The treatment strategy for epilepsy depends on an accurate diagnosis and precise understanding of the pathophysiology of the disease. The diagnosis of epilepsy itself must be based on the combination of the patient’s clinical information (medical history, ictal symptoms and their change), neurological findings, EEG, and imaging study of CT/MRI. In some cases, long-term video-EEG monitoring, capable of recording ictal EEG and symptoms simultaneously, is essential to discriminate non-epileptic seizures. Although the primary care of epilepsy starts with medical treatment, surgical treatment has been expanding its indication for medically intractable epilepsy, along with the development of more precise imaging techniques. Also, to obtain good seizure control after epilepsy surgery, it is essential to identify the epileptogenic area to resect. Since there exist no single modality of non-invasive pre-surgical examination up to today, we usually combine multiple modalities for finding clues to the epileptogenic area. In the case that some discrepancies were found among these modalities, and/or that the border between the epileptogenic and functional areas was not clearly identified, invasive EEG with intracranial electrodes is necessary for recording ictal brain activity directly from the cerebral cortex. Pre-surgical evaluation, commonly evaluated with intracranial subdural electrodes, has practical limitation inside, according to many clinical reports. On the other hand, application of stereotactic electroencephalography (SEEG) with depth electrodes has been reported more frequently in the last several years. In addition to this, the concept of epilepsy, whereby an abnormal intracranial neural network corresponds to the cause of disease, has been proposed and reported. clinical trials based on this concept have been applied for therapeutic intervention to obtain relief of symptoms and good seizure control.

  Neuromodulation is a therapy that uses alternating nerve activity through targeted delivery of stimulus, such as electrical stimulation, magnetic stimulation, or chemical agents, with advanced medical devices. It is highly reversible and adjustable, compared to functional ablation. The indication of neuromodulation has recently expanded to various disorders ; not only neurological disorders, but also internal and systemic diseases such as chronic infection. The progress of neuromodulation is based on advances in medical engineering. New and novel modalities of stimulus and modulating methods are being developed, such as optic and ultrasound stimulation, and closed-loop stimulation. We need a multi-disciplinal understanding of neural and biological systems to clarify the therapeutic mechanism of these stimulations. Finally, the management of ethical issues is also important.

  Deep brain stimulation (DBS) is an indispensable technique in the current treatment strategy for Parkinson’s disease (PD) and involuntary movements. Here, we discuss the future prospects of DBS for treating movement disorders, based on the results of studies conducted so far.

   [Parkinson’s disease] : It is currently difficult to decide whether the subthalamic nucleus (STN) or the globus pallidus internus (GPi) is better as the target for DBS treatment. The decision should be based on each patient’s symptoms. DBS is generally ineffective for levodopa-unresponsive motor symptoms, but the pedunculopontine nucleus (PPN) is expected to be a target that can improve levodopa-resistant axial symptoms. Its side effects may be reduced by directional (current) steering that can control current diffusion to neighboring structures in the brainstem. [Dystonia] : The effect of GPi-DBS has been established statistically, but the postoperative improvement varies across patients and studies. The patient characteristics that predict their treatment outcomes are discussed. [Essential tremor] : The thalamic ventrointermediate (Vim) nucleus is the major target for DBS and conventional radiofrequency thalamotomy. A new incisionless technique called “transcranial ultrasound surgery (FUS)” facilitates reevaluation of ablation surgery. However, because of possible side effects such as irreversible dysphagia or dysarthria, bilateral FUS is not recommended at present. [Rare involuntary movements] : DBS theoretically can be applied for rare involuntary movements including Lance-Adams syndrome, a metabolic neurodegenerative disease, ballismus, and Holmes’ tremor, but its use for these conditions has only been reported in relatively few case reports.

  In conclusion, adaptive optimization based on disease and patient properties is necessary while promoting development of DBS through introduction of new technology.

  Spasticity manifests primarily as hypertonia accompanying central nervous system disorders such as cerebrovascular accident (CVA) and traumatic brain injury (TBI), and is a neurological symptom that is frequently encountered by neurosurgeons in the course of their everyday practices.

  The exact prevalence of spasticity in Japan is not known, but reports of cases in other countries indicate that over 35% of patients who have suffered CVA and 75% of patients with severe TBI exhibit spasticity. A 2014 study of patients in Japan who had suffered CVA surveyed approximately 1.18 million patients and reported that those with spasticity alone numbered over 410,000, while the number of patients with severe spasticity originating from a cause without CVA was estimated to be over 80,000. To date, only approximately 50,000 spasticity patients have been treated with botulinum neurotoxin therapy and only around 1,700 have been treated with intrathecal baclofen therapy. Based on these numbers, it is possible that the benefits of these therapies are being made available to fewer patients in Japan compared to Europe and the US.

  In order to continue developing these therapies for spasticity, we need to be familiar with the characteristics of various treatment methods used to treat spasticity, and to create frameworks for regional alliances that focus primarily on education and rehabilitation programs targeting spasticity treatment and that involve the patient, the patient’s family, and medical staff.

  Brain function analysis from a physiological point of view, especially brain network analysis, is progressing rapidly and this progress is expected to result in the elucidation of the brain network and in overcoming neurological diseases. Furthermore, analysis of the brain information processing mechanism itself is also applicable to machine learning and artificial intelligence. A large amount of funding is invested in this field with new research projects springing up all over the world.

  In this paper, we outline the brain network and introduce our recent research concerning idiopathic normal pressure hydrocephalus and temporal lobe epilepsy.

  A questionnaire survey was conducted to build a navigational chart (current status) with an accurate compass for resident physicians designated as “specialist trainees” to establish future career directions. On February 9, 2015, we sent an email to persons in charge of training programs of the Japan Neurosurgical Society to request their assistance with a questionnaire survey on the current status of resident physician. The email was forwarded to resident physicians in training programs and they answered the questionnaire on a website. The deadline was March 6, 2015. The questionnaire included the background of resident physicians, satisfaction with and completeness of training programs, and nature of work desired in the future. The response rate was 39.9% (299 persons). The respondents were 88.6% male and 53.8% worked in a university hospital. Many belonged to urban branches, including Kanto branch (38.1%) and Kinki branch (18.1%). The major societies of respondents were the Japan Stroke Society and the Japanese Society for Neuroendovascular Therapy. The reasons to choose the current program were ①a program at the medical school from which they graduated and ②a program with opportunities to treat many patients. The respondents were generally satisfied with the training programs, but slightly less satisfied with working conditions at their hospital. Completeness of training by field was judged to be high for cerebrovascular disorder, but low for pediatric neurosurgery, indicating marked differences between fields. Many resident physicians intended to study for a Ph.D. and to follow a subspecialty of cerebrovascular disorder and cerebrovascular surgery. The respondents generally indicated satisfaction with the comprehensive nature of the training programs, but noted that in some fields it was difficult to treat or manage patients. This indicates a need to improve some activities at institutions that have training programs.