Chikashi Fukaya

Nihon University, Edo, Tōkyō, Japan

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Publications (100)170.85 Total impact

  • Chikashi Fukaya · Takamitsu Yamamoto ·
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    ABSTRACT: To date, deep brain stimulation (DBS) has already been performed on more than 120,000 patients worldwide and in more than 7,000 patients in Japan. However, fundamental understanding of DBS effects on the pathological neural circuitry remains insufficient. Recent studies have specifically shown the importance of cortico-striato-thalamo-cortical (CSTC) loops, which were identified as functionally and anatomically discrete units. Three main circuits exist in the CSTC loops, namely, the motor, associative, and limbic circuits. From these theoretical backgrounds, it is determined that DBS sometimes influences not only motor functions but also the cognitive and affective functions of Parkinson's disease (PD) patients. The main targets of DBS for PD are subthalamic nucleus (STN) and globus pallidus interna (GPi). Ventralis intermedius (Vim)-DBS was found to be effective in improving tremor. However, Vim-DBS cannot sufficiently improve akinesia and rigidity. Therefore, Vim-DBS is seldom carried out for the treatment of PD. In this article, we review the present state of DBS, mainly STN-DBS and GPi-DBS, for PD. In the first part of the article, appropriate indications and practical effects established in previous studies are discussed. The findings of previous investigations on the complications caused by the surgical procedure and on the adverse events induced by DBS itself are reviewed. In the second part, we discuss target selection (GPi vs. STN) and the effect of DBS on nonmotor symptoms. In the final part, as issues that should be resolved, the suitable timing of surgery, symptoms unresponsive to DBS such as on-period axial symptoms, and the related postoperative programing of stimulation parameters, are discussed.
    Neurologia medico-chirurgica 04/2015; 55(5). DOI:10.2176/nmc.ra.2014-0446 · 0.72 Impact Factor
  • Chikashi Fukaya · Takamitsu Yamamoto ·
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    ABSTRACT: We conducted a systematic review to assess the incidence of various surgical complications both during and after stereotactic and functional neurosurgery. Initially, we considered that surgical complications and the adverse effects of stimulation should be differentiated. In some reports, intracranial hemorrhage, infection, device-related problems, and epileptic seizure have been regarded as major and serious surgical complications. The established rates of hemorrhagic complications are 3.7%[95% confidence interval(CI):2.8-4.6%]for coagulation surgery and 4.6%(95% CI:3.8-5.3%)for deep brain stimulation(DBS). However, the rates of significant permanent neurological deficits originating from hemorrhage were relatively low. The average rates were 1.2%(95% CI:0.7-1.6%)for coagulation surgery and 1.0%(95% CI:0.6-1.3%)for DBS. Almost all of the patients with infectious complications had undergone DBS, and these complications were very rarely encountered after coagulation surgery. The rate of the occurrence of infection in DBS patients was 4.0%(95% CI:3.5-4.5%). Device-related problems were complications of DBS, and the main problems were migration and fracture. Epileptic seizure was noted in 0.4%(95% CI:0.1-0.7%)of the patients who underwent coagulation surgery and in 3.2%(95% CI:2.3-4.0%)of those who underwent DBS. The actual rate of occurrence of epileptic seizure was speculated to be much lower than the above rate because we did not include analytical reports that did not mention epileptic seizure. The exact rate of the occurrence of adverse effects caused by DBS was difficult to determine. Skill in the programming of the stimulation parameters, disease progression, and the balance between drugs and stimulation may affect the postoperative adverse events. However, we can advise patients and their families of the potential for psychiatric symptoms, depression, and cognitive dysfunction, which could seriously infringe on the patient's quality of life, after DBS.
    No shinkei geka. Neurological surgery 08/2014; 42(8):751-68. · 0.13 Impact Factor
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    ABSTRACT: A 62-year-old man complained of resting tremor and posture tremor. In spite of presence of the tremor, other parkinsonian component was very mild. [(11)C]2β-carbomethoxy-3β-(4-fluorophenyl)-tropane ([(11)C]CFT) PET showed asymmetrical reduction of the uptake and [(11)C]raclopride PET showed slightly increased uptake in the striatum. Although he was diagnosed as having benign tremulous parkinsonism (BTP), anti-parkinsonian medications, including anti-cholinergic agent, dopamine agonist and l-dopa, were not effective for his tremor. His tremor gradually deteriorated enough to disturb writing, working, and eating. Because his quality of life (QOL) was disturbed by the troublesome tremor, deep brain stimulation of the subthalamic nucleus (STN-DBS) was performed. After STN-DBS, his tremor was dramatically improved. According to clinical course of our patient as well as previous reports, STN-DBS should be considered as a therapeutic option for BTP patients with severe tremor.
    Rinsho shinkeigaku = Clinical neurology 07/2014; 54(6):511-4. DOI:10.5692/clinicalneurol.54.511
  • Takamitsu Yamamoto · Chikashi Fukaya · Atsuo Yoshino ·
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    ABSTRACT: Development of instruments for spinal cord stimulation is remarkable. We can implant two cylinder-type stimulation electrodes in parallel into the spinal epidural space. We call this method for dual-lead SCS. Dual lead-SCS is useful to induce paresthesia over the painful area, and the success rate of pain reduction induced by dual-lead SCS is increasing. For dual-lead stimulation, the RestoreSensor, the EonMini, and the Precision Plus are suitable and useful for the treatment of intractable pain. Based on the results of a drug-challenge test with ketamine, we applied dual-SCS for the treatment of various kinds of neuropathic pain. Comparing with the results of single-lead SCS, dual-lead SCS has obvious advantages to evoke paresthesia over the painful area, and showed a remarkable effects for pain reduction. Dual-lead SCS combined with low-dose ketamine drip infusion method is useful for the treatment of various kinds of neuropathic pain. Even if the direct effect of ketamine is transient, effects that provide release from central sensitization and the wind-up phenomenon may be important to increase the effects of dual-lead SCS. Based on the development of dual-lead SCS, SCS therapy has become an important and powerful method for the treatment of intractable pain.
    Masui. The Japanese journal of anesthesiology 07/2014; 63(7):775-82.
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    ABSTRACT: Object: Holmes' tremor (HT) is generally considered to be a symptomatic tremor associated with lesions of the cerebellum, midbrain, or thalamus. Deep brain stimulation (DBS) therapy for essential tremor and parkinsonian tremor has proved quite successful. In contrast, surgical treatment outcomes for HT have often been disappointing. The use of 2 ipsilateral DBS electrodes implanted in parallel within the thalamus for severe essential tremor has been reported. Since dual-lead stimulation within a single target can cover a wider area than single-lead stimulation, it produces greater effects. On the other hand, DBS of the subthalamic area (SA) was recently reported to be effective for refractory tremor. Methods: The authors implanted 2 DBS electrodes (one at the nucleus ventralis oralis/nucleus ventralis intermedius and the other at the SA) in 4 patients with HT. For more than 2 years after implantation, each patient's tremor was evaluated using a tremor rating scale under the following 4 conditions of stimulation: "on" for both thalamus and SA DBS; "off" for both thalamus and SA DBS; "on" for thalamus and "off" for SA DBS; and "on" for SA and "off" for thalamus DBS. Results: The tremor in all patients was improved for more than 2 years (mean 25.8 ± 3.5 months). Stimulation with 2 electrodes exerted greater effect on the tremor than did 1-electrode stimulation. Interestingly, in all patients progressive effects were observed, and in one patient treated with DBS for 1 year, tremor did not appear even while stimulation was temporarily switched off, suggesting irreversible improvement effects. The presence of both resting and intentional/action tremor implies combined destruction of the pallidothalamic and cerebellothalamic pathways in HT. A larger stimulation area may thus be required for HT patients. Multitarget, dual-lead stimulation permits coverage of the wide area needed to suppress the tremor without adverse effects of stimulation. Some reorganization of the neural network may be involved in the development of HT because the tremor appears several months after the primary insult. The mechanism underlying the absence of tremor while stimulation was temporarily off remains unclear, but the DBS may have normalized the abnormal neural network. Conclusions: The authors successfully treated patients with severe HT by using dual-electrode DBS over a long period. Such DBS may offer an effective and safe treatment modality for intractable HT.
    Journal of Neurosurgery 03/2014; 120(5). DOI:10.3171/2014.1.JNS12392 · 3.74 Impact Factor

  • Clinical Neurophysiology 08/2013; 124(8):e19. DOI:10.1016/j.clinph.2013.02.027 · 3.10 Impact Factor

  • Clinical Neurophysiology 08/2013; 124(8):e20. DOI:10.1016/j.clinph.2013.02.030 · 3.10 Impact Factor

  • Clinical Neurophysiology 08/2013; 124(8):e23. DOI:10.1016/j.clinph.2013.02.045 · 3.10 Impact Factor
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    ABSTRACT: Background: Vegetative state (VS) is a complex condition that represents a challenging frontier for medicine and neuroscience research. Nowadays there is no scientifically validated treatment for VS patients, and their chronic long-term assistance is very demanding for healthcare systems worldwide. Objectives: The present paper is a systematic review of the role of spinal cord stimulation (SCS) as a treatment of patients with VS. Methods: Published literature on this topic was analyzed systematically. Clinical and epidemiological characteristics of VS, present therapeutic options and social costs of VS were also evaluated. Results: Only 10 papers have been published since 1988, and overall 308 VS patients have been treated with SCS worldwide; 51.6% displayed a clinical improvement and an amelioration of the environmental interaction. These effects are probably mediated by the stimulation of the reticular formation-thalamus-cortex pathway and by cerebral blood flow augmentation induced by SCS. Conclusions: The experience on this topic is still very limited, and on this basis it is still hard to make any rigorous assessment. However, the most recent experiments represent significant progress in the research on this topic and display SCS as a possible therapeutic tool in the treatment of VS.
    Stereotactic and Functional Neurosurgery 06/2013; 91(5):275-287. DOI:10.1159/000348271 · 2.02 Impact Factor
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    ABSTRACT: Deep brain stimulation (DBS) has already been recognized as an effective therapy for involuntary movements. As DBS has become more widely used, psychiatric symptoms and personality changes induced by DBS have sometimes been observed. Such phenomena are associated with the close relationship of motor, associative and limbic circuits in the corticobasal ganglia-thalamic-cortical (CBTC) circuit, which is often selected as a target for DBS. On the other hand, clinical research on DBS by stimulating the CBTC circuit for depression and obsessive compulsive disorder is being carried out in Western countries. The reversibility of DBS allowed it to be used as a new therapeutic method for psychiatric disorders, epilepsy, aggressiveness, obesity, and cluster headache, among others. However, apprehension on the history of abuse of psychosurgery backs up the development of this field. Prospects and ethical and social issues of DBS should be noted. © 2013, Japanese Congress of Neurological Surgeons. All rights reserved.
    Japanese Journal of Neurosurgery 03/2013; 22(3):200-206. DOI:10.7887/jcns.22.200
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    ABSTRACT: It is obvious that deep brain stimulation (DBS) is one of the useful treatment choices for progressive Parkinson disease (PD). The main targets for DBS for PD are the thalamic Vim nucleus, globus pallidus interna (GPi), and subthalamic nucleus (STN). Vim-DBS is useful for tremor but not very effective for other Parkinson symptoms. Therefore, presently, STN and GPi are the common targets for DBS for PD. Diminishing the dose of anti-PD drugs is possible usually only after STN-DBS. However, no evident differences in the effect between STN-DBS and GPi-DBS are noted in the majority of studies. Appropriate indication should be decided on the basis of individual target's feature. Dopa responsiveness is a very important factor when considering the operative indications for both STN-DBS and GPi-DBS. CAPSIT protocol is usually used to evaluate the dopa responsiveness. DBS is considered to be characterized by the bottom-up and substitution effects. The disappearance of wearing-off is expected owing to the bottom-up effect and the disappearance of the side effects of anti-PD drugs is expected owing to the substitution effect. Age at surgery, duration of PD, and degree of dopa responsiveness are important factors for outcome prediction. On the other hand, the rate of complications such as cognitive decline, psychosis, and intracranial hemorrhage is relatively high in elderly patients.
    11/2012; 52(11):1095-7. DOI:10.5692/clinicalneurol.52.1095
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    ABSTRACT: Objective: High-intensity and high-frequency repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex was carried out in poststroke patients with increased spasticity, and the changes in F-wave parameters in comparison with M-wave parameters induced by rTMS were examined. Methods: Ten-hertz rTMS pulses were delivered to the primary motor cortex of the lesion side at 110% intensity of the resting motor threshold, and F-waves were obtained from the first dorsal interosseous muscle. F-waves were recorded before (pre-stim) and immediately after the end of rTMS (post-stim) in poststroke patients. Results: F-wave persistence and F/M Amp.Ratio increased significantly in patients with lesions in upper motor tract as compared with healthy subjects (Wilcoxon rank sum test, p = 0.00023 and p = 0.0073, respectively). After the rTMS application, both F-wave persistence and F/M Amp.Ratio decreased significantly (paired t-test, p = 0.0095 and p = 0.037, respectively). However, the F-wave amplitude did not show a statistically significant variance in poststroke patients. Conclusions: High-frequency suprathreshold rTMS may suppress the F-waves by enhancing the inhibitory effect on spinal excitability through the corticospinal tract, and F-wave persistence and F/M Amp.Ratio can be used to determine the effect of rTMS on patients with increased spasticity.
    Neuromodulation 10/2012; 16(3). DOI:10.1111/j.1525-1403.2012.00520.x · 2.70 Impact Factor
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    ABSTRACT: Objectives: Intention tremor becomes evident only when patients intend to move their body and is characterized by dysmetria. We have developed an on-demand control system that triggers the switching on/off of deep brain stimulation (DBS) instantly for the control of intention tremor. Material and methods: We used surface electrodes for the recording of electromyographic (EMG) activity, and the power of EMG activity was analyzed instantly employing the fast Fourier transform. The on-demand control system switched on DBS when only the power of tremor frequency exceeded the on-trigger threshold, and the system switched off DBS when the total power of EMG activity decreased below the off-trigger threshold. Results: The on-demand control system triggered the switching on/off of DBS accurately, and controlled intention tremor completely. Our on-demand control system is small and portable, and suitable for clinical use. Conclusions: The on-demand control system for DBS is useful for controlling intention tremor and may decrease the incidence of tolerance to DBS and may be a powerful tool for various applications of neuromodulation therapy.
    Neuromodulation 10/2012; 16(3). DOI:10.1111/j.1525-1403.2012.00521.x · 2.70 Impact Factor
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    ABSTRACT: Objectives Intracranial hemorrhage is a crucial complication of deep brain stimulation (DBS) surgery. The bleeding caused by mechanical tissue injury due to microelectrode and/or DBS electrode lead insertion has been well studied. However, hemorrhage caused by a congenital underlying disease such as vascular malformation has not been examined carefully. Materials and Methods We encountered a case of intracerebral hemorrhage from arteriovenous malformation (AVM) after DBS surgery. Preoperative magnetic resonance (MR) imaging did not show any abnormality in the patient. Computed tomography (CT) images taken immediately after the surgery did not show any intracranial hematoma and other abnormal findings. However, the patient did not recover from the general anesthesia, and hemorrhage in the left occipital lobe was detected by CT performed a day after the surgery. The location of the hematoma was markedly distant from the trajectory of DBS leads. Evacuation of the hematoma under general anesthesia was immediately performed. ResultsAs an intraoperative finding, we noted the presence of abnormal vessels inside the hematoma in the occipital lobe. Tissue specimens including the abnormal vessels were obtained for histopathological analysis, results of which led to the diagnosis was AVM. Conclusion Despite its low incidence, we would like to advise that such a type of hemorrhage could occur and measures should be taken to prevent its occurrence as much as possible. Preoperative detection of abnormal vessels by MR angiography and/or CT angiography might be helpful. Moreover, paying close attention to the possible leakage of cerebrospinal fluid during surgery might be important.
    Neuromodulation 10/2012; 16(5). DOI:10.1111/j.1525-1403.2012.00516.x · 2.70 Impact Factor
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    ABSTRACT: Minimally conscious state (MCS) is characterized by inconsistent but clearly discernible behavioral evidence of consciousness, and can be distinguished from coma and the vegetative state (VS). Ten MCS patients were evaluated neurologically and electrophysiologically over 3 months after the onset of brain injury, and were treated by spinal cord stimulation (SCS). A flexible four-contact, cylinder electrode was inserted into the epidural space of the cervical vertebrae, and placed at the C2-C4 levels. Stimulation was applied for 5 minutes every 30 minutes during the daytime at an intensity that produced motor twitches of the upper extremities. We used 5 Hz for SCS, considering that the induced muscle twitches can be a useful functional neurorehabilitation for MCS patients. Eight of the 10 MCS patients satisfied the electrophysiological inclusion criteria, which we proposed on the basis of the results of deep brain stimulation for the treatment of patients in the VS. Seven patients recovered from MCS following SCS therapy, and were able to carry out functional interactive communication and/or demonstrate the functional use of two different objects. Cervical SCS increased cerebral blood flow (CBF) diffusely in the brain, and CBF increased by 22.2% during the stimulation period compared with CBF before stimulation in MCS patients (p < 0.0001, paired t-test). Five-Hz cervical SCS could increase CBF and induce muscle twitches of the upper extremities. This SCS therapy method may be suitable for treating MCS.
    Neurologia medico-chirurgica 08/2012; 52(7):475-81. DOI:10.2176/nmc.52.475 · 0.72 Impact Factor
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    ABSTRACT: Autonomic nervous system impairment is an untoward symptom that is typically observed in advanced Parkinson's disease (PD) patients. However, details of the effects of subthalamic nucleus deep brain stimulation (STN-DBS) on the autonomic nervous system remain unclear. Twenty-eight patients with advanced PD (12 males and 16 females) who underwent bilateral STN-DBS and 13 age-matched healthy controls were included in this study. We analyzed the dynamic cardiovascular autonomic function regulating the R-R interval and blood pressure by spectral and transfer function analyses of cardiovascular variability before and after STN-DBS. Vagally mediated arterial-cardiac baroreflex function improved after STN-DBS compared to that before STN-DBS (p < 0.05). However, there were no statistically significant differences in the results of the comparison of vagally mediated arterial-cardiac baroreflex function between on-stimulation and off-stimulation. The vagal component in cardiac autonomic dysfunction associated with PD is expected to improve after STN-DBS. We considered that the patients improved their lifestyle; in particular, increasing the amount of exercise by STN-DBS and the best pharmachological treatment may have positive effects on parasympathetic activities.
    Stereotactic and Functional Neurosurgery 06/2012; 90(4):248-54. DOI:10.1159/000338090 · 2.02 Impact Factor
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    ABSTRACT: Background and objective: Deep brain stimulation (DBS) candidates with neurologic diseases such as unruptured aneurysm present additional challenges to neurosurgeons when craniotomy must precede DBS surgery. Such craniotomy may potentially overlap with intended burr hole sites for the later insertion of DBS electrodes, and the skin incision for craniotomy may lie very close to or intersect with that for the burr holes. We report here a case of forehead craniotomy prior to DBS surgery in which we employed a neuronavigation system to simulate locations for the craniotomy and burr holes. Method: A 62-year-old male patient with Parkinson's disease was a candidate for DBS. He also had an aneurysm and was planned first to undergo frontal craniotomy for clipping before the DBS surgery. The locations of the craniotomy, burr holes, and skin incisions were therefore simulated using a neuronavigation system during craniotomy. Results: Two weeks after the craniotomy, the patient underwent DBS surgery. Planning software confirmed the absence of cortical veins beneath the entry points of tentative burr holes and aided trajectory planning. The DBS surgery was performed without the interference of the burr holes and head pins and the craniotomy. Conclusion: Simulation of the locations of craniotomy and burr holes using a neuronavigation system proved valuable in the present case of frontal craniotomy before DBS surgery.
    Neuromodulation 06/2012; 16(1). DOI:10.1111/j.1525-1403.2012.00466.x · 2.70 Impact Factor
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    ABSTRACT: OBJECTIVE: On the basis of the findings of the electrophysiological evaluation of vegetative state (VS) and minimally conscious state (MCS), the effect of deep brain stimulation (DBS) was examined according to long-term follow-up results. The results of spinal cord stimulation (SCS) on MCS was also examined and compared with that of DBS. METHODS: One hundred seven patients in VS and 21 patients in MCS were evaluated neurologically and electrophysiologically over 3 months after the onset of brain injury. Among the 107 VS patients, 21 were treated by DBS. Among the 21 MCS patients, 5 were treated by DBS and 10 by SCS. RESULTS: Eight of the 21 patients recovered from VS and were able to follow verbal instructions. These eight patients showed desynchronization on continuous electroencephalographic frequency analysis. The Vth wave of the auditory brainstem response and N20 of somatosensory evoked potential were recorded even with a prolonged latency, and pain-related P250 was recorded with an amplitude of more than 7 μV. In addition, DBS and SCS induced a marked functional recovery in MCS patients who satisfied the electrophysiological inclusion criteria. CONCLUSION: DBS for VS and MCS patients and SCS for MCS patients may be useful, when the candidates are selected on the basis of the electrophysiological inclusion criteria. Only 16 (14.9%) of the 107 VS patients and 15 (71.4%) of the 21 MCS patients satisfied the electrophysiological inclusion criteria.
    World Neurosurgery 04/2012; 80(3-4). DOI:10.1016/j.wneu.2012.04.010 · 2.88 Impact Factor
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    ABSTRACT: In well-designed multicenter studies, the protocol of continuing motor cortex stimulation (MCS) temporarily for 3-6 weeks was employed with rehabilitation therapy, and these studies showed some recovery of motor weakness in post-stroke patients. We aimed to clarify the effects of long-term MCS and the optimal stimulation conditions to improve motor weakness in post-stroke patients. We applied chronic MCS in 6 post-stroke pain patients with motor weakness. We then examined the correlation between the duration of daily MCS applied over 6 months and motor function assessed on the basis of the Fugl-Meyer Assessment (FMA) score of the patients. In the 6 patients with motor weakness, the FMA score of the upper extremity increased in 4 patients who underwent daily MCS for less than 4 h. On the other hand, 2 patients who continued excessive MCS to control their complicating post-stroke pain showed decreased FMA scores and worsened motor function owing to their increased rigidity and/or spasticity. These 2 patients recovered their motor function after their daily MCS was restricted to less than 4 h. These findings indicate that MCS could be a new therapeutic approach to improving motor performance after stroke by attenuating rigidity and/or spasticity. However, it may be important to define the appropriate number of hours and conditions of daily MCS.
    Stereotactic and Functional Neurosurgery 11/2011; 89(6):381-9. DOI:10.1159/000332060 · 2.02 Impact Factor
  • Chikashi Fukaya · Takamitsu Yamamoto · Yoichi Katayama ·

    No shinkei geka. Neurological surgery 11/2011; 39(11):1033-44. · 0.13 Impact Factor