Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2007
ReviewMotor cortex stimulation for chronic non-malignant pain: current state and future prospects.
Motor cortex stimulation (MCS) was proposed by Tsubokawa in 1991 for the treatment of post-stroke thalamic pain. Since that time, the indications have been increased and included trigeminal neuropathic pain and later other types of central and peripheral deafferentation pain. The results reported in the literature are quite good; the mean long-term success rate is 80% in facial pain and 53% in non-facial pain. ⋯ Biochemical processes involving endorphins and GABA may also be implicated in the mechanism of MCS. It is time for a large multicenter prospective randomized double blind study evaluating not only the effect of MCS on pain (based on the available guidelines for assessment of neuropathic pain), but also the optimal electrode placement and stimulation parameters, and the possible relationship with the response to rTMS. New electrode design and a new generation of stimulators may help in improving the results.
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Acta Neurochir. Suppl. · Jan 2007
ReviewPeripheral nerve stimulation for the treatment of neuropathic craniofacial pain.
Treatment of neuropathic pain in the region of head and face presents a challenging problem for pain specialists. In particular, those patients who do not respond to conventional treatment modalities usually continue to suffer from pain due to lack of reliable medical and surgical approaches. Peripheral nerve stimulation (PNS) has been used for treatment of neuropathic pain for many decades, but only recently it has been systematically applied to the craniofacial region. Here we summarize published experience with PNS in treatment of craniofacial pain and discuss some technical details of the craniofacial PNS procedure.
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Acta Neurochir. Suppl. · Jan 2007
ReviewOccipital neurostimulation for treatment of intractable headache syndromes.
Intractable migraine and other headache syndromes affect almost 40 million Americans and many more millions worldwide. Although many treatment protocols exist, mainly designed around medication regimens, there are estimated to be at least 3-5% of these headache sufferers that do not respond in a meaningful way to medications and whose lives can be severely restricted to darkened, quiet rooms, heavy doses of narcotics, failed personal relationships and an overwhelming sense of hopelessness. In this article, we describe current neuromodulation-based approach to the management of intractable headache.
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Acta Neurochir. Suppl. · Jan 2007
ReviewDBS in tourette syndrome: rationale, current status and future prospects.
Tourette syndrome is a neuropsychiatric disorder with onset in early childhood and characterized by tics, often associated with behavioural abnormalities. Symptoms often disappear before or during adulthood. Treatment consists of psychotherapy or pharmacotherapy. ⋯ The pathophysiology of Tourette syndrome is not well understood. On the basis of our current knowledge of cortico-basal ganglia-thalamocortical circuits, an explanation for the beneficial effects of DBS on tics is proposed. It is concluded that a meticulous evaluation of the electrode position, and a blinded assessment of the clinical effects on tics and behavioural disorders, is absolutely mandatory in order to identify the best target of DBS for Tourette syndrome.
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Spasticity is a clinical condition characterized by a velocity-dependent increase of muscle tone due to "parapyramidal" disturbance of the inhibitory afferents to the second motor neuron. Intrathecal baclofen (ITB) is at present the most effective treatment tor generalized spasticity provided that an accurate assessment of patients to be candidates for ITB is made. The most important patient ,election criterion is lack of positive response to any oral antispastic drug or appearance of undesired side effects of such oral treatment. ⋯ In each of these two groups treatment goals vary and require different protocols for the patients' evaluation. Assessment of patients is completed with the functional index measurement (FIM) scale in order evaluate changes in patients' quality of life caused by variations in the motor performance. Currently, treatment of spasticity with ITB is the most effective way of reducing spasticity regardless of its cause.