Neurological research
-
Electrical stimulation of selected peripheral nerves for treatment of intractable pain has been used inconsistently over the past 30 years due to difficulties in clarifying appropriate indications, utilizing approved device technology, and standardizing the surgical techniques. Circumferential electrodes treating mononeuropathies have given way to paddle electrode techniques and, most recently, the application of percutaneous wire electrode methods will allow for minimally invasive peripheral nerve stimulation for certain intractable CRPS and other painful monoeuropathies.
-
An increasing number of patients are suffering from angina pectoris that is chronically refractory to standard anti-ischemic treatment such as pharmacological and surgical strategies. To improve the quality of life of these severely disabled patients, without adversely affecting their prognosis, a number of adjunct therapies are available. One of the most promising appears to be spinal cord stimulation. We will review the literature and discuss the efficacy, safety and mechanisms of neuromodulation as an adjuvant therapy for chronic refractory angina pectoris.
-
Neurological research · Mar 2000
Case ReportsThe relationship of blunt head trauma, subarachnoid hemorrhage, and rupture of pre-existing intracranial saccular aneurysms.
Patients with a history of closed head trauma and subarachnoid hemorrhage are uncommonly diagnosed with an intracranial saccular aneurysm. This study presents a group of patients in whom a pre-existing aneurysm was discovered during work-up for traumatic subarachnoid hemorrhage. Without an accurate pre-trauma clinical history, it is difficult to define the relationship between trauma and the rupture of a pre-existing intracranial saccular aneurysm. ⋯ Five patients (8%) were diagnosed with a saccular intracranial aneurysm, and all underwent surgical clipping of the aneurysm. We conclude that the majority of patients (92%), with post-traumatic SAH do not harbor intracranial aneurysms. However, during initial evaluation, a high level of suspicion must be entertained when post-traumatic subarachnoid hemorrhage is encountered in the basal cisterns or Sylvian fissure, as 8% of our population were diagnosed with aneurysms.
-
Neurological research · Mar 2000
Long-term intrathecal administration of glycine prevents mechanical hyperalgesia in a rat model of neuropathic pain.
Neuropathic pain has been postulated to be mediated, in part, by amino acid neurotransmitters including glycine. The current study examined the effects of continuous intrathecal glycine administration (0.1 mumol 0.5 microliter-1 h-1) on the development of mechanical hyperalgesia and other features of neuropathic pain evoked by unilateral loose ligation of the sciatic nerve in the rat. Each hind paw was tested for withdrawal threshold to mechanical stimuli prior to, and after ligation at intervals of 3, 6, 9, 12 and 16 days. ⋯ Glycine increased the normal mechano-nociceptive responses and prevented the development of mechano-nociceptive hyperalgesia. Spontaneous nociceptive behavior and hind paw dystrophic features, seen in the saline treated rats, were significantly diminished. Our results suggest that spinal cord inhibitory glycinergic activity is important for normal mechano-receptive responsitivity and development of mechano-nociceptive hyperalgesia in this model.
-
Neurological research · Jan 2000
Hydrocephalus and the reproductive health of women: the medical implications of maternal shunt dependency in 70 women and 138 pregnancies.
An increasing number of women with cerebrospinal fluid shunts are surviving to child-bearing age, and are making independent decisions in regard to planning their families. As a result, a broad range of interdisciplinary health care professionals will require information about the management of these patients, especially during pregnancy and delivery. The purpose of this ongoing study is to gather comprehensive data from shunted women regarding their clinical history during pregnancy and within the six-month post-partum period. ⋯ No signs of shunt malfunction were identified in 100 of the pregnancies described in this series; 31 of these resulting in miscarriage and 69 resulting in live births. This study extends observations made previously to a larger population of shunt dependent mothers, and nearly doubles the amount of data available in our last publication. The results suggest that maternal shunt dependency carries a relatively high incidence of complications for some patients, but that proper management of these patients can lead to normal pregnancy and delivery.