Acta neurochirurgica. Supplement
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Deep brain stimulation (DBS) at the globus pallidus pars internus (GPi) is an effective treatment for some patients with medically refractory torsion dystonia. In this chapter we review the classification and treatment of torsion dystonia including the current indications for DBS surgery. Details of the DBS procedure and programming of the DBS devices are discussed. ⋯ Children and adolescents possessing the DYT1 gene mutation may respond best of all. Patients with cervical dystonia may also improve with pallidal DBS but definitive clinical evidence is lacking. As a group, patients with secondary dystonias respond less well to DBS than do patients with primary dystonia; however, patients with dystonia secondary to anoxic brain injury who have grossly intact basal ganglia anatomy, and patients with tardive dystonia may represent secondary dystonia subtypes for whom pallidal DBS is a viable option.
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Acta Neurochir. Suppl. · Jan 2007
ReviewManagement of chronic back and leg pain by intrathecal drug delivery.
Intrathecal delivery of analgesic drugs by implantable pump systems has been recognized as a treatment option for patients with chronic pain of benign or malignant origin that is resistant to oral or parenteral medication. Patients with chronic back and leg pain (CBLP), a benign but severely disabling condition of the lumbar spine with multifactorial genesis, have been demonstrated in a number of retrospective and in some prospective clinical studies to benefit from intrathecal delivery of opioid and/or non-opioid substances, either as single drugs or in combinations. ⋯ It discusses important clinical issues such as drug selection, drug combinations, and side effects and complications of intrathecal infusion. It is concluded that further clinical research is needed in order to provide stronger evidence for the usefulness of a number of drugs currently used for intrathecal therapy on a mostly empirical basis.
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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
ReviewRestoration of neurological functions by neuroprosthetic technologies: future prospects and trends towards micro-, nano-, and biohybrid systems.
Today applications of neural prostheses that successfully help patients to increase their activities of daily living and participate in social life again are quite simple implants that yield definite tissue response and are well recognized as foreign body. Latest developments in genetic engineering, nanotechnologies and materials sciences have paved the way to new scenarios towards highly complex systems to interface the human nervous system. Combinations of neural cells with microimplants promise stable biohybrid interfaces. ⋯ Different sciences start to interact and discuss the synergies when methods and paradigms from biology, computer sciences and engineering, neurosciences, psychology will be combined. They envision the era of "converging technologies" to completely change the understanding of science and postulate a new vision of humans. In this chapter, these research lines will be discussed on some examples as well as the societal implications and ethical questions that arise from these new opportunities.
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Acta Neurochir. Suppl. · Jan 2007
ReviewRationale, mechanisms of efficacy, anatomical targets and future prospects of electrical deep brain stimulation for epilepsy.
Electrical stimulation of deep brain structures is a promising new technology for the treatment of medically intractable seizures. Performed in vitro and on animal models of epilepsy, electrical stimulation has shown to reduce seizure frequency. Preliminary results on humans are encouraging. ⋯ Anatomical targets such as the thalamus (centromedian nucleus, anterior thalamus, mamillary body and mamillothalamic tracts), the subthalamic nucleus, the caudate nucleus and direct stimulation of the hippocampal formation have been successfully investigated. Although randomized controlled studies are still missing, deep brain stimulation is a promising treatment option for a subgroup of carefully selected patients with intractable epilepsy who are not candidates for resective surgery. The effectiveness, the optimal anatomic targets, the ideal stimulation parameters and devices, as well as patient selection criteria are still to be defined.