Acta neurochirurgica. Supplement
-
Vagus nerve stimulation (VNS) is an established treatment for selected patients with medically refractory seizures. Recent studies suggest that VNS could be potentially useful in the treatment of resistant depressive disorder. ⋯ VNS is currently investigated in clinical studies, as a potential treatment for essential tremor, cognitive deficits in Alzheimer's disease, anxiety disorders, and bulimia. Finally, other studies explore the potential use of VNS in the treatment of resistant obesity, addictions, sleep disorders, narcolepsy, coma and memory and learning deficits.
-
For more than 20 years intrathecal opioid application with implantable pumps is an option for selected patients with malignant as well as non-malignant pain. In general, most types of pain should be treatable by opioid medication. However, the associated systemic side-effects such as nausea, vomiting, constipation or the risk of suppression of the central nervous system hinder the application of oral or intravenous opioid therapy as a sole, widely applicable treatment. ⋯ Intrathecal drug application is cost effective and can significantly improve the quality of life in selected patients. An intensive training in this method and awareness of its specific complications is necessary for everyone to participate in the consulting and implanting team. Pumps for chronic intrathecal opioid application should only be implanted in specialized centers.
-
Acta Neurochir. Suppl. · Jan 2007
ReviewNeural prostheses in clinical practice: biomedical microsystems in neurological rehabilitation.
Technical devices have supported physicians in diagnosis, therapy, and rehabilitation since ancient times. Neural prostheses interface parts of the nervous system with technical (micro-) systems to partially restore sensory and motor functions that have been lost due to trauma or diseases. Electrodes act as transducers to record neural signals or to excite neural cells by means of electrical stimulation. ⋯ The implementation of microsystem technology with integrated microelectronics in neural implants 20 years ago opened new fields of application, but also new design paradigms and approaches with respect to the biostability of passivation and housing concepts and electrode interfaces. Microsystem specific applications in the peripheral nervous system, vision prostheses and brain-machine interfaces show the variety of applications and the challenges in biomedical microsystems for chronic nerve interfaces in new and emerging research fields that bridge neuroscientific disciplines with material science and engineering. Different scenarios are discussed where system complexity strongly depends on the rehabilitation objective and the amount of information that is necessary for the chosen neuro-technical interface.
-
Extradural cortical stimulation is a recent addition to the armamentarium of operative neuromodulation. Motor cortex stimulation (MCS) is offered by positioning a stimulating plate extradurally on the primary motor cortex. It is a minimally invasive technique that was originally proposed for the control of central neuropathic pain. ⋯ The mechanisms of action may include "hyperdirect" motor cortex-subthalamic nucleus (MI-STN) input, inhibition, resynchronisation, plasticity changes, interhemispheric transfer of inhibition/excitation and modulation of other cortical areas. In this article, we review the mechanism of action of MCS in movement disorders, the predictive factors of MCS efficacy in PD, the indications, particularly in the elderly who are not suitable for DBS, the adverse effects, and the technique for localization of the central sulcus and for performing the procedure. The future prospects and developments are also discussed.
-
Spasticity is a disorder of the sensorimotor system resulting in velocity-dependent increased muscle tone and tendon reflexes. Intrathecal baclofen is currently the most effective means of treating diffuse abnormal spasticity of both cerebral and spinal origin in the adult and pediatric patient. Careful patient assessment, selection and continued therapies are essential to a successful intrathecal baclofen management program. ⋯ Excellent understanding of the baclofen delivery system, programming and dose effects are needed to evaluate any patient complaints. Future uses of intrathecal pump therapy includes use of other intrathecal drugs besides baclofen (or in combination with baclofen) and the effects of placing the catheter tip at various spinal levels. At the University of Minnesota, Sister Kenny Institute and Gillette Children's Specialty Healthcare our experience has shown excellent results with this form of therapy over the last 12-16 years.