Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialHardware failures in spinal cord stimulation (SCS) for chronic benign pain of spinal origin.
Spinal cord stimulation (SCS) has become an established clinical option for treatment of refractory chronic pain not related to cancer. Current hardware and implantation techniques for SCS are already highly developed and continuously improving, however equipment failures over the course of the long-term treatment are still encountered in a relatively high proportion of treated cases. ⋯ This review summarizes the experience of the authors with management of hardware failures and their causes in patients treated with SCS for chronic pain of benign origin. The published literature is critically surveyed and discussed.
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialDrug-enhanced spinal stimulation for pain: a new strategy.
Neuropathic pain is notoriously difficult to manage and only a few classes of drugs may provide adequate benefits. Thus, in many cases spinal cord stimulation (SCS) is considered; however, in this group of patients, between 30-50% of the cases offered a percutaneous SCS trial may fail to obtain a satisfactory effect. Additionally, a certain number of patients with a good initial effect, report that after a period the benefits are reduced necessitating additional peroral drug therapy. ⋯ However, in a group of three patients with peroral baclofen therapy and SCS, complaints of side-effects were common and this therapy was terminated. Informal reports from collegues support the negative experience with additional peroral baclofen. In conclusion, in patients with neuropathic pain demonstrating inadequate response to SCS (small VAS reduction; short duration) a trial of intrathecal baclofen in combination with SCS may be warranted.
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialFactors affecting spinal cord stimulation outcome in chronic benign pain with suggestions to improve success rate.
For patient selection, psychological factors like fear avoidance, depression, secondary gain or refusal to be weaned off narcotics should be avoided. Trial Stimulation is an important tool to reduce the rate of failed permanent implants, and to improve cost-effectiveness. The etiology of pain has a strong influence on the success rate. ⋯ The electrode fracture rate can be reduced by using the paramedian approach, the use of three wing silicone anchor placed immediately at the point of exit of the lead from the deep fascia and avoiding a hard plastic twist lock anchor. The displacements can be reduced by fixing the anchor to the deep fascia firmly, supplemented by the use of silicone glue, and by placing the implantable pulse generator (IPG) in the abdominal wall, instead of the gluteal region. The use of prophylactic antibiotics tends to reduce the infection rate.
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Acta Neurochir. Suppl. · Jan 2007
Case ReportsNeuromodulation of the inferior thalamic peduncle for major depression and obsessive compulsive disorder.
Neuromodulation of the inferior thalamic peduncle is a new surgical treatment for major depression and obsessive-compulsive disorder. The inferior thalamic peduncle is a bundle of fibers connecting the orbito-frontal cortex with the non-specific thalamic system in a small area behind the fornix and anterior to the polar reticular thalamic nucleus. Electrical stimulation elicits characteristic frontal cortical responses (recruiting responses and direct current (DC)-shift) that confirm correct localization of this anatomical structure. ⋯ GAF improved significantly in both cases. The neuropsychological tests battery showed no significant changes except from a reduction in the perseverative response of the obsessive-compulsive patient and better performance in manual praxias of the female depressive patient. Moderate increase in weight (5 kg on average) was observed in both cases.
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialDeep brain stimulation for treatment of the epilepsies: the centromedian thalamic target.
Electrical stimulation (ES) of the thalamic centromedian nucleus (CMN) has been proposed as a minimally invasive alternative for the treatment of difficult-to-control seizures of multifocal origin and seizures that are generalized from the onset. ES intends to interfere with seizure propagation in a non-specific manner through the thalamic system. By adopting a frontal parasagittal approach and based on anterior-posterior (AC-PC) commissure intersection, deep brain stimulation (DBS) electrodes are stereotactically inserted. ⋯ ES of CMN significantly decreases generalized seizures of cortical origin and focal motor seizures. Best results are obtained in non-focal generalized tonic clonic seizures and atypical absences of the Lennox-Gastaut syndrome. Experience has indicated that the most effective target for seizure control is the thalamic parvocellular centromedian subnucleus.