Stereotactic and functional neurosurgery
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Paresthesia-producing (PP), but not periventricular grey (PVG) deep brain stimulation (DBS) proved effective in steady neuropathic pain in 25 patients receiving both, regardless of the PP site stimulated, but PVG-DBS suppressed allodynia or hyperpathia in 3 cases of stroke-induced pain. In patients with stroke-induced central pain, PP-DBS was unpleasant in 6 of 17 (35%), all with allodynia and/or hyperpathia, but not in patients with spinal cord central or peripheral neuropathic pain with allodynia or hyperpathia. Of 11 patients in whom prior ineffective dorsal column stimulation (DCS) produced appropriate paresthesia, none responded to PP-DBS; 5 of 7 did so in whom DCS produced no paresthesia or relieved pain. Periaqueductal grey DBS was nearly always unpleasant, PVG-DBS sometimes was.
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Stereotact Funct Neurosurg · Jan 1995
Effect of spinal cord stimulation on cerebral blood flow in cats.
Effects of electric spinal cord stimulation (SCS) on cerebral blood flow (CBF) were investigated in anesthetized adult cats. SCS was performed under various stimulus conditions for 1 h via a wire electrode inserted into the dorsal epidural space at various levels in the spinal cord. CBF was measured in the subcortex of the parietal lobe by hydrogen clearance method before, during, and after SCS. ⋯ Nor did SCS of the high cervical cord with frequencies of 200 and 2,000 Hz increase CBF. No CBF increase was observed after SCS of the high cervical cord with 20 Hz when the dorsal column was sectioned at the medullo-cervical junction. These results suggest that the ability of SCS to increase CBF is peculiar to high cervical cord stimulation with moderately low frequencies.
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Stereotact Funct Neurosurg · Jan 1995
Complications associated with infusion pumps implanted for spasticity.
Implanted infusion pumps are an effective method for delivering medications into the intrathecal space to reduce spasticity. Complications can occur with the surgical aspect of implantation, as well as with the hardware. ⋯ The overall incidence of total complications was 62%; 24% in the Infusaid pumps, and 167% in the Medtronic pumps. The incidence and types of complications are important in informed consent as well as in the selection of pumps and connectors.
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Stereotact Funct Neurosurg · Jan 1994
Case Reports Comparative StudyIncrease of cerebral blood flow and improvement of brain motor control following spinal cord stimulation in ischemic spastic hemiparesis.
A 64-year-old man had an ischemic stroke in the left parietotemporal cortical-subcortical areas. He developed a severe right spastic hemiparesis and dysphasia. An angiographic study showed left internal carotid artery occlusion and right internal carotid artery stenosis. ⋯ Such a TCD pattern, suggesting an increase of cerebral blood flow (CBF) during SCS, was reproducible. This case confirms efficacy of SCS in the treatment of ischemic hemiparesis and the increase of CBF following cervical SCS in man. The marked increase of CBF, particularly evident on the ischemic side, may play a role in mediating the improvement of motor control in our patient together with a possible arousal of the so-called 'sleeping neurons' of the penumbra zone.
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Stereotact Funct Neurosurg · Jan 1994
Randomized Controlled Trial Comparative Study Clinical TrialA prospective, randomized study of spinal cord stimulation versus reoperation for failed back surgery syndrome: initial results.
Spinal cord stimulation (SCS) has been reported to be effective treatment for the failed back surgery syndrome in a number of retrospective case series. Its retrospectively reported results compare favorably with those of neurosurgical treatment alternatives, such as reoperation and ablative procedures. There has been no direct prospective comparison, however, between SCS and other techniques for pain management. ⋯ The primary outcome measure is the frequency of crossover to the alternative procedure, if the results of the first have been unsatisfactory after 6 months. Results for the first 27 patients reaching the 6-month crossover point show a statistically significant (p = 0.018) advantage for SCS over reoperation. This is one of many potentially important outcome measures, which are to be followed long-term as a larger overall study population accrues.