Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2007
ReviewDBS in tourette syndrome: rationale, current status and future prospects.
Tourette syndrome is a neuropsychiatric disorder with onset in early childhood and characterized by tics, often associated with behavioural abnormalities. Symptoms often disappear before or during adulthood. Treatment consists of psychotherapy or pharmacotherapy. ⋯ The pathophysiology of Tourette syndrome is not well understood. On the basis of our current knowledge of cortico-basal ganglia-thalamocortical circuits, an explanation for the beneficial effects of DBS on tics is proposed. It is concluded that a meticulous evaluation of the electrode position, and a blinded assessment of the clinical effects on tics and behavioural disorders, is absolutely mandatory in order to identify the best target of DBS for Tourette syndrome.
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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.
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialHardware failures in spinal cord stimulation (SCS) for chronic benign pain of spinal origin.
Spinal cord stimulation (SCS) has become an established clinical option for treatment of refractory chronic pain not related to cancer. Current hardware and implantation techniques for SCS are already highly developed and continuously improving, however equipment failures over the course of the long-term treatment are still encountered in a relatively high proportion of treated cases. ⋯ This review summarizes the experience of the authors with management of hardware failures and their causes in patients treated with SCS for chronic pain of benign origin. The published literature is critically surveyed and discussed.
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialDrug-enhanced spinal stimulation for pain: a new strategy.
Neuropathic pain is notoriously difficult to manage and only a few classes of drugs may provide adequate benefits. Thus, in many cases spinal cord stimulation (SCS) is considered; however, in this group of patients, between 30-50% of the cases offered a percutaneous SCS trial may fail to obtain a satisfactory effect. Additionally, a certain number of patients with a good initial effect, report that after a period the benefits are reduced necessitating additional peroral drug therapy. ⋯ However, in a group of three patients with peroral baclofen therapy and SCS, complaints of side-effects were common and this therapy was terminated. Informal reports from collegues support the negative experience with additional peroral baclofen. In conclusion, in patients with neuropathic pain demonstrating inadequate response to SCS (small VAS reduction; short duration) a trial of intrathecal baclofen in combination with SCS may be warranted.