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京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19273号 / 医博第4037号 / 新制||医||1011(附属図書館) / 32275 / 京都大学大学院医学研究科医学専攻 / (主査)教授 渡邉 大, 教授 村井 俊哉, 教授 高橋 淳 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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1 Abstract Electrical stimulation by coupled impulses according to Hufschmidt was created with the primary goal of reducing spasticity. However, there are currently few studies that confirm or refute the effect of this type of electrical stimulation in reducing spasticity. The aim of this diploma thesis was to determine the effect of electrostimulation according to Hufschmidt on the reduction of biceps brachii spasticity in patients after stroke. In addition, the effect of electrical stimulation on increasing the active range of movement of the antagonist of the examined muscle and on the active function of the spastic limb was investigated. For these purposes, a non-randomized controlled pilot study was created, which involved a total of 16 probands, 8 - in the therapeutic group, 8 - in the control group. Five-step clinical assessment in spastic paresis according to Gracies were used for the examination. In the therapeutic group, electrostimulation took place 3 times a week, a total of 8 times. The intragroup difference was evaluated using the Friedman and Wilcoxon paired tests, the intergroup difference was subsequently evaluated using the Mann-Whitney U test. The significance level p = 0.05 applies to all tests. The measured values show that Hufschmidt's electrical stimulation has a positive effect on...

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The resection of tumors within the primary motor cortex is a constant challenge. Although tractography may help in preoperative planning, it has limited application. While it can give valuable information on subcortical fibers, it is less accurate in the cortical layer of the brain. A 38-year-old patient presented with paresis of the right hand and focal epileptic seizures due to a tumor in the left precentral gyrus. Transcranial magnetic stimulation was not applicable due to seizures, so microsurgical resection was performed with preoperative tractography and intraoperative direct electrical stimulation. A histopathological assessment revealed a diagnosis of glioblastoma. Postoperative magnetic resonance imaging (MRI) showed complete resection. The paresis dissolved completely during follow-up. Surgery within the precentral gyrus is of high risk and requires multimodal functional planning. If interpreted with vigilance and consciousness of the underlying physical premises, tractography can provide helpful information within its limitations, which is especially subcortically. However, it may also help in the identification of functional cortex columns of the brain in the presence of a tumor.

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