Neurosurg Focus
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Reduction of leg pain and lower-extremity weakness for 1 year with Oxiplex/SP gel following laminectomy, laminotomy, and discectomy.
Although good surgical technique is effective in reducing postoperative epidural fibrosis, compression or tethering of the nerve root may cause recurrent radicular pain and physical impairment. The implantation of a bioresorbable gel on the dura may further decrease the amount of scar formation after surgery and thus improve the patient's ability to perform activities of daily living (ADL). This study is a 12-month evaluation of the safety and effectiveness of Oxiplex/SP Gel (FzioMed, Inc., San Luis Obispo, CA) in the reduction of pain and radiculopathy after lumbar discectomy. ⋯ Oxiplex/SP Gel was easy to use and safe in patients who underwent unilateral discectomy. A greater benefit in clinical outcome measures was seen over the 12-month follow-up period in gel-treated patients.
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Object. Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is a promising new procedure for the treatment of dystonia. The authors present their technical approach for placement of electrodes into the GPi in awake patients with dystonia, including the methodology used for electrophysiological mapping of the GPi in the dystonic state, clinical outcomes and complications, and the location of electrodes associated with optimal benefit. ⋯ Spontaneous discharge rates of GPi neurons in dystonia are similar to those of globus pallidus externus neurons, such that the two nuclei must be distinguished by neuronal discharge patterns rather than by rates. Active electrode locations associated with robust improvement (> 50% decrease in BFMDRS score) were located near the intercommissural plane, at a mean distance of 3.7 mm from the pallidocapsular border. Patients with juvenile-onset primary dystonia and those with the tardive form benefited greatly from this procedure, whereas benefits for most secondary dystonias and the adult-onset craniocervical form of this disorder were more modest.
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The authors demonstrate that high-frequency electrical stimulation dorsal to the subthalamic nucleus (STN) can directly suppress levodopa-induced dyskinesias. This 63-year-old woman with idiopathic Parkinson disease underwent surgery for placement of bilateral subthalamic deep brain stimulation (DBS) electrodes to control progressive rigidity, motor fluctuations, and levodopa-induced dyskinesias. The model 3389 DBS leads were implanted with microelectrode guidance. ⋯ The patient's dopaminergic medication intake increased slightly. These findings indicate that electrical stimulation dorsal to the STN can directly suppress levodopa-induced dyskinesias independent of dopaminergic medication changes. The 3389 lead may provide inadequate coverage of the subthalamic region for some patients.
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Review Comparative Study
Comparison of pallidal and subthalamic deep brain stimulation for the treatment of levodopa-induced dyskinesias.
Deep brain stimulation (DBS) can relieve dyskinesias effectively and safely. This modality is applied most commonly in the treatment of dyskinesias associated with levodopa therapy for Parkinson disease. The subthalamic nucleus (STN) and globus pallidus internus (GPi) are the most common surgical targets. ⋯ Deep brain stimulation of the STN has become the surgical treatment of choice in many movement disorders programs but this modality has not been compared with DBS of the GPi in randomized controlled trials, and the superiority of one site over the other remains unproven. In the absence of data demonstrating superiority, selection of the stimulation target should be individualized to meet the needs of each patient. Selection of the target should be based on the patient's most disabling symptoms, response to medications (including side effects), and the goals of therapy, with consideration given to the different antidyskinetic effects of DBS of the STN and GPi.