Neurosurg Focus
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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.
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Spinal epidural hematoma (SEH) is an uncommon cause of acute cauda equina syndrome. Most of these hematomas are caused by trauma, anticoagulation therapy, and vascular anomalies or occur following spinal epidural procedures and, rarely, spinal surgery. Spontaneous SEH is an extremely rare occurrence. ⋯ Clinical evaluation is the most important tool in the early diagnosis of SEH. Once the disease is suspected clinically and confirmed on diagnostic imaging, emergency evacuation of the lesion should be performed. Prognosis depends on the rate of development of symptoms, interval to surgery, level of spinal involvement, and degree of neurological deficit.
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Symptoms of cauda equina syndrome (CES) can include low-back pain, sciatica, lower-extremity weakness, sensory deficit, perineal hypesthesia or anesthesia, and loss of bowel or bladder function. Several causes of the syndrome are recognized, but its optimal treatment remains controversial and has been broadly based on data gathered from series involving herniated discs. Information on the treatment of CES caused by low lumbar traumatic injuries has not been well documented. ⋯ Based on the evidence in this study, the severity of a patient's condition on initial presentation is the most crucial factor in predicting outcome following CES due to low lumbar injuries. Although the matter of the timing of surgery remains controversial, the authors of this study recommend that surgery be performed within 48 hours of syndrome onset.
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The authors focus on injury mechanisms involved in 1019 operative brachial plexus injuries (BPIs) managed between 1968 and 1998 at Louisiana State University Health Sciences Center (LSUHSC). ⋯ The conclusion of this study is that the brachial plexus can be injured by multiple mechanisms of which stretch/contusion injury is the most frequently encountered, followed by GSWs.