Stereotactic and functional neurosurgery
-
Stereotact Funct Neurosurg · Jan 2010
Review Case ReportsShould we consider Vim thalamic deep brain stimulation for select cases of severe refractory dystonic tremor.
Dystonic tremor, which may present with many different clinical presentations (rhythmic oscillations, abnormal posture, pain, and/or a null point) has proven to be a challenge for the clinician to effectively treat. Although recent studies have demonstrated excellent outcomes in select cases following deep brain stimulation (DBS) of the internal globus pallidus, the optimal target for dystonia and particularly for dystonic tremor remains unknown. ⋯ We also review the literature concerning the efficacy of Vim DBS for addressing dystonia. This case series illustrates the potential use of Vim DBS for select cases of dystonic tremor.
-
Stereotact Funct Neurosurg · Jan 2010
Case ReportsA case of mania following deep brain stimulation for obsessive compulsive disorder.
Deep brain stimulation (DBS) of the basal ganglia is an effective treatment for select movement disorders, including Parkinson's disease, essential tremor and dystonia. Based on these successes, DBS has been explored as an experimental treatment for medication-resistant neuropsychiatric disease. ⋯ We present a case of a young woman treated for OCD with DBS of the anterior limb of the internal capsule and nucleus accumbens region, who subsequently manifested a manic episode. We aim to discuss the case details, treatment and potential neuroanatomical underpinnings of this response.
-
Stereotact Funct Neurosurg · Jan 2010
Case ReportsElectrocorticographic frequency alteration mapping of speech cortex during an awake craniotomy: case report.
Traditional electrocortical stimulation (ECS) mapping is limited by the lengthy serial investigation (one location at a time) and the risk of afterdischarges in localizing eloquent cortex. Electrocorticographic frequency alteration mapping (EFAM) allows the parallel investigation of many cortical sites in much less time and with no risk of afterdischarges because of its passive nature. We examined its use with ECS in the context of language mapping during an awake craniotomy for a tumor resection. ⋯ EFAM was technically achieved in an awake craniotomy patient and had good concordance with ECS mapping. Because it poses no risk of afterdischarges and offers substantial time savings, EFAM holds promise for future development as an adjunct intraoperative mapping tool. Additionally, the cortical signals obtained by this modality can be utilized for localization in the presence of a tumor adjacent to the eloquent regions.
-
Stereotact Funct Neurosurg · Jan 2010
Case Reports Comparative StudyPrevalence of Twiddler's syndrome as a cause of deep brain stimulation hardware failure.
We reviewed our deep brain stimulation patient database to describe hardware complications which resulted from implantable pulse generator mobility, a phenomenon referred to as Twiddler's syndrome. A prospectively collected database of adverse events for all patients operated on at the University of Florida was queried searching for hardware malfunctions. Of 362 total leads implanted in 226 patients since 2002, there were 17 hardware malfunctions. ⋯ In all cases securing the implantable pulse generator within the chest pocket resolved the issue. Twiddler's syndrome in the population of movement disorder patients treated with deep brain stimulation is an uncommon but important adverse event. It possesses a characteristic presentation and with appropriate diagnostic evaluation it is treatable and future occurrences are preventable.
-
Stereotact Funct Neurosurg · Jan 2010
Case ReportsThalamic deep brain stimulation for the treatment of action myoclonus caused by perinatal anoxia.
Perinatal anoxia rarely causes myoclonus as the main neurologic abnormality. The exact neuronal mechanism underlying myoclonus induced by perinatal anoxia remains unknown. Some studies have indicated that the development of involuntary movements may be related to the maturation of the thalamus after birth. ⋯ The effectiveness of chronic thalamic DBS in this patient supports the concept of involvement of the thalamus in post-perinatal anoxic myoclonus.