Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2007
Review Case ReportsNeuroprosthetics of the upper extremity--clinical application in spinal cord injury and challenges for the future.
The complete restoration of movements lost due to a spinal cord injury (SCI) is the greatest hope of physicians, therapists and certainly of the patients themselves. Particularly, in patients with lesions of the cervical spinal cord every little improvement of missing or weak grasp function will result in a large gain in quality of life. Despite the fact that novel drugs for axonal regeneration in the spinal cord are in the phase of imminent human application, up to now, the only possibility of restoration of basic movements in SCI persons consists in the use of functional electrical stimulation (FES). ⋯ Particularly, with the use of implantable systems a long-term stable, user-friendly application is possible. Most recent work aims at the development of minimally invasive, subminiature systems for individual functional support. The possibility of direct brain control of FES systems will extend the application of grasp neuroprostheses to patients with injuries of the highest cervical spinal cord.
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Spinal cord stimulation (SCS) has been shown to be particularly useful, safe and effective treatment in the management of patients with refractory angina pectoris and those unsuitable for percutaneous or surgical revascularisation. Clinical and experimental research has shown that it decreases myocardial ischemia without masking the clinical symptoms of its imminent development. ⋯ Patients have reported not only significantly fewer angina attacks but also decreased consumption of glyceryl trinitrate and improved quality of life. A number of mechanisms have been proposed including placebo effects, primary anti-nociceptive effects, involvement of endogenous opiates, anti sympathetic nervous system effects, increases in coronary blood flow, and redistribution of myocardial blood flow.
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Acta Neurochir. Suppl. · Jan 2007
ReviewElectrical stimulation and gene-based neuromodulation for control of medically-refractory epilepsy.
The failure of available antiepileptic medications to adequately control seizures in a substantial number of patients underscores the need to develop novel epilepsy therapies. Recent advancements in technology and the success of neuromodulation in treating a variety of neurological disorders have spurred interest in exploring promising therapeutic alternatives, such as electrical stimulation and gene-based synaptic control. A variety of different stimulation approaches to seizure control targeting structures in the central or peripheral nervous system have been investigated. ⋯ Gene delivery to epileptogenic targets or targets implicated in regulating seizure threshold has been investigated as an alternative means of neuromodulation in animal models. In summary, positive preliminary results and the lack of alternative treatment options provide the impetus for further exploration of electrical stimulation and gene-based therapies in pharmacoresistant epilepsy. Various specific targets and approaches to modulating their activity have been investigated in human studies.
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Acta Neurochir. Suppl. · Jan 2007
ReviewNeurosurgical pain therapy with epidural spinal cord stimulation (SCS).
Neurosurgical therapy for intractable pain with epidural implantable electrodes has become a widely used and efficient alternative when conservative or less invasive therapies are no longer effective. A complete interdisciplinary work-up is required before considering a patient as a candidate for a spinal cord stimulation (SCS) device. In more than 1300 patients we implanted an SCS device in our clinic; more than 52% reported a significant (>50%) long-term improvement for more than 3 years and a significant reduction in their analgesic drugs. ⋯ Hence. SCS therapy should only be performed in specialized centers. In peripheral vascular disease (PVD) and angina, the initial results are very promising, but the long-term efficacy has to be proven by multicenter studies.
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Acta Neurochir. Suppl. · Jan 2007
ReviewClinical experience with vagus nerve stimulation and deep brain stimulation in epilepsy.
Patients with refractory epilepsy present a particular challenge to new therapies. Vagus nerve stimulation (VNS) for the control of intractable seizures has become available since 1989. VNS is a relatively noninvasive treatment. ⋯ Analysis of larger patient groups and insight in the mode of action may help to identify patients with epileptic seizures or syndromes that respond better either to VNS or to DBS. Randomized and controlled studies in larger patient series are mandatory to identify the potential treatment population and optimal stimulation paradigms. Further improvements of clinical efficacy may result from these studies.