Sean Martin

Bio: Sean Martin is an academic researcher from University of Oxford. The author has contributed to research in topics: Deep brain stimulation & Pedunculopontine nucleus. The author has an hindex of 7, co-authored 30 publications receiving 166 citations. Previous affiliations of Sean Martin include Southern General Hospital & Wishaw General Hospital.

The effectiveness of percutaneous balloon compression in the treatment of trigeminal neuralgia in patients with multiple sclerosis.

Abstract: OBJECT Trigeminal neuralgia (TN) is more common in multiple sclerosis (MS) patients than in the general population and among the former has an incidence of approximately 2%. The pathophysiology of TN in MS patients is believed to be caused by a demyelinating plaque at the root entry zone, and therefore procedures that cause direct nerve damage are thought to be the most effective surgical modality. The authors aimed to compare the efficacy of percutaneous balloon compression (PBC) in TN patients with and without MS. METHODS Retrospectively collected clinical data on 80 consecutive patients who underwent 144 procedures and who received PBC forTN treatment between January 2000 and January 2010 were analyzed. The cohort included 17 MS and 63 non-MS patients. RESULTS The mean age at first operation was significantly younger in the MS group compared with the non-MS group (59 years vs 72 years, respectively, p < 0.0001). After a mean follow-up of 43 months (MS group) and 25 months (non-MS group), the symptom re...

30-day outcomes in hip fracture patients during the COVID-19 pandemic compared to the preceding year.

Abstract: Aims To establish if COVID-19 has worsened outcomes in patients with AO 31 A or B type hip fractures. Methods Retrospective analysis of prospectively collected data was performed for a five-week pe...

DyNeuMo Mk-2: An Investigational Circadian-Locked Neuromodulator with Responsive Stimulation for Applied Chronobiology

Abstract: Deep brain stimulation (DBS) for Parkinson’s disease, essential tremor and epilepsy is an established palliative treatment. DBS uses electrical neuromodulation to suppress symptoms. Most current systems provide a continuous pattern of fixed stimulation, with clinical follow-ups to refine settings constrained to normal office hours. An issue with this management strategy is that the impact of stimulation on circadian, i.e. sleep-wake, rhythms is not fully considered; either in the device design or in the clinical follow-up. Since devices can be implanted in brain targets that couple into the reticular activating network, impact on wakefulness and sleep can be significant. This issue will likely grow as new targets are explored, with the potential to create entraining signals that are uncoupled from environmental influences. To address this issue, we have designed a new brain-machine-interface for DBS that combines a slow-adaptive circadian-based stimulation pattern with a fast-acting pathway for responsive stimulation, demonstrated here for seizure management. In preparation for first-in-human research trials to explore the utility of multi-timescale automated adaptive algorithms, design and prototyping was carried out in line with ISO risk management standards, ensuring patient safety. The ultimate aim is to account for chronobiology within the algorithms embedded in brain-machine-interfaces and in neuromodulation technology more broadly.

A survival analysis of GBM patients in the West of Scotland pre- and post-introduction of the Stupp regime.

Abstract: Objective. It is now accepted that the concomitant administration of temozolomide with radiotherapy (Stupp regime), in the treatment of patients with newly diagnosed glioblastoma multiforme (GBM), significantly improves survival and this practice has been adopted locally since 2004. However, survival outcomes in cancer can vary in different population groups, and outcomes can be affected by a number of local factors including socioeconomic status. In the West of Scotland, we have one of the worse socioeconomic status and overall health record for a western European country. With the ongoing reorganisation and rationalisation in the National Health Service, the addition of prolonged courses of chemotherapy to patients’ management significantly adds to the financial burden of a cash stripped NHS. A survival analysis in patients with GBM was therefore performed, comparing outcomes of pre- and post-introduction of the Stupp regime, to justify the current practice. Materials and methods. Prospectively ...

Autonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System

Abstract: This book provides a series of reviews about pathophysiology, treatment, and, especially, diagnostic testing of clinical syndromes of autonomie failure. The book is organized into sections about integration of sympathetic and parasympathetic function, progressive autonomie failure, and syndromes of autonomie failure. Even cursory examination of the table of contents reveals a lack of consensus about the proper classification for the several conditions involving autonomie failure, reflecting our relative ignorance about pathophysiology in this new discipline in neurology. The chapter authors are well-chosen experts, the quality of writing is generally good, and the chapters fit together well. Several typographical errors are annoying or misleading (eg, description of prazosin as an ot-2 adrenoceptor blocker, page 164). The book is a worthwhile compilation for cardiologists, neurologists, endocrinologiste, and internists who evaluate patients with suspected autonomie failure and need to know the relevant diagnostic tests. Medical students, medical residents, and fellows should benefit from

Trends in glioblastoma: outcomes over time and type of intervention: a systematic evidence based analysis.

Abstract: Despite aggressive treatment with chemoradiotherapy and maximum surgical resection, survival in patients with glioblastoma (GBM) remains poor. Ongoing efforts are aiming to prolong the lifespan of these patients; however, disparities exist in reported survival values with lack of clear evidence that objectively examines GBM survival trends. We aim to describe the current status and advances in the survival of patients with GBM, by analyzing median overall survival through time and between treatment modalities. A systematic review was conducted according to PRISMA guidelines to identify articles of newly diagnosed glioblastoma from 1978 to 2018. Full-text glioblastoma papers with human subjects, ≥ 18 years old, and n ≥ 25, were included for evaluation. The central tendency of median overall survival (MOS) was 13.5 months (2.3–29.6) and cumulative 5-year survival was 5.8% (0.01%–29.1%), with a significant difference in survival between studies that predate versus postdate the implementation of temozolomide and radiation, [12.5 (2.3–28) vs 15.6 (3.8–29.6) months, P < 0.001]. In clinical trials, bevacizumab [18.2 (10.6–23.0) months], tumor treating fields (TTF) [20.7 (20.5–20.9) months], and vaccines [19.2 (15.3–26.0) months] reported the highest central measure of median survival. Coadministration with radiotherapy and temozolomide provided a statistically significant increase in survival for patients suffering from glioblastoma. However, the natural history for GBM remains poor. Therapies including TTF pooled values of MOS and provide means of prolonging the survival of GBM patients.

The Survival Advantage of "Supratotal" Resection of Glioblastoma Using Selective Cortical Mapping and the Subpial Technique.

Abstract: BACKGROUND A substantial body of evidence suggests that cytoreductive surgery is a prerequisite to prolonging survival in patients with glioblastoma (GBM). OBJECTIVE To evaluate the safety and impact of "supratotal" resections beyond the zone of enhancement seen on magnetic resonance imaging scans, using a subpial technique. METHODS We retrospectively evaluated 86 consecutive patients with primary GBM, managed by the senior author, using a subpial resection technique with or without carmustine (BCNU) wafer implantation. Multivariate Cox proportional hazards regression was used to analyze clinical, radiological, and outcome variables. Overall impacts of extent of resection (EOR) and BCNU wafer placement were compared using Kaplan-Meier survival analysis. RESULTS Mean patient age was 56 years. The median OS for the group was 18.1 months. Median OS for patients undergoing gross total, near-total, and subtotal resection were 54, 16.5, and 13.2 months, respectively. Patients undergoing near-total resection ( P = .05) or gross total resection ( P < .01) experienced statistically significant longer survival time than patients undergoing subtotal resection as well as patients undergoing ≥95% EOR ( P < .01) when compared to <95% EOR. The addition of BCNU wafers had no survival advantage. CONCLUSIONS The subpial technique extends the resection beyond the contrast enhancement and is associated with an overall survival beyond that seen in similar series where resection of the enhancement portion is performed. The effect of supratotal resection on survival exceeded the effects of age, Karnofsky performance score, and tumor volume. A prospective study would help to quantify the impact of the subpial technique on quality of life and survival as compared to a traditional resection limited to the enhancing tumor.

Magnetic Resonance Diffusion Tensor Imaging in Patients WithCervical Spondylotic Spinal Cord Compression CorrelationsBetween Clinical and Electrophysiological Findings

Abstract: Study Design. A prospective study evaluating a cohort of patients with spondylotic cervical spine compression. Objective. To analyze the potential of diffusion tensor imaging (DTI) of the cervical spinal cord in the detection of changes associated with spondylotic myelopathy, with particular reference to clinical and electrophysiological findings. Summary of Background Data. Conventional magnetic resonance imaging (MRI) may provide confusing findings because of a frequent disproportion between the degree of the spinal cord compression and clinical symptoms. The DTI is known to be more sensitive to subtle pathological changes of the spinal cord compared with conventional MRI. Methods. The DTI of the cervical spinal cord was performed within a group of 52 patients with spondylotic spinal cord compression and 13 healthy volunteers on a 1.5-T MRI scanner. All patients underwent clinical examination that differentiated between asymptomatic and symptomatic myelopathy subgroups, and 45 patients underwent electrophysiological examination. We measured the apparent diffusion coefficient and fractional anisotropy of the spinal cord at C2/C3 level without compression and at the maximal compression level (MCL). Sagittal spinal canal diameter, cross-sectional spinal cord area, and presence of T2 hyperintensity at the MCL were also recorded. Nonparametric statistical testing was used for comparison of controls with subgroups of patients. Results. Significant differences in both the DTI parameters measured at the MCL, between patients with compression and control group, were found, while no difference was observed at the noncompression level. Moreover, fractional anisotropy values were lower and apparent diffusion coefficient values were higher at the MCL in the symptomatic patients than in the asymptomatic patients. The DTI showed higher potential to discriminate between clinical subgroups in comparison with standard MRI parameters and electrophysiological findings. Conclusion. The DTI appears to be a promising imaging modality in patients with spondylotic spinal cord compression. It reflects the presence of symptomatic myelopathy and shows considerable potential for discriminating between symptomatic and asymptomatic patients.

General Anesthesia and Altered States of Arousal: A Systems Neuroscience Analysis

Abstract: Placing a patient in a state of general anesthesia is crucial for safely and humanely performing most surgical and many nonsurgical procedures. How anesthetic drugs create the state of general anesthesia is considered a major mystery of modern medicine. Unconsciousness, induced by altered arousal and/or cognition, is perhaps the most fascinating behavioral state of general anesthesia. We perform a systems neuroscience analysis of the altered arousal states induced by five classes of intravenous anesthetics by relating their behavioral and physiological features to the molecular targets and neural circuits at which these drugs are purported to act. The altered states of arousal are sedation-unconsciousness, sedation-analgesia, dissociative anesthesia, pharmacologic non-REM sleep, and neuroleptic anesthesia. Each altered arousal state results from the anesthetic drugs acting at multiple targets in the central nervous system. Our analysis shows that general anesthesia is less mysterious than currently believed.