;54:370–376.
PURPOSE: Fast ripples are reported to be highly localizing to the epileptogenic or seizure-onset zone (SOZ) but may not be readily found in neocortical epilepsy, whereas ripples are insufficiently localizing. Herein we classified interictal neocortical ripples by associated characteristics to identify a subtype that may help to localize the SOZ in neocortical epilepsy. We hypothesize that ripples associated with an interictal epileptiform discharge (IED) are more pathologic,since the IED is not a normal physiologic event.
For full abstract and article, refer as the previous.

Sunday, October 27, 2013

The Lancet Paper on "Spinal Cord Damage" -some improvement in Movements of Paralyzed Patients

The patient seems to have had the following type of spinal cord damage:
 The Lancet Quote "An individual three years post C7-T1 subluxation presented with a complete loss of clinically detectable voluntary motor function and partial preservation of sensation below the T1 cord segment" end of Quote.
In this interesting Lancet paper on neuronal recovery/functional recovery, the authors claims they have noticed significant improvement of Paralyzed patients after implant and electrical stimulation. This new positive results was not achieved by the same group in their own earlier clinical studies,  authors say "we have not seen such a result in their earlier research studies". 
Spinal cord stimulation studies been done both in lab rats as well as paralyzed patients. This is the latest report on paralyzed patients responding to stimulation with visible movements, it is interesting but we have long way to go to have a wholesome or meaningful treatment of spinal cord damages, it all comes to the extent of damage, and severity of neural paths that are severed by accidents......if the integrity of both afferent and efferent pathways are preserved with mild or minor damages, the recovery can be significant, in cases were more than 50% percent damages or even more severe, that determines the possibility of any recovery. In either case, it is good to read some results. And, when it is published in The Lancet, got to be little credible to listen to the news?..

Logo of nihpaAbout Author manuscriptsSubmit a manuscriptNIH Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;

Effect of Epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study


Epidural stimulation enabled the human lumbosacral spinal circuitry to dynamically elicit full weight-bearing standing with assistance provided only for balance for 4·25 minutes in a subject with a clinically motor complete SCI. This occurred when using stimulation at parameters optimized for standing while providing bilateral load-bearing proprioceptive input. Locomotor-like patterns were also observed when stimulation parameters were optimized for stepping. In addition, seven months after implantation, the subject recovered supraspinal control of certain leg movements, but only during epidural stimulation.

Friday, August 9, 2013

Orthopedic Surgeon Spyros Pranos Medical Fraud, 250 Law suits?.

Orthopedic surgeon Dr.Pranos seems to have  had detailed OP notes about treatments to his patients but that never took place?, hmmm....it seems he scheduled as large as 22 surgeries in a single day?, now he is under scrutiny and more than 250 law suits been filed.
Orthopedic Surgeon Sued Over Fraudulent Cases

Spyros Panos, MD, who practiced in suburban Dutchess County, N.Y., north of New York City, is said to have scheduled as many as 22 surgeries in a day, according to his former patients' attorneys. He has reportedly failed to adequately cement joint replacement components, implanted incorrect components and carried out an unneeded rotators cuff repair while ignoring a fractured clavicle.
Full Article: Link

Intraoperative Neurophysiological Monitoring guidelines & Societies!

Where to Look for Intraoperative Neuromonitoring Policies, standards and guidlines!!
ABNM American Board of Neurophysiologic Monitoring
ASNM The American Society of Neurophysiological Monitoring

American Clinical Neurophysiology Society
IFCN International Federation of Clinical Neurophysiology
ASET American Society of Electroneurodiagnostic Technologist
OSET International Organization of Societies for
Electrophysiological Technology

Other NeuroPhysiology Societies to look for more information
ABCN-American Board of Clinical Neurophysiology, Inc

Apart from these Main Societies, there are other organizations that provides technological platform and guidelines
List to be updated........!

Michael R. Isley and Roland C. Pearlman Strongly recommend neuromonitoring guidelines from the above societies!.