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Article ; Online: Opportunities and challenges for the use of deep brain stimulation in the treatment of refractory major depression.

Unadkat, Prashin / Quevedo, Joao / Soares, Jair / Fenoy, Albert

Discover mental health

2024 Volume 4, Issue 1, Page(s) 9

Abstract: Major Depressive Disorder continues to remain one of the most prevalent psychiatric diseases globally. Despite multiple trials of conventional therapies, a subset of patients fail to have adequate benefit to treatment. Deep brain stimulation (DBS) is a ... ...

Abstract	Major Depressive Disorder continues to remain one of the most prevalent psychiatric diseases globally. Despite multiple trials of conventional therapies, a subset of patients fail to have adequate benefit to treatment. Deep brain stimulation (DBS) is a promising treatment in this difficult to treat population and has shown strong antidepressant effects across multiple cohorts. Nearly two decades of work have provided insights into the potential for chronic focal stimulation in precise brain targets to modulate pathological brain circuits that are implicated in the pathogenesis of depression. In this paper we review the rationale that prompted the selection of various brain targets for DBS, their subsequent clinical outcomes and common adverse events reported. We additionally discuss some of the pitfalls and challenges that have prevented more widespread adoption of this technology as well as future directions that have shown promise in improving therapeutic efficacy of DBS in the treatment of depression.
Language	English
Publishing date	2024-03-14
Publishing country	Switzerland
Document type	Journal Article ; Review
ISSN	2731-4383
ISSN (online)	2731-4383
DOI	10.1007/s44192-024-00062-9
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Article ; Online: Commentary on: A Network Approach to Understanding the Effects of Focused Ultrasound for Essential Tremor: Insights into Pathophysiology, Treatment, and Imaging Biomarkers.

Unadkat, Prashin / Eidelberg, David

Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics

2022 Volume 19, Issue 6, Page(s) 1883–1885

MeSH term(s)	Humans ; Essential Tremor/diagnostic imaging ; Essential Tremor/therapy ; Thalamus ; Magnetic Resonance Imaging/methods ; Biomarkers ; Treatment Outcome
Chemical Substances	Biomarkers
Language	English
Publishing date	2022-10-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2316693-9
ISSN	1878-7479 ; 1933-7213
ISSN (online)	1878-7479
ISSN	1933-7213
DOI	10.1007/s13311-022-01321-9
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Article ; Online: Functional Brain Networks to Evaluate Treatment Responses in Parkinson's Disease.

Barbero, János A / Unadkat, Prashin / Choi, Yoon Young / Eidelberg, David

Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics

2023 Volume 20, Issue 6, Page(s) 1653–1668

Abstract: Network analysis of functional brain scans acquired with [ ...

Abstract	Network analysis of functional brain scans acquired with [
MeSH term(s)	Humans ; Parkinson Disease/therapy ; Parkinson Disease/drug therapy ; Brain/metabolism ; Genetic Therapy/methods ; Positron-Emission Tomography ; Dependovirus/genetics ; Magnetic Resonance Imaging
Language	English
Publishing date	2023-09-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2316693-9
ISSN	1878-7479 ; 1933-7213
ISSN (online)	1878-7479
ISSN	1933-7213
DOI	10.1007/s13311-023-01433-w
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Article: Meningothelial Hamartoma Overlying a Prior Craniotomy: A Case Report and Review of Literature.

Unadkat, Prashin / Vitkovski, Taisia / Zaidi, Raza / Eisenberg, Mark

Asian journal of neurosurgery

2022 Volume 17, Issue 1, Page(s) 137–140

Abstract: Meningothelial hamartomas are benign lesions of the scalp with a handful of case reports published. Usually thought to be congenital lesions, they have, on occasion, been seen in older adults. In this report, we describe the first ever reported case of a ...

Abstract	Meningothelial hamartomas are benign lesions of the scalp with a handful of case reports published. Usually thought to be congenital lesions, they have, on occasion, been seen in older adults. In this report, we describe the first ever reported case of a patient diagnosed with a meningothelial hamartoma overlying a prior craniotomy performed two decades prior. We also briefly describe the literature surrounding these rare lesions, as well as their management and differential diagnosis.
Language	English
Publishing date	2022-07-05
Publishing country	India
Document type	Case Reports
ZDB-ID	2621446-5
ISSN	2248-9614 ; 1793-5482
ISSN (online)	2248-9614
ISSN	1793-5482
DOI	10.1055/s-0042-1749129
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Article ; Online: Direct-cortical visual evoked potential monitoring during brain tumor resection.

Shah, Harshal A / Begley, Sabrina L / Unadkat, Prashin / Kelly Hugo, Kaitlin / Schulder, Michael

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

2023 Volume 115, Page(s) 1–7

Abstract: Background: Visual evoked potential (VEP) recording is traditionally regarded as an unreliable evoked potential monitoring technique, precluding widespread use in intracranial neurosurgery. However, VEPs can serve as a useful intraoperative adjunct for ... ...

Abstract	Background: Visual evoked potential (VEP) recording is traditionally regarded as an unreliable evoked potential monitoring technique, precluding widespread use in intracranial neurosurgery. However, VEPs can serve as a useful intraoperative adjunct for real-time detection of mechanical damage to optic apparatuses. The low obtainability and prognostic utility of VEPs are associated with transcranial recording, which typically provides non-focal information and poor signal-to-noise ratio. Direct cortical VEP (DC-VEP) recordings may offer a solution. Methods: We evaluated the obtainability of DC-VEPs as well as their prognostic utility in predicting postoperative visual function deterioration in a series of brain tumor patients undergoing craniotomies for tumor resection. Patient records were retrospectively reviewed for all consecutive patients undergoing brain tumor resections with DC-VEP monitoring. Pre- and postoperative visual fields were characterized from patient charts and associated with the presence of intraoperative monitoring alerts to determine the sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of DC-VEPs in detecting postoperative visual field deficits. Results: Twenty-two patients (9 male, 13 female) were included, with a median age of 60 years. DC-VEPs were reliably detected in 19 of 23 included surgeries (82.6%). The reported sensitivity, specificity, PPV, and NPV in detecting postoperative visual field deficits was 60%, 92.9%, 75%, and 86.7%, respectively. There was a statistically significant association between monitoring alerts and the presence of visual field deterioration by Fischer's exact test (p = 0.0374). Conclusions: DC-VEPs can be reliably obtained and are useful for detecting mechanical injury to optic areas and tracts during tumor resection.
MeSH term(s)	Humans ; Male ; Female ; Middle Aged ; Evoked Potentials, Visual ; Retrospective Studies ; Neurosurgical Procedures/adverse effects ; Neurosurgical Procedures/methods ; Brain Neoplasms/surgery ; Craniotomy
Language	English
Publishing date	2023-07-14
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	1193674-5
ISSN	1532-2653 ; 0967-5868
ISSN (online)	1532-2653
ISSN	0967-5868
DOI	10.1016/j.jocn.2023.06.014
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Article: A Novel Portable, Mobile MRI: Comparison with an Established Low-Field Intraoperative MRI System.

Bossert, Sharon / Unadkat, Prashin / Sheth, Kevin N / Sze, Gordon / Schulder, Michael

Asian journal of neurosurgery

2023 Volume 18, Issue 3, Page(s) 492–498

Abstract: ... ...

Abstract	Background
Language	English
Publishing date	2023-09-22
Publishing country	India
Document type	Journal Article
ZDB-ID	2621446-5
ISSN	2248-9614 ; 1793-5482
ISSN (online)	2248-9614
ISSN	1793-5482
DOI	10.1055/s-0043-1760857
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Article ; Online: An Institutional Experience of Directional Deep Brain Stimulation and a Review of the Literature.

Mishra, Akash / Unadkat, Prashin / McBriar, Joshua D / Schulder, Michael / Ramdhani, Ritesh A

Neuromodulation : journal of the International Neuromodulation Society

2023 Volume 27, Issue 3, Page(s) 544–550

Abstract: Introduction: Directional deep brain stimulation (dDBS) has been suggested to have a similar therapeutic effect when compared with the traditional omnidirectional DBS, but with an improved therapeutic window that yields optimized clinical effect owing ... ...

Abstract	Introduction: Directional deep brain stimulation (dDBS) has been suggested to have a similar therapeutic effect when compared with the traditional omnidirectional DBS, but with an improved therapeutic window that yields optimized clinical effect owing to the ability to better direct, or "steer," electric current. We present our single-center, retrospective analysis of our experience in the use of dDBS in patients with movement disorders and provide a review of the literature. Materials and methods: We identified all patients with Parkinson disease (PD) and essential tremor (ET) who received a dDBS system between 2018 and 2022 and retrospectively examined characteristics of their longitudinal treatment. A total of 70 leads were identified across 42 patients (28 PD, 14 ET). Results: Three types of systems were implemented (single-segment activation, 45.2% of patients; multiple independent current control, 50.0%; and local field potential sensing-enabled, 4.7%). The subthalamic nucleus or globus pallidus internus was targeted in PD, and the ventral intermediate nucleus of the thalamus in ET. Across the entire cohort (n = 70 leads), at initial programming, 54.2% of leads (n = 38) were programmed using directional stimulation. At the most recent reprogramming, 58.6% of leads (n = 41) implemented directionality. In patients with PD, the average decrease in levodopa-equivalent daily dose at six months after implantation was 35.4% ± 39.2%. Despite the ability to steer current to relieve stimulation-induced side effects, ten leads in six patients required surgical revision owing to electrode malposition. Conclusions: We show wide adaptability and implementation of directional stimulation, adding to the growing compendium of real-world uses of dDBS therapy. We used directionality to improve clinical response in both patients with PD and patients with ET and found that its programming flexibility was used at high rates long after implantation and initial programming. In patients with PD, dDBS led to a significant reduction in dopaminergic medication, suggesting sustained clinical improvement. Nonetheless, accurate surgical placement remains necessary to ensure optimal clinical outcomes.
MeSH term(s)	Humans ; Deep Brain Stimulation ; Essential Tremor/therapy ; Parkinson Disease/therapy ; Retrospective Studies ; Subthalamic Nucleus ; Treatment Outcome
Language	English
Publishing date	2023-01-17
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1500372-3
ISSN	1525-1403 ; 1094-7159
ISSN (online)	1525-1403
ISSN	1094-7159
DOI	10.1016/j.neurom.2022.12.008
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Zs.A 5912: Show issues

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Article: Meningothelial Hamartoma Overlying a Prior Craniotomy: A Case Report and Review of Literature

Unadkat, Prashin / Vitkovski, Taisia / Zaidi, Raza / Eisenberg, Mark

Asian Journal of Neurosurgery

2022 Volume 17, Issue 01, Page(s) 137–140

Abstract	Meningothelial hamartomas are benign lesions of the scalp with a handful of case reports published. Usually thought to be congenital lesions, they have, on occasion, been seen in older adults. In this report, we describe the first ever reported case of a patient diagnosed with a meningothelial hamartoma overlying a prior craniotomy performed two decades prior. We also briefly describe the literature surrounding these rare lesions, as well as their management and differential diagnosis.
Keywords	meningothelial hamartoma ; scalp tumor ; craniotomy ; Meningioma
Language	English
Publishing date	2022-03-01
Publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2621446-5
ISSN	2248-9614 ; 1793-5482 ; 2248-9614
ISSN (online)	2248-9614
ISSN	1793-5482 ; 2248-9614
DOI	10.1055/s-0042-1749129
Database	Thieme publisher's database

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Article ; Online: Short and long-term prognostic value of intraoperative motor evoked potentials in brain tumor patients: a case series of 121 brain tumor patients.

Silverstein, Justin W / Shah, Harshal A / Unadkat, Prashin / Vilaysom, Sabena / Boockvar, John A / Langer, David J / Ellis, Jason A / D'Amico, Randy S

Journal of neuro-oncology

2023 Volume 161, Issue 1, Page(s) 127–133

Abstract: Purpose: Iatrogenic neurologic deficits adversely affect patient outcomes following brain tumor resection. Motor evoked potential (MEP) monitoring allows surgeons to assess the integrity of motor-eloquent areas in real-time during tumor resection to ... ...

Abstract	Purpose: Iatrogenic neurologic deficits adversely affect patient outcomes following brain tumor resection. Motor evoked potential (MEP) monitoring allows surgeons to assess the integrity of motor-eloquent areas in real-time during tumor resection to lessen the risk of iatrogenic insult. We retrospectively associate intraoperative transcranial and direct cortical MEPs (TC-MEPs, DC-MEPs) to early and late post-operative motor function to prognosticate short- and long-term motor recovery in brain tumor patients undergoing surgical resection in peri-eloquent regions. Methods: We reviewed 121 brain tumor patients undergoing craniotomies with DC-MEP and/or TC-MEP monitoring. Motor function scores were recorded at multiple time-points up to 1 year postoperatively. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated at each time point. Results: The sensitivity, specificity, PPV, and NPV of TC-MEP in the immediate postoperative period was 17.5%, 100%, 100%, and 69.4%, respectively. For DC-MEP monitoring, the respective values were 25.0%, 100%, 100%, and 68.8%. By discharge, sensitivity had increased for both TC-MEP and DC MEPs to 43.8%, and 50.0% respectively. Subset analysis on patients without tumor recurrence/progression at long term follow-up (n = 62 pts, 51.2%) found that all patients with stable monitoring maintained or improved from preoperative status. One patient with transient intraoperative TC-MEP loss and permanent DC-MEP loss suffered a permanent deficit. Conclusion: Brain tumor patients who undergo surgery with intact MEP monitoring and experience new postoperative deficits likely suffer transient deficits that will improve over the postoperative course in the absence of disease progression.
MeSH term(s)	Humans ; Evoked Potentials, Motor/physiology ; Prognosis ; Retrospective Studies ; Neoplasm Recurrence, Local ; Brain Neoplasms/surgery ; Iatrogenic Disease
Language	English
Publishing date	2023-01-11
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	604875-4
ISSN	1573-7373 ; 0167-594X
ISSN (online)	1573-7373
ISSN	0167-594X
DOI	10.1007/s11060-022-04229-8
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Article ; Online: A Quantitative Assessment of ChatGPT as a Neurosurgical Triaging Tool.

Ward, Max / Unadkat, Prashin / Toscano, Daniel / Kashanian, Alon / Lynch, Daniel G / Horn, Alexander C / D'Amico, Randy S / Mittler, Mark / Baum, Griffin R

Neurosurgery

2024

Abstract: Background and objectives: ChatGPT is a natural language processing chatbot with increasing applicability to the medical workflow. Although ChatGPT has been shown to be capable of passing the American Board of Neurological Surgery board examination, ... ...

Abstract	Background and objectives: ChatGPT is a natural language processing chatbot with increasing applicability to the medical workflow. Although ChatGPT has been shown to be capable of passing the American Board of Neurological Surgery board examination, there has never been an evaluation of the chatbot in triaging and diagnosing novel neurosurgical scenarios without defined answer choices. In this study, we assess ChatGPT's capability to determine the emergent nature of neurosurgical scenarios and make diagnoses based on information one would find in a neurosurgical consult. Methods: Thirty clinical scenarios were given to 3 attendings, 4 residents, 2 physician assistants, and 2 subinterns. Participants were asked to determine if the scenario constituted an urgent neurosurgical consultation and what the most likely diagnosis was. Attending responses provided a consensus to use as the answer key. Generative pretraining transformer (GPT) 3.5 and GPT 4 were given the same questions, and their responses were compared with the other participants. Results: GPT 4 was 100% accurate in both diagnosis and triage of the scenarios. GPT 3.5 had an accuracy of 92.59%, slightly below that of a PGY1 (96.3%), an 88.24% sensitivity, 100% specificity, 100% positive predictive value, and 83.3% negative predicative value in triaging each situation. When making a diagnosis, GPT 3.5 had an accuracy of 92.59%, which was higher than the subinterns and similar to resident responders. Conclusion: GPT 4 is able to diagnose and triage neurosurgical scenarios at the level of a senior neurosurgical resident. There has been a clear improvement between GPT 3.5 and 4. It is likely that the recent updates in internet access and directing the functionality of ChatGPT will further improve its utility in neurosurgical triage.
Language	English
Publishing date	2024-02-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	135446-2
ISSN	1524-4040 ; 0148-396X
ISSN (online)	1524-4040
ISSN	0148-396X
DOI	10.1227/neu.0000000000002867
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