Disruptions of cortico-kinematic interactions in Parkinson's disease.

The cortical role of the motor symptoms reflected by kinematic characteristics in Parkinson's disease (PD) is poorly understood. In this study, we aim to explore how PD affects cortico-kinematic interactions. Electroencephalographic (EEG) and kinematic data were recorded from seven healthy participants and eight participants diagnosed with PD during a set of self-paced finger tapping tasks. Event-related desynchronization (ERD) was compared between groups in the α (8-14 Hz), low-ß (14-20 Hz), and high-ß (20-35 Hz) frequency bands to investigate between-group differences in the cortical activities associated with movement. Average kinematic peak amplitudes and latencies were extracted alongside Sample Entropy (SaEn), a measure of signal complexity, as variables for comparison between groups. These variables were further correlated with average EEG power in each frequency band to establish within-group interactions between cortical motor functions and kinematic motor output. High ß-band power correlated with mean kinematic peak latency and signal complexity in the healthy group, while no correlation was found in the PD group. Also, the healthy group demonstrated stronger ERD in the broad ß-band than the PD participants. Our results suggest that cortical ß-band power in healthy populations is graded to finger tapping latency and complexity of movement, but this relationship is impaired in PD. These insights could help further enhance our understanding of the role of cortical ß-band oscillations in healthy movement and the possible disruption of that relationship in PD. These outcomes can provide further directions for treatment and therapeutic applications and potentially establish cortical biomarkers of Parkinson's disease.

Rate and prognosis of patients under conscious sedation requiring emergent intubation during neuroendovascular procedures.

BACKGROUND AND PURPOSE: Neuroendovascular procedures are performed with the patient under conscious sedation (local anesthesia) in varying numbers of patients in different institutions, though the risk of unplanned conversion to general anesthesia is poorly characterized. Our aim was to ascertain the rate of failure of conscious sedation in patients undergoing neuroendovascular procedures and compare the in-hospital outcomes of patients who were converted from conscious sedation to general anesthesia with those whose procedures were initiated with general anesthesia. MATERIALS AND METHODS: All patients who had an endovascular procedure initiated under general anesthesia or conscious sedation were identified through a prospective data base maintained at 2 comprehensive stroke centers. Patient clinical and procedural characteristics, in-hospital deaths, and favorable outcomes (modified Rankin Scale score, 0-2) at discharge were ascertained. RESULTS: Nine hundred seven endovascular procedures were identified, of which 387 were performed with the patient under general anesthesia, while 520 procedures were initiated with conscious sedation. Among procedures initiated with intent to be performed under conscious sedation, 9 (1.7%) procedures required emergent conversion to general anesthesia. Favorable clinical outcome and in-hospital mortality in patients requiring emergent conversion from conscious sedation to general anesthesia and in those with procedures initiated with general anesthesia were not statistically different (42% versus 50%, P = .73 and 17% versus 13%, P = 1.00, respectively). CONCLUSIONS: In our study, there was a very low rate of conscious sedation failure and associated adverse outcomes among patients undergoing neuroendovascular procedures. Proper patient selection is important if procedures are to be performed with the patient under conscious sedation. Limitations of the methodology used in our study preclude us from offering specific recommendations regarding when to use a specific anesthetic protocol.