Calibration improvements expand filterscope diagnostic use.

The filterscope diagnostic on DIII-D utilizes photomultiplier tubes to measure visible light emission from the plasma. The system has undergone a substantial upgrade since previous attempts to cross-calibrate the filterscope with other spectroscopic diagnostics were unsuccessful. The optics now utilize a dichroic mirror to initially split the light at nearly 99% transmission or reflectance for light below or above 550 nm. This allows the system to measure Dα emission without degrading visible light emission from the plasma for wavelengths below 550 nm (to measure Dß, Dγ, W-I, C-III, etc.). Additional optimization of the optical components and calibration techniques reduce the error in the signal up to 10% in some channels compared to previous methods. Cross-calibration measurements with two other high resolution spectroscopic diagnostics now show excellent agreement for the first time. This expands the capabilities of the filterscope system allowing measurement of divertor detachment, emission profiles, edge-localized mode behavior, and plasma-wall interactions. It also enables direct comparisons against calculations from boundary plasma simulations. These were not possible before.

Ion temperature and rotation fluctuation measurements with ultra-fast charge exchange recombination spectroscopy (UF-CHERS) in the DIII-D tokamak.

An upgraded detector and several optimizations have significantly improved the Ultra-Fast Charge Exchange Recombination Spectroscopy (UF-CHERS) diagnostic sensitivity to ion temperature and parallel velocity fluctuations at turbulence relevant spatio-temporal scales. Normalized broadband ion temperature and parallel velocity fluctuations down to x̃x∼1% (x = Ti, v∥) and up to ∼450 kHz have been measured in a variety of plasmas. The multi-field nature of the CHERS technique also allows measurements of the cross-phase angles of the fluctuating fields. UF-CHERS is optimized to observe emissions from the electron exchange reaction between intrinsic C6+ and hydrogenic neutral beam injected particles near 529 nm. UF-CHERS consists of two chords separated by ∼1 cm radially, less than the turbulence correlation length in DIII-D plasmas, which enables correlated measurements to suppress incoherent electronic and photon noise. The optical components of the spectrometer include a volume-phase-holographic grating with >90% transmission between 528 and 530 nm and f/2 200-mm lenses, selected to maximize the optical efficiency and photon flux. Diffracted light from each chord is collected in eight spectral bins, each with a bandwidth of ∼0.25 nm, and detected and amplified by chilled avalanche photodiodes and custom high-gain, wide bandwidth low-noise preamplifiers to achieve the optimal signal-to-noise ratio. The resulting signals are digitized at 1 MHz, 103-104× faster than the conventional CHERS diagnostics. Spatial coverage is achieved by repositioning a motorized fiber tray between plasmas. UF-CHERS measurements will advance the understanding of turbulent ion transport and contribute to the validation of transport models and simulations.

Optimization and application of cooled avalanche photodiodes for spectroscopic fluctuation measurements with ultra-fast charge exchange recombination spectroscopy.

The Ultra-Fast Charge Exchange Recombination Spectroscopy (UF-CHERS) diagnostic is a highly specialized spectroscopic instrument with 2 spatial channels consisting of 8 spectral channels each and a resolution of ∼0.25 nm deployed at DIII-D to measure turbulent ion temperature fluctuations. Charge exchange emissions are obtained between 528 and 530 nm with 1 µs time resolution to study plasma instabilities. A primary challenge of extracting fluctuation measurements from raw UF-CHERS signals is photon and electronic noise. In order to reduce dark current, the Avalanche Photodiode (APD) detectors are thermo-electrically cooled. State-of-the-art components are used for the signal amplifiers and conditioners to minimize electronic noise. Due to the low incident photon power (≤1 nW), APDs with a gain of up to 300 are used to optimize the signal to noise ratio. Maximizing the APDs' gain while minimizing the excess noise factor (ENF) is essential since the total noise of the diagnostic sets a floor for the minimum level of detectable broadband fluctuations. The APDs' gain should be high enough that photon noise dominates electronic noise, but not excessive so that the ENF overwhelms plasma fluctuations. A new generation of cooled APDs and optimized preamplifiers exhibits significantly enhanced signal-to-noise compared to a previous generation. Experiments at DIII-D have allowed for characterization and optimization of the ENF vs. gain. A gain of ∼100 at 1700 V is found to be near optimal for most plasma conditions. Ion temperature and toroidal velocity fluctuations due to the edge harmonic oscillation in quiescent H-mode plasmas are presented to demonstrate UF-CHERS' capabilities.

High spatial resolution upgrade of the electron cyclotron emission radiometer for the DIII-D tokamak.

The 40-channel DIII-D electron cyclotron emission (ECE) radiometer provides measurements of Te(r,t) at the tokamak midplane from optically thick, second harmonic X-mode emission over a frequency range of 83-130 GHz. The frequency spacing of the radiometer's channels results in a spatial resolution of ∼1-3 cm, depending on local magnetic field and electron temperature. A new high resolution subsystem has been added to the DIII-D ECE radiometer to make sub-centimeter (0.6-0.8 cm) resolution Te measurements. The high resolution subsystem branches off from the regular channels' IF bands and consists of a microwave switch to toggle between IF bands, a switched filter bank for frequency selectivity, an adjustable local oscillator and mixer for further frequency down-conversion, and a set of eight microwave filters in the 2-4 GHz range. Higher spatial resolution is achieved through the use of a narrower (200 MHz) filter bandwidth and closer spacing between the filters' center frequencies (250 MHz). This configuration allows for full coverage of the 83-130 GHz frequency range in 2 GHz bands. Depending on the local magnetic field, this translates into a "zoomed-in" analysis of a ∼2-4 cm radial region. Expected uses of these channels include mapping the spatial dependence of Alfven eigenmodes, geodesic acoustic modes, and externally applied magnetic perturbations. Initial Te measurements, which demonstrate that the desired resolution is achieved, are presented.

Idebenone induces apoptotic cell death in the human dopaminergic neuroblastoma SHSY-5Y cells.

Idebenone is a coenzyme Q10 analog and an antioxidant that has been used clinically to treat Friedreich Ataxia. Being an antioxidant, idebenone could have potential therapeutic potential to treat other neurodegenerative diseases such as Parkinson's disease in which oxidative stress plays a role in their pathogenesis. But whether idebenone can be used to treat Parkinson's disease has not been evaluated. In this study, we found that exposure of the dopaminergic neuroblastoma SHSY-5Y cells to 1-10 µM idebenone for 72 h had no effect on the cell viability revealed by trypan blue exclusion assay and MTT assay. However, cells exposed to 25 µM or higher concentrations of idebenone showed extensive trypan blue-positive staining and significant reduction in cell viability revealed by MTT assay indicating that most of the cells were no longer viable. Idebenone-induced cell death was characterized by genomic DNA fragmentation and accumulation of cytochrome c in the cytosol indicating that the death was apoptotic in nature. In addition, idebenone induced an increase in the total RNA of the pro-apoptosis protein BAX, it also increased the caspase-3 activity in the cell lysates when compared with the untreated control cells or cells exposed to 10 µM or lower concentrations of idebenone. The detrimental effect of idebenone was attenuated by glutathione, an antioxidant, suggesting that oxidative stress contributed to the idebenone-induced cell death. In conclusion, our results suggest that antioxidant idebenone induced apoptosis when used in high concentrations.

Novel THAP1 sequence variants in primary dystonia.

BACKGROUND: THAP1 encodes a transcription factor (THAP1) that harbors an atypical zinc finger domain and regulates cell proliferation. An exon 2 insertion/deletion frameshift mutation in THAP1 is responsible for DYT6 dystonia in Amish-Mennonites. Subsequent screening efforts in familial, mainly early-onset, primary dystonia identified additional THAP1 sequence variants in non-Amish subjects. OBJECTIVE: To examine a large cohort of subjects with mainly adult-onset primary dystonia for sequence variants in THAP1. METHODS: With high-resolution melting, all 3 THAP1 exons were screened for sequence variants in 1,114 subjects with mainly adult-onset primary dystonia, 96 with unclassified dystonia, and 600 controls (400 neurologically normal and 200 with Parkinson disease). In addition, all 3 THAP1 exons were sequenced in 200 subjects with dystonia and 200 neurologically normal controls. RESULTS: Nine unique melting curves were found in 19 subjects from 16 families with primary dystonia and 1 control. Age at dystonia onset ranged from 8 to 69 years (mean 48 years). Sequencing identified 6 novel missense mutations in conserved regions of THAP1 (G9C [cervical, masticatory, arm], D17G [cervical], F132S [laryngeal], I149T [cervical and generalized], A166T [laryngeal], and Q187K [cervical]). One subject with blepharospasm and another with laryngeal dystonia harbored a c.-42C>T variant. A c.57C>T silent variant was found in 1 subject with segmental craniocervical dystonia. An intron 1 variant (c.71+9C>A) was present in 7 subjects with dystonia (7/1,210) but only 1 control (1/600). CONCLUSIONS: A heterogeneous collection of THAP1 sequence variants is associated with varied anatomical distributions and onset ages of both familial and sporadic primary dystonia.

Intracisternal administration of glibenclamide or 5-hydroxydecanoate does not reverse the neuroprotective effect of ketogenic diet against ischemic brain injury-induced neurodegeneration.

PRIMARY OBJECTIVE: To investigate the role of ATP-sensitive potassium (K(ATP)) channels in the neuroprotective effects of a ketogenic diet against cardiac arrest-induced cerebral ischemic brain injury-induced neurodegeneration. RESEARCH DESIGN: Male Sprague Dawley rats were randomly divided into three groups and were fed with a ketogenic diet for 25 days before being subjected to a cardiac arrest-induced cerebral ischemia for 8 minutes 30 seconds. Four hours before cardiac arrest-induced cerebral ischemia, one group was intracisternally injected with glibenclamide, a plasma membrane K(ATP) channel blocker. The second group was injected with 5-hydroxydecanoate, a mitochondrial K(ATP) channel blocker. The third group was without the pre-treatment with K(ATP) channel antagonist. Nine days after the cardiac arrest, rats were sacrificed. Fluoro-jade (FJ) staining was used to evaluate cerebral ischemic neurodegeneration in the rat brain sections. MAIN OUTCOMES AND RESULTS: The number of FJ-positive degenerating neurons in the CA1 area of the hippocampus, the cerebellum and the thalamic reticular nucleus of the ketogenic diet-fed rats with or without glibenclamide or 5-hydroxydecanoate pre-treatment before cardiac arrest-induced cerebral ischemia is zero. CONCLUSIONS: The results suggest that K(ATP) channels do not play a significant role in the neuroprotective effects of the ketogenic diet against cardiac arrest-induced cerebral ischemic injury-induced neurodegeneration.

Hemifacial spasm producing tremor-like movements of the head.

Tremor is defined as involuntary rhythmic oscillation and is produced by muscle contractions. Hemifacial spasm is rapid involuntary muscle contractions on one side of the face in the distribution of the VIIth nerve. We present a severe case of hemifacial spasm that produces a head-nodding tremor-like movements.

Ketogenic diet prevents cardiac arrest-induced cerebral ischemic neurodegeneration.

Ketogenic diet (KD) is an effective treatment for intractable epilepsies. We recently found that KD can prevent seizure and myoclonic jerk in a rat model of post-hypoxic myoclonus. In the present study, we tested the hypothesis that KD can prevent the cerebral ischemic neurodegeneration in this animal model. Rats fed a standard diet or KD for 25 days were being subjected to mechanically induced cardiac arrest brain ischemia for 8 min 30 s. Nine days after cardiac arrest, frozen rat brains were sectioned for evaluation of ischemia-induced neurodegeneration using fluoro-jade (FJ) staining. The FJ positive degenerating neurons were counted manually. Cardiac arrest-induced cerebral ischemia in rats fed the standard diet exhibited extensive neurodegeneration in the CA1 region of the hippocampus, the number of FJ positive neurons was 822+/-80 (n=4). They also showed signs of neurodegeneration in the Purkinje cells of the cerebellum and in the thalamic reticular nucleus, the number of FJ positive neurons in the cerebellum was 55+/-27 (n=4), the number of FJ positive neurons in the thalamic reticular nucleus was 22+/-5 (n=4). In contrast, rats fed KD showed no evidence of neurodegeneration, the number of FJ positive neurons in these areas were zero. The results demonstrate that KD can prevent cardiac arrest-induced cerebral ischemic neurodegeneration in selected brain regions.

Evidence for the effectiveness of botulinum toxin for sialorrhoea.

Sialorrhoea is a common symptom in many neurological disorders. Recently, botulinum toxin has been introduced as a treatment for sialorrhoea, and in this paper, we review the evidence for its effectiveness. The publications on the topic were searched and reviewed independently by two authors using the scale developed by the Therapeutics and Technology Assessment subcommittee for the American Academy of Neurology. All papers identified in our search fulfilled were evaluated, and classified into 1 of the 4 levels of evidence. According to this scheme, the effectiveness of botulinum toxin A in the treatment of sialorrhoea is considered established (level A). Botulinum toxin B is considered probably effective in the treatment of sialorrhoea (level B).

Evidence for the effectiveness of botulinum toxin for spasmodic dysphonia from high-quality research designs.

The practice of evidence-based medicine promotes use of the knowledge ascertained from high quality research designs. The objective of this review was to determine what evidence has been provided from high quality research designs (e.g., randomized control trials or high quality prospective, matched group cohort studies), through December of 2006, relative to the effectiveness of botulinum toxin for treating spasmodic dysphonia. Results of the review indicated that no new high quality (Class I or Class II) studies have been published since 2001. One Class I study has been published since 1973, which found significant treatment effects for acoustic and perceptual variables of vocal function. Four Class II studies have been published during this same time frame, all finding significant treatment effects, though the nature of studied factors was variable between investigations. Based on the quality of evidence scale used, botulinum toxin can be considered an effective treatment for adductor spasmodic dysphonia.

Evidence for effectiveness of botulinum toxin for hyperhidrosis.

Hyperhidrosis refers to excessive and uncontrollable sweating beyond that is required to return body temperature to normal. Although a broad spectrum of treatment modalities are available including topical and systemic therapies, iontophoresis, and surgical interventions, their efficacy are usually short-term or are associated with unacceptable side effects. Recently, chemodenervation using botulinum toxin has emerged as a safe and effective treatment for both primary palmar and axillary hyperhidrosis in several clinical trials. In this article, we utilized the scale developed by the Therapeutics and Technology Assessment (TTA) subcommittee of the American Academy of Neurology evaluating current evidence supporting the use of botulinum toxin for the treatment of primary focal hyperhidrosis. As a result, there is a strong evidence to support the efficacy of botulinum toxin type A in axillary (Level A evidence) and palmar (Level B evidence) hyperhidrosis.

Brivaracetam is superior to levetiracetam in a rat model of post-hypoxic myoclonus.

In the present study, we evaluated the anti-seizure and anti-myoclonic activity of levetiracetam and brivaracetam in an established rat model of cardiac arrest-induced post-hypoxic myoclonus. We found that brivaracetam (0.3 mg/kg, the minimal effective dose) was more potent than levetiracetam (3 mg/kg, the minimal effective dose) against post-hypoxic seizures. The anti-seizure activity of both compounds occurred 30 min following intraperitoneal (i.p.) administration and was maintained over the entire 150 min post-dose observation period. Both brivaracetam and levetiracetam significantly reduced auditory stimulated post-hypoxic myoclonus from a dose 0.3 mg/kg. At that dose, the anti-myoclonic activity of brivaracetam was already maximal whereas it continued to increase in a dose-relation manner with levetiracetam, suggesting that brivaracetam is a more potent agent. The onset and the duration of anti-myoclonic activity of both compounds were similar. These findings demonstrate that brivaracetam possesses more potent anti-seizure and anti-myoclonic activity than levetiracetam in an established rat model of cardiac arrest-induced post-hypoxic myoclonus.

Ropinirole 24-hour prolonged release: randomized, controlled study in advanced Parkinson disease.

OBJECTIVE: To evaluate the efficacy of ropinirole 24-hour prolonged release (ropinirole 24-hour) as an adjunct to levodopa in patients with Parkinson disease (PD) and motor fluctuations. METHODS: In a double-blind, placebo-controlled, 24-week study, 393 subjects with PD were randomized to ropinirole 24-hour (n = 202) or placebo (n = 191). The primary outcome measure was reduction in hours of daily "off" time. RESULTS: At week 24, the mean dose of ropinirole 24-hour was 18.8 mg/day with a mean reduction in daily levodopa of 278 mg. There was a mean reduction in daily "off" time of 2.1 hours in the ropinirole 24-hour group and 0.3 hours with placebo. Secondary outcome measures including change in hours and percent of daily "on" time and "on" time without troublesome dyskinesia, Unified PD Rating Scale motor and activities of daily living subscales, Beck Depression Inventory-II, PDQ-39 subscales of mobility, activities of daily living, emotional well-being, stigma and communication, and PD Sleep Scale were significantly improved at week 24 with ropinirole 24-hour. The most common adverse events (AE) with ropinirole 24-hour were dyskinesia, nausea, dizziness, somnolence, hallucinations, and orthostatic hypotension and AEs led to study withdrawal in 5% of both the active and placebo groups. CONCLUSION: Ropinirole 24-hour was effective and well tolerated as adjunct therapy in patients with Parkinson disease (PD) not optimally controlled with levodopa. Ropinirole 24-hour demonstrated an improvement in both motor and non-motor PD symptoms, while permitting a reduction in adjunctive levodopa dose.

Botulinum toxin therapy of hemifacial spasm: comparing different therapeutic preparations.

Hemifacial spasm (HFS) is characterized by involuntary irregular clonic or tonic movements of the muscles innervated by cranial nerve VII on one side of the face, and is most often a result of vascular compression of the facial nerve at the root exit zone (Muscle and Nerve 1998;21:1740). Disability associated with this disorder ranges from social embarrassment to interference with vision resulting from involuntary eye closure. Treatment of HFS most often involves botulinum toxin injections, but may also include medications and surgery. We describe treatment with the three types of botulinum toxin currently commercially available--Botox, Dysport and Myobloc/NeuroBloc.

Botulinum toxin in blepharospasm and oromandibular dystonia: comparing different botulinum toxin preparations.

Amongst all regions of the body, the craniocervical region is the one most frequently affected by dystonia. Whilst blepharospasm--involuntary bilateral eye closure--is produced by spasmodic contractions of the orbicularis oculi muscles, oromandibular dystonia may cause jaw closure with trismus and bruxism, or involuntary jaw opening or deviation, interfering with speaking and chewing. Both forms of dystonia can be effectively treated with botulinum toxin injection. This article summarizes injection techniques in both forms of dystonia and compares doses, potency and efficacy of different commercially available toxins, including Botox, Dysport, Xeomin and Myobloc/NeuroBloc.

Botulinum toxin therapy of laryngeal muscle hyperactivity syndromes: comparing different botulinum toxin preparations.

Spasmodic dysphonia (SD) is a focal dystonia characterized by a strained, strangled voice. Botulinum toxin is a symptomatic treatment for SD and has become the mainstay of therapy over the last two decades. In this manuscript, we briefly review different laryngeal muscle hyperactivity syndromes, their injection techniques and toxins currently available. Adductor SD is the most common indication for botulinum toxin treatment in the larynx. All studies report similar results with regard to improvement, patient satisfaction and side effects. We describe different injection techniques to treat this disorder such as the percutaneous, transoral, transnasal, point-touch techniques. In abductor SD, a subtype of SD, the treatment is aimed at the posterior cricoarytenoid muscle. Other applications of botulinum toxin in the larynx include spasmodic laryngeal dyspnea and voice tremors. We also review injection techniques, the different toxin types used, and toxin doses.

Chorea and related disorders.

Chorea refers to irregular, flowing, non-stereotyped, random, involuntary movements that often possess a writhing quality referred to as choreoathetosis. When mild, chorea can be difficult to differentiate from restlessness. When chorea is proximal and of large amplitude, it is called ballism. Chorea is usually worsened by anxiety and stress and subsides during sleep. Most patients attempt to disguise chorea by incorporating it into a purposeful activity. Whereas ballism is most often encountered as hemiballism due to contralateral structural lesions of the subthalamic nucleus and/or its afferent or efferent projections, chorea may be the expression of a wide range of disorders, including metabolic, infectious, inflammatory, vascular, and neurodegenerative, as well as drug induced syndromes. In clinical practice, Sydenham's chorea is the most common form of childhood chorea, whereas Huntington's disease and drug induced chorea account for the majority of adult onset cases. The aim of this review is to provide an up to date discussion of this disorder, as well as a practical approach to its management.

The natural history of embouchure dystonia.

Focal task-specific dystonias are unusual disorders of motor control, often affecting individuals who perform complex repetitive movements. Musicians are especially prone to develop these disorders because of their training regimens and intense practice schedules. Task-specific dystonia occurring in keyboard or string instrumentalists usually affects the hand. In contrast, there have been few descriptions of musicians with task-specific dystonia affecting the muscles of the face and jaw. We report detailed clinical observations of 26 professional brass and woodwind players afflicted with focal task-specific dystonia of the embouchure (the pattern of lip, jaw, and tongue muscles used to control the flow of air into a mouthpiece). This is the largest and most comprehensively studied series of such patients. Patients developed embouchure dystonia in the fourth decade, and initial symptoms were usually limited to one range of notes or style of playing. Once present, dystonia progressed without remission and responded poorly to oral medications and botulinum toxin injection. Patients with embouchure dystonia could be separated by the pattern of their abnormal movements into several groups, including embouchure tremor, involuntary lip movements, and jaw closure. Dystonia not infrequently spread to other oral tasks, often producing significant disability. Effective treatments are needed for this challenging and unusual disorder.

Animal models of myoclonus: an overview.

Attempts to characterize the mechanism(s) associated with myoclonus have led to the development of several naturally occurring and pharmacologically based animal models of myoclonus. Congenital disorders in animals that result in myoclonic seizures have been found in subpopulations of baboons that exhibit photoresponsive myoclonus and in herds of Hereford cattle that possess a fatal, autosomal-inherited imbalance in spinal glycine neurotransmission. Pharmacologically based models of myoclonus use a variety of approaches to product myoclonic seizures in test animals.