Advanced automatic detection of fetal body movements from multichannel magnetocardiographic signals.

OBJECTIVE: Both heart rate (HR) monitoring and detection and description of fetal movements provide essential information of the integrity of in utero development and fetal wellbeing. Our previously described method to identify movements from multichannel magnetocardiographic (MCG) recordings lacks of reliability in some cases. This work is aimed at the improvement of fetal movement detection by means of an advanced signal processing and validation strategy. APPROACH: The previously proposed methodology of fetal body movement detection from MCG recordings using single space angle (SSA), min-max amplitude (MMA) and a measure of the overall signal strength across (RSS) was extended by moving correlation coefficient (MCC). The methodology was developed with respect to the discrimination between active and quiet sleep, validated by testing its coupling with HR accelerations in a total of 137 recordings lasting 30 min from 98 fetuses aged 34-38 weeks of gestation (WGA) of normal pregnancy. MAIN RESULTS: The developed algorithm improves the reliable automatic detection of fetal body movements independent of the fetal sleep states and their changes in the individual MCG recordings. In the fetuses aged 34-38 WGA 94% of 15 × 15 HR accelerations were coupled with detected movements. The visual inspection of the movement graphs of 30 fetuses aged 20-32 WGA supports the transferability of the movement detector to this age. In four subjects MCG-based movement detection and maternal report on percepted fetal movements were consistent. SIGNIFICANCE: The presented methodology allows the parallel automatic acquisition of precise fetal heart rate variability (HRV) indices based on subsequent beat intervals and of fetal body movements from MCG recordings during late 2nd and 3rd trimester. Potential advantages of parallel monitoring of fetal HRV and movements using MCG compared to established ultrasound technology should be investigated in subsequent studies with respect to the identification of fetuses at risk.

Modifying the transition temperature, 120 K ≤ Tc ≤ 1150 K, of amorphous Fe90-xCoxSc10 with simultaneous alteration of fluctuation of exchange integral up to zero.

Amorphous (a-) Fe90-xCoxSc10 alloys have been produced by rapid quenching from the melt. The Curie temperature, TC, was determined using both mean field theory and Landau's theory of second-order phase transitions in zero and non-zero external fields. The dependence of TC on the atomic spacing can be explained by the empirical Bethe-Slater curve. The value of TC of a- Fe5Co85Sc10, determined by the above theoretical approaches is 1150 K, which is the highest TC ever measured for amorphous alloys. The flattening of the measured normalized magnetization, M(T)/M(0), as a function of the reduced temperature, T/TC, is explained within the framework of the Handrich- Kobe model. According to this model the fluctuation of the exchange integral is the main reason for the flattening of M(T)/M(0). In the case of a-Fe90Sc10 without Co, however, the fluctuation of the exchange integral is dominant only at zero external field, Bex = 0. At Bex = 9 T, however, the fluctuation of the exchange integral has no conspicuous effect on the reduction of the magnetization. It is shown that at Bex = 9 T the frozen magnetic clusters control the behaviour of the reduced magnetization as function of T/TC. In contrast to other ferromagnetic alloys, where the flattening of M(T)/M(0) is characteristic for an amorphous structure, the a- Fe5Co85Sc10 does not exhibit any trace of the fluctuation of the exchange integral.

Comparison of a Photon-Counting-Detector CT with an Energy-Integrating-Detector CT for Temporal Bone Imaging: A Cadaveric Study.

BACKGROUND AND PURPOSE: Evaluating abnormalities of the temporal bone requires high-spatial-resolution CT imaging. Our aim was to assess the performance of photon-counting-detector ultra-high-resolution acquisitions for temporal bone imaging and compare the results with those of energy-integrating-detector ultra-high-resolution acquisitions. MATERIALS AND METHODS: Phantom studies were conducted to quantify spatial resolution of the ultra-high-resolution mode on a prototype photon-counting-detector CT scanner and an energy-integrating-detector CT scanner that uses a comb filter. Ten cadaveric temporal bones were scanned on both systems with the radiation dose matched to that of the clinical examinations. Images were reconstructed using a sharp kernel, 0.6-mm (minimum) thickness for energy-integrating-detector CT, and 0.6- and 0.25-mm (minimum) thicknesses for photon-counting-detector CT. Image noise was measured and compared using adjusted 1-way ANOVA. Images were reviewed blindly by 3 neuroradiologists to assess the incudomallear joint, stapes footplate, modiolus, and overall image quality. The ranking results for each specimen and protocol were compared using the Friedman test. The Krippendorff α was used for interreader agreement. RESULTS: Photon-counting-detector CT showed an increase of in-plane resolution compared with energy-integrating-detector CT. At the same thickness (0.6 mm), images from photon-counting-detector CT had significantly lower (P < .001) image noise compared with energy-integrating-detector CT. Readers preferred the photon-counting-detector CT images to the energy-integrating-detector images for all 3 temporal bone structures. A moderate interreader agreement was observed with the Krippendorff α = 0.50. For overall image quality, photon-counting-detector CT image sets were ranked significantly higher than images from energy-integrating-detector CT (P < .001). CONCLUSIONS: This study demonstrated substantially better delineation of fine anatomy for the temporal bones scanned with the ultra-high-resolution mode of photon-counting-detector CT compared with the ultra-high-resolution mode of a commercial energy-integrating-detector CT scanner.

Rotational magneto-acousto-electric tomography (MAET): theory and experimental validation.

We present a novel two-dimensional (2D) MAET scanner, with a rotating object of interest and two fixed pairs of electrodes. Such an acquisition scheme, with our novel reconstruction techniques, recovers the boundaries of the regions of constant conductivity uniformly well, regardless of their orientation. We also present a general image reconstruction algorithm for the 2D MAET in a circular chamber with point-like electrodes immersed into the saline surrounding the object. An alternative linearized reconstruction procedure is developed, suitable for recovering the material interfaces (boundaries) when a non-ideal piezoelectric transducer is used for acoustic excitation. The work of the scanner and the linearized reconstruction algorithm is demonstrated using several phantoms made of high-contrast materials and a biological sample.

Temporal Bone CT: Improved Image Quality and Potential for Decreased Radiation Dose Using an Ultra-High-Resolution Scan Mode with an Iterative Reconstruction Algorithm.

BACKGROUND AND PURPOSE: Radiation dose in temporal bone CT imaging can be high due to the requirement of high spatial resolution. In this study, we assessed whether CT imaging of the temporal bone by using an ultra-high-resolution scan mode combined with iterative reconstruction provides higher spatial resolution and lower image noise than a z-axis ultra-high-resolution mode. MATERIALS AND METHODS: Patients with baseline temporal bone CT scans acquired by using a z-axis ultra-high-resolution protocol and a follow-up scan by using the ultra-high-resolution-iterative reconstruction technique were identified. Images of left and right temporal bones were reconstructed in the axial, coronal, and Poschl planes. Three neuroradiologists assessed the spatial resolution of the following structures: round and oval windows, incudomallear and incudostapedial joints, basal turn spiral lamina, and scutum. The paired z-axis ultra-high-resolution and ultra-high-resolution-iterative reconstruction images were displayed side by side in random order, with readers blinded to the imaging protocol. Image noise was compared in ROIs over the posterior fossa. RESULTS: We identified 8 patients, yielding 16 sets of temporal bone images (left and right). Three sets were excluded because the patient underwent surgery between the 2 examinations. Spatial resolution was comparable (Poschl) or slightly better (axial and coronal planes) with ultra-high-resolution-iterative reconstruction than with z-axis ultra-high-resolution. A paired t test indicated that noise was significantly lower with ultra-high-resolution-iterative reconstruction than with z-axis ultra-high-resolution (P < .001), with a mean noise reduction of 37% (range, 18%-49%). CONCLUSIONS: The ultra-high-resolution-iterative reconstruction scan mode has similar or slightly better resolution relative to the z-axis ultra-high-resolution mode for CT of the temporal bone but significantly (P < .01) lower image noise, which may enable the dose to be reduced by approximately 50%.

The mechanically induced structural disorder in barium hexaferrite, BaFe12O19, and its impact on magnetism.

The response of the structure of the M-type barium hexaferrite (BaFe12O19) to mechanical action through high-energy milling and its impact on the magnetic behaviour of the ferrite are investigated. Due to the ability of the (57)Fe Mössbauer spectroscopic technique to probe the environment of the Fe nuclei, a valuable insight on a local atomic scale into the mechanically induced changes in the hexagonal structure of the material is obtained. It is revealed that the milling of BaFe12O19 results in the deformation of its constituent polyhedra (FeO6 octahedra, FeO4 tetrahedra and FeO5 triangular bi-pyramids) as well as in the mechanically triggered transition of the Fe(3+) cations from the regular 12k octahedral sites into the interstitial positions provided by the magnetoplumbite structure. The response of the hexaferrite to the mechanical treatment is found to be accompanied by the formation of a non-uniform nanostructure consisting of an ordered crystallite surrounded/separated by a structurally disordered surface shell/interface region. The distorted polyhedra and the non-equilibrium cation distribution are found to be confined to the amorphous near-surface layers of the ferrite nanoparticles with the thickness extending up to about 2 nm. The information on the mechanically induced short-range structural disorder in BaFe12O19 is complemented by an investigation of its magnetic behaviour on a macroscopic scale. It is demonstrated that the milled ferrite nanoparticles exhibit a pure superparamagnetism at room temperature. As a consequence of the far-from-equilibrium structural disorder in the surface shell of the nanoparticles, the mechanically treated BaFe12O19 exhibits a reduced magnetization and an enhanced coercivity.

Four-dimensional ultrasound current source density imaging of a dipole field.

Ultrasound current source density imaging (UCSDI) potentially transforms conventional electrical mapping of excitable organs, such as the brain and heart. For this study, we demonstrate volume imaging of a time-varying current field by scanning a focused ultrasound beam and detecting the acoustoelectric (AE) interaction signal. A pair of electrodes produced an alternating current distribution in a special imaging chamber filled with a 0.9% NaCl solution. A pulsed 1 MHz ultrasound beam was scanned near the source and sink, while the AE signal was detected on remote recording electrodes, resulting in time-lapsed volume movies of the alternating current distribution.

Wide, short bore magnetic resonance at 1.5 t: reducing the failure rate in claustrophobic patients.

PURPOSE: Claustrophobic reactions in patients undergoing magnetic resonance imaging (MRI) have a significant impact on the workflow, patient acceptance and ultimately the costs involved in obtaining a diagnostic scan. The purpose of this study was to determine if the use of a wide, short bore MRI scanner could reduce the need for general anesthesia assistance in these cases. METHODS: Between September 2006 and March 2008, all patients for whom MRI examinations of the head and/or spine were canceled or prematurely terminated due to claustrophobia on a standard 60 cm bore, 1.5 T scanner were scheduled to be re-scanned on a 70 cm wide bore, 1.25 m long 1.5 T scanner. This re-scanning attempt was made 2 or more days prior to a scheduled anesthesia-assisted MRI appointment. If the patient successfully completed the wide bore MRI examination then the anesthesia-assisted MRI appointment was canceled. RESULTS: A total of 56 patients were included in this study. The examinations included individual body regions as well as combination examinations (head and cervical spine, entire spine etc.). A total of 72 body regions were examined in 56 patients. Of these regions, 65 (90%) were completed successfully, 50 patients (89%) successfully completed a diagnostic examination on the 70 cm scanner and 6 patients (11%), all of whom were scheduled for examinations which included the head, were unable to complete the examination on the wide bore scanner. CONCLUSIONS: A 1.5 T wide short bore scanner increases the examination success rate in patients with claustrophobia and substantially reduces the need for anesthesia-assisted MRI examinations even when claustrophobia is severe.

Correlation of outcome to neurosurgical lesions: confirmation of a new method using data after microelectrode-guided pallidotomy.

The purpose of this study was the development of a new method to correlate functional surgery with outcome measures. Lesions following microelectrode guided globus pallidus internus (GPi) pallidotomy for Parkinson's disease are presented to demonstrate this new method in regard to clinical outcome. A clinical series of 26 patients with extensive neurological and neuropsychological data were studied. Three-month postoperative MRI lesion borders at the AC-PC plane were scaled to a standard size, and the lesions were stored in a virtual array with a cell size of one voxel. The average outcome measure for each voxel is presented graphically. Unified Parkinson's disease rating scale (UPDRS) motor scores improved more with posterolateral and centrally located GPi lesions than with anteromedial lesions. A correlation of lesion location to outcome was also visible for subscales of the UPDRS. The distributions were similar for the left and right sides, as well as for ipsi- and contralateral measurements. In general, verbal fluency decreased after lesioning the dominant hemisphere, and posterolateral lesions caused less impairment. This method enables associative analyses between brain area and outcome down to the size of a few voxels. This may be particularly helpful for planning and validating neurosurgical targets for various disorders.

State of the art: 3T imaging of the membranous labyrinth.

This article reviews the anatomy of the membranous labyrinth and demonstrates the ability of high-resolution MR imaging at 3T to visualize the neurosensory epithelium by using the latest fast spin-echo techniques.

Performance of laser bonded glass/polyimide microjoints in cerebrospinal fluid.

In this paper, laser bonded microjoints between glass and polyimide is considered to examine their potential applicability in encapsulating neural implants. To facilitate bonding between polyimide and glass, a thin titanium film with a thickness of 2 microm was deposited on borosilicate glass plates by a physical vapor deposition (PVD) process. Titanium coated glass was then joined with polyimide by using a cw fiber laser emitting at a wavelength of 1.1 microm (1.0 W) to prepare several tensile samples. Some of the samples were exposed to artificial cerebrospinal fluid (aCSF) at 37 degrees C for two weeks to assess long-term integrity of the joints. Both the as-received and aCSF soaked samples were subjected to uniaxial tensile loads for bond strengths measurements. The bond strengths for the as-received and aCSF soaked samples were measured to be 7.31 and 5.33 N/mm, respectively. Although the long-term exposure of the microjoints to aCSF has resulted in 26% reduction of bond strength, the samples still retain considerably high strength as compared with the titanium-polyimide samples. The failed glass/polyimide samples were also analyzed using optical microscopy, and failure mechanisms are discussed. In addition, a two dimensional finite element analysis (FEA) was conducted to understand the stress distribution within the substrate materials while the samples are in tension. The FEA results match reasonably well with the experimental load-displacement curves for as-received samples. Detailed discussion on various stress contours is presented in the paper, and the failure mechanisms observed from the experiment are shown in good agreement with the FEA predicted ones.

A comparison between glass/polyimide and titanium/polyimide microjoint performances in cerebrospinal fluid.

Assessment of neural biocompatibility requires that materials be tested with exposure in neural fluids. Laser bonded microjoint samples made from Ti coated glass substrate and polyimide film (GPI) and titanium foil and polyimide film (TIPI) were evaluated for mechanical performance before and after exposure in artificial cerebrospinal fluid (CSF) for two, four, and 12 weeks at 37 degrees C. These samples represent a critical feature, i.e., the microjoint-a major weakness in the bioencapsulation system. Both material systems showed initial degradation up to 4 weeks which then stabilized afterwards and retained similar strength until 12 weeks. The TIPI system appears to exhibit better overall performance with less degradation compared to its as-received strength. The CSF exposed TIPI samples predominantly failed at the interface, while GPI samples had mixed glass and polyimide substrate and interface failure. The amount of glass failure decreases and interface failure increases with increase in CSF exposure time. The failure mechanism of the as-received (not exposed to CSF) GPI samples under tension was predominantly flexure type failure of the glass substrate.

Laser bonded microjoints between titanium and polyimide for applications in medical implants.

Bioencapsulation of medical implant devices, and neural implant devices in particular, requires development of reliable hermetic joints between packaging materials that are often dissimilar. Titanium-polyimide is one of the biocompatible material systems, which are of interest to our research groups at Wayne State University and Fraunhofer USA. We have found processing conditions for successful joining of titanium with polyimide using near-infrared diode lasers or fiber lasers along transmission bonding lines with widths ranging from 200 to 300 microm. Laser powers of 2.2 and 3.8 W were used to create these joints. Laser-joined samples were tested in a microtester under tensile loading to determine joint strengths. In addition, finite element analysis (FEA) was conducted to understand the stress distribution within the bond area under tensile loading. The FEA model provides a full-field stress distribution in and around the joint that cause eventual failure. Results from the investigation provide an initial approach to characterize laser-fabricated microjoints between dissimilar materials that can be potentially used in optimization of bio-encapsulation design.

Microwave-induced thermal imaging of tissue dielectric properties.

A new imaging method, microwave-induced thermal imaging (MITI), was developed to differentiate tissue based on thermal and dielectric properties. Image contrast depends on temporal strain in tissue, which was determined by one-dimensional speckle tracking using a phase-sensitive, correlation-based technique. The underlying mechanisms were analyzed and experimental results on biologic tissue agreed well with theoretical predictions. Because of its strong contrast between water-bearing and lipid-bearing tissue, the technique may enhance existing intravascular ultrasound (IVUS) imaging systems to identify vulnerable arterial plaque.

Comparison of 5-fluorouracil alone, 5-fluorouracil with levamisole, and 5-fluorouracil with hepatic irradiation in the treatment of patients with residual, nonmeasurable, intra-abdominal metastasis after undergoing resection for colorectal carcinoma.

BACKGROUND: The authors conducted a randomized Phase III trial of three treatment regimens for patients with residual, nonmeasurable, intra-abdominal metastatic disease after undergoing resection for primary colorectal carcinoma. METHODS: To be eligible for this study, patients had to be both free of other malignancies and capable of starting their therapy within 3-6 weeks after surgery. They were required to have an Eastern Cooperative Oncology Group performance status < 3; to be chemotherapy, radiation, and immunotherapy naïve; to have adequate bone marrow, renal, and hepatic function; and to provide written, informed consent. The patients were divided into two cohorts: patients with no demonstrable hepatic metastasis (Group A) and patients with hepatic metastasis (Group B). RESULTS: The 229 patients in Group A were randomized to receive either 5-fluorouracil (5-FU) (n = 116 patients) or 5-FU with levamisole (n = 113 patients). The median survival (15.4 months and 15.3 months, respectively, for Groups A and B) was virtually identical. The two groups also were similar in terms of time to treatment progression, which was 7.9 months for group that received 5-FU alone 7.7 months for the group that received levamisole with 5-FU. The 168 patients in Group B with hepatic metastasis underwent a three-way randomization: 5-FU alone (n = 60 patients), 5-FU with levamisole (n = 54 patients), and 5-FU with hepatic irradiation (n = 54 patients). The median overall survival for the three treatment arms were similar, with 17.3 months for the group that received 5-FU alone, 16 months for the group that received 5-FU with levamisole, and 14.4 months for the group that received hepatic irradiation in addition to 5-FU: The time to treatment failure was 6.7 months, 6.8 months, and 8.3 months, respectively, for the three groups. The toxicity experienced by patients was as expected with the regimens, and no differences were observed between any of the treatment groups. The primary toxicities were hematologic and gastrointestinal. There was one treatment-related death due to adult respiratory distress syndrome, which occurred on the first day of the fourth cycle of 5-FU and levamisole. Other Grade 4 toxicities included nine patients with Grade 4 leukopenia, one patient with Grade 4 sepsis, and one patient with Grade 4 gastrointestinal toxicity, including blood loss and diarrhea. CONCLUSIONS: This study showed no treatment advantage for any of the combined modalities over 5-FU alone in this group of patients with intra-abdominal, nonmeasurable disease.

Quantitative and qualitative outcome measures after thalamic deep brain stimulation to treat disabling tremors.

OBJECTIVE: We studied outcome measures after unilateral and bilateral thalamic stimulation to treat disabling tremor resulting from essential tremor and Parkinson's disease. The surgical technique, qualitative and quantitative tremor assessments, stimulation parameters, locations of active electrodes, complications, and side effects are described and analyzed. METHODS: Forty-one patients with essential tremor or Parkinson's disease underwent implantation of 56 thalamic stimulators. Preoperative qualitative and quantitative tremor measurements were compared with those obtained after unilateral and bilateral surgery, with activated and deactivated stimulators. Stimulation parameters and stimulation-related side effects were recorded, and outcome measures were statistically analyzed. RESULTS: Qualitative measurements demonstrated significant improvement of contralateral upper-limb (P < 0.001), lower-limb (P < 0.01), and midline (P < 0.001) tremors after unilateral surgery. Ipsilateral arm tremor also improved (P < 0.01). No differences were observed with the Purdue pegboard task. Quantitative accelerometer measurements were correlated with qualitative assessments and confirmed improvements in contralateral resting (P < 0.001) and postural (P < 0.01) tremors and ipsilateral postural tremor (P < 0.05). Activities of daily living improved after unilateral surgery (P < 0.001) and additionally after bilateral surgery (P < 0.05). Adjustments of the pulse generator were required more frequently for tremor control than for amelioration of side effects. Bilateral thalamic stimulation caused more dysarthria and dysequilibrium than did unilateral stimulation. Stimulation-related side effects were reversible for all patients. Stimulation parameters did not change significantly with time. A significantly lower voltage and greater pulse width were used for patients with bilateral implants. CONCLUSION: Unilateral thalamic stimulation and bilateral thalamic stimulation are safe and effective procedures that produce qualitative and quantitative improvements in resting, postural, and kinetic tremor. Thalamic stimulation-related side effects are mild and reversible.

Simultaneous thalamic deep brain stimulation and implantable cardioverter-defibrillator.

Thalamic deep brain stimulation is becoming increasingly popular for the control of drug-refractory tremor. Implantable cardiac pacemakers and defibrillators are commonly used therapeutic modalities. Concerns exist about the potential interactions between these 2 devices in the same patient, but no experience has been reported previously. We describe a patient with essential tremor who had a deep brain stimulator implanted into the left ventral intermediate nucleus of thalamus, who subsequently needed an implantable cardioverter-defibrillator. Despite concerns about possible interactions between the 2 types of implanted electrical devices (i.e., a situation similar to drug-drug interactions), the deep brain stimulator and the implanted pacemaker-defibrillator functioned appropriately, and no interaction occurred in our patient.

Cross sectional study on cytokine production (TNF-α, IL-8) in German coalminers with progressive massive fibrosis and in control miners using a rapid wholeblood assay.

Whole-blood release of tumour necrosis factor (TNF-α) and interleukin 8 (IL-8) was studied in 26 German ex-coalminers with progressive massive fibrosis (≥A, ILO 1980; cases) and 26 ex-miners free of pneumoconiosis (≤ 0/1; controls) using a simple wholeblood assay. Cases and controls were matched individually by age and duration of coalmine dust exposure (5-year window). Whole-blood cytokine release was determined (blinded to case control status) in incubations without additions (spontaneous) and with endotoxin (LPS, 3 ng ml(-1)) or with coalmine dust (CMD; 5 mg ml(-1)). CMD-stimulated TNF-α release was significantly increased and LPS-induced IL-8 release was significantly decreased in cases (matched t-tests: p < 0.01). No effect of duration of exposure was detectable in an unmatched analysis. No clear relationship with lung function parameters independent from case/control-status was observed, although a possible positive association with central airway resistance was indicated by multiple regression for both CMD stimulated TNF-α and LPS-stimulated IL-8. This study on individually matched coalminers validates previous findings on monocyte TNF release as a marker for pneumoconiosis using a method (whole-blood assay) that is more feasible for epidemiological studies. The different response of TNF-α and IL-8 may be useful in studying the occurrence of different endpoints like pneumoconiosis and lung function decrease.

Acute tumor lysis syndrome with choriocarcinoma.

A 52-year-old man with retroperitoneal nodal, lung, and liver metastases from choriocarcinoma received chemotherapy with etoposide, cisplatin, and bleomycin. Within 48 hours of starting treatment, he had hypotension, hypoxemia, and anuria. Laboratory values showed hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and metabolic acidosis. He was placed on mechanical ventilation, and hemodialysis was instituted, with marked improvement in renal function. A second, shortened course of chemotherapy with carboplatin and etoposide was given 21 days later. However, on hospital day 48, the patient died of progressive pulmonary insufficiency and cardiac arrest. This represents the first reported case of acute tumor lysis syndrome after systemic chemotherapy for advanced nonseminomatous germ cell cancer.

Predictors of neuropsychological outcome in patients following microelectrode-guided pallidotomy for Parkinson's disease.

OBJECT: The authors studied neuropsychological performance following microelectrode-guided posteroventral pallidotomy in patients with Parkinson's disease (PD) and evaluated correlations with presurgical and surgical factors. METHODS: Neuropsychological changes 3 months (43 patients) and 12 months (27 patients) after microelectrode-guided pallidotomy for PD are reported in a series of 44 consecutive patients with the disease, who improved neurologically, as measured by the Unified Parkinson's Disease Rating Scale (UPDRS) in both the "off' (p<0.001) and best "on" (p<0.001) states. Findings of the vocabulary subtest of the Wechsler Adult Intelligence Scale-Revised (p<0.01), Letter Fluency (p<0.001), Verbal Fluency for semantic categories (p<0.001), and the Wisconsin Card Sorting Test (p<0.01) showed a significant decline in neuropsychological performance in patients 3 months after undergoing left-sided pallidotomy. Impairment in the language domain (semantic fluency) persisted at the 12-month follow-up examination (p<0.01). Visual memory improved after right-sided pallidotomies (p<0.01 after 3 months), with a nonsignificant trend toward persistent improvement 1 year postsurgery (p<0.02 after 12 months). Preoperative semantic fluency was influenced by patient age (p<0.001) and by the width of the third ventricle (p<0.05), as measured by magnetic resonance imaging. A regression model revealed that semantic fluency 3 months postoperatively was significantly affected by the baseline score (p<0.001), side of surgery (p<0.001), handedness (p<0.01), and patient age (p<0.05). However, postoperative lesion volume, lesion location, number of tracks, number of lesions, distance from anatomical landmarks, or UPDRS score did not significantly contribute to neuropsychological outcome. CONCLUSIONS: Neuropsychological changes in a cohort of patients with PD who underwent pallidotomy and experienced excellent clinical benefits and minimum postoperative complications, emphasize the importance of neuropsychological examinations and further investigation of predictive factors.