Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2010
Case ReportsA case of mania following deep brain stimulation for obsessive compulsive disorder.
Deep brain stimulation (DBS) of the basal ganglia is an effective treatment for select movement disorders, including Parkinson's disease, essential tremor and dystonia. Based on these successes, DBS has been explored as an experimental treatment for medication-resistant neuropsychiatric disease. ⋯ We present a case of a young woman treated for OCD with DBS of the anterior limb of the internal capsule and nucleus accumbens region, who subsequently manifested a manic episode. We aim to discuss the case details, treatment and potential neuroanatomical underpinnings of this response.
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Stereotact Funct Neurosurg · Jan 2010
Case Reports Comparative StudyPrevalence of Twiddler's syndrome as a cause of deep brain stimulation hardware failure.
We reviewed our deep brain stimulation patient database to describe hardware complications which resulted from implantable pulse generator mobility, a phenomenon referred to as Twiddler's syndrome. A prospectively collected database of adverse events for all patients operated on at the University of Florida was queried searching for hardware malfunctions. Of 362 total leads implanted in 226 patients since 2002, there were 17 hardware malfunctions. ⋯ In all cases securing the implantable pulse generator within the chest pocket resolved the issue. Twiddler's syndrome in the population of movement disorder patients treated with deep brain stimulation is an uncommon but important adverse event. It possesses a characteristic presentation and with appropriate diagnostic evaluation it is treatable and future occurrences are preventable.
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Stereotact Funct Neurosurg · Jan 2010
Case ReportsThalamic deep brain stimulation for the treatment of action myoclonus caused by perinatal anoxia.
Perinatal anoxia rarely causes myoclonus as the main neurologic abnormality. The exact neuronal mechanism underlying myoclonus induced by perinatal anoxia remains unknown. Some studies have indicated that the development of involuntary movements may be related to the maturation of the thalamus after birth. ⋯ The effectiveness of chronic thalamic DBS in this patient supports the concept of involvement of the thalamus in post-perinatal anoxic myoclonus.
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Stereotact Funct Neurosurg · Jan 2010
Comparative StudyAsymptomatic deep venous thrombosis after deep brain stimulation for Parkinson disease.
Patients with advanced Parkinson disease (PD) are at increased risk for asymptomatic leg deep venous thrombosis (DVT) because of severe motor fluctuations. Protracted immobility in the absence of antiparkinsonian therapy during stereotactic surgery may further increase the risk for venous thrombosis. Our aim was to determine the incidence of asymptomatic DVT of leg veins in PD patients undergoing subthalamic nucleus deep brain stimulation (STN-DBS). ⋯ Our data show that advanced PD patients are at risk for developing asymptomatic leg DVT following stereotactic surgery performed for STN-DBS. A strict clinical monitoring in the perioperative period is advisable in order to ensure early detection of DVT and prevent further thrombo-embolic complications.
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Stereotact Funct Neurosurg · Jan 2010
Comparative StudySurgical outcome and improvement in quality of life after microvascular decompression for hemifacial spasms: a case series assessment using a validated disease-specific scale.
Hemifacial spasm (HFS) is a movement disorder characterized by intermittent, involuntary clonic or tonic-clonic contractions of muscles innervated by the ipsilateral facial nerve. Recent studies have documented change in quality of life after HFS management with botulinum toxin injection. However, we failed to locate any study that documented change in quality of life after surgical management with retrosigmoid microvascular decompression (MVD). ⋯ MVD offers significant and prolonged improvement in quality of life for the HFS patients we studied, as measured using a disease-specific, validated quality of life assessment scale. Postoperative quality of life, however, was strongly influenced by both the success of surgery in resolving the symptoms and the absence of any permanent complications of surgery.