Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2003
Clinical TrialClinical study for alleviating opiate drug psychological dependence by a method of ablating the nucleus accumbens with stereotactic surgery.
The aim of this study was to explore a new way of treating drug addiction by ablating the nucleus accumbens (NAC), which has a close relationship with drug-induced psychological dependence, using stereotactic surgery, blocking the mesocorticolimbic dopamine circuit, alleviating craving for drugs and lowering the relapse rate after detoxification. On the basis of animal experiments, stereotactic surgery was performed in 28 patients by making a lesion in the NAC bilaterally to treat opiate drug dependence. Indications, the criterion of therapeutic effect, treatment process and the therapeutic and safety evaluation index of the surgery were formulated particularly. ⋯ The mean follow-up time in this study was 15 months. The effectiveness was satisfactory. The relapse rate of drug addicts after detoxification was clearly reduced.
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Stereotact Funct Neurosurg · Jan 2003
Longevity of batteries in internal pulse generators used for deep brain stimulation.
The longevity of batteries in internal pulse generators (IPGs) used clinically for deep brain stimulation is not known. We conducted a study to assess the life span of these batteries. From 1993 to 2000, 163 single-channel batteries were surgically implanted in our institution. ⋯ Batteries with high energy consumption as assessed by TEED had a reduced life span (r = -0.82, p < or = 0.001). Patients with essential tremor who required battery replacement needed higher settings to control their symptoms and therefore presented a shorter battery life when compared to patients with Parkinson's disease. In our series of patients who needed battery replacement, battery longevity varied with stimulation parameters but was longer than expected from the manufacturer's specifications.
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Stereotact Funct Neurosurg · Jan 2003
Long-term outcome of spinal cord stimulation and hardware complications.
Spinal cord stimulation (SCS) is a treatment modality for medically intractable chronic pain. This study reports an 11-year experience with SCS assessing long-term pain relief and specifically evaluating complications and revisions. It took the form of a retrospective review of medical/surgical records with a postal questionnaire. ⋯ Clinician-reported pain relief was substantial in 69 (68%) patients. This study adds to the weight of evidence that patients undergoing SCS derive significant benefits in terms of pain relief. However, revision rates remain high due to technical and biological factors.
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Stereotact Funct Neurosurg · Jan 2003
Spinal cord stimulation for the treatment of refractory unilateral limb pain syndromes.
Spinal cord stimulation (SCS) is an established therapy for chronic pain. Its success depends on vigorous patient selection and good follow-up. ⋯ We feel that SCS is an effective treatment in RULPS and its results depend upon vigorous patient selection and an adequate follow-up and maintenance program.
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Stereotact Funct Neurosurg · Jan 2003
Microvascular decompression for trigeminal neuralgia in patients with multiple sclerosis.
To assess whether microvascular decompression (MVD) is a safe and efficacious treatment for patients with trigeminal neuralgia (TGN) and multiple sclerosis (MS). ⋯ Although MVD provides good initial pain relief, the recurrence rate is much higher than that obtained in 'idiopathic' TGN. Although all procedures for the treatment of TGN are worse than those for idiopathic TGN, it is concluded that because of the high recurrence rate together with the morbidity associated with the procedure MVD should not be offered to patients with TGN and MS.