Der Nervenarzt
-
Induced therapeutic hypothermia (TH) is defined as a controlled reduction of the core body temperature below the physiological range. While TH is neuroprotective in many different models of brain injury, it is only recommended for patients after cardiopulmonary resuscitation and newborns suffering from perinatal hypoxic-ischemic encephalopathy (HIE). Although a strong association exists between elevated body core temperature (fever) and worsening of outcome, TH has so far not been proven to influence outcome after ischemic stroke, intracerebral hemorrhage or subarachnoidal hemorrhage because of insufficient clinical data. This review summarizes the data on TH for different clinical indications and discusses relevant aspects of its use in neurological intensive care units.
-
Neurostimulation techniques are applied to reduce the frequency and severity of epileptic seizures. Class I evidence showed that vagus nerve stimulation (VNS) reduces seizure burden by 25-28% compared to 6-15% in placebo controls. Open-label studies, however, reported much greater efficacy. ⋯ Responsive neurostimulation (RNS) combines an automated seizure detection device with on-demand triggered stimulation of the epileptogenic zone. A randomized controlled trial reported seizure frequency reduction by 37.9% compared to 17.3% in controls. There were no relevant neuropsychological or psychiatric side-effects noted.