Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2007
ReviewManagement of chronic back and leg pain by intrathecal drug delivery.
Intrathecal delivery of analgesic drugs by implantable pump systems has been recognized as a treatment option for patients with chronic pain of benign or malignant origin that is resistant to oral or parenteral medication. Patients with chronic back and leg pain (CBLP), a benign but severely disabling condition of the lumbar spine with multifactorial genesis, have been demonstrated in a number of retrospective and in some prospective clinical studies to benefit from intrathecal delivery of opioid and/or non-opioid substances, either as single drugs or in combinations. ⋯ It discusses important clinical issues such as drug selection, drug combinations, and side effects and complications of intrathecal infusion. It is concluded that further clinical research is needed in order to provide stronger evidence for the usefulness of a number of drugs currently used for intrathecal therapy on a mostly empirical basis.
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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
Review Multicenter StudySpinal cord stimulation for failed back surgery syndrome and other disorders.
Chronic pain is a complex condition that requires a multi-disciplinary approach to management. Spinal cord stimulation (SCS) has evolved into a relatively easily implemented, reversible technique with low morbidity for the management of chronic, intractable pain in selected patients. ⋯ Multicenter prospective studies were conducted and demonstrated that SCS. as a neuromodulation procedure, is indeed a superior method for treatment of chronic pain if the patients are selected with caution and a proper strategy. Future development of innovative electrodes and pulse generation systems will continue to improve this therapy.
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Acta Neurochir. Suppl. · Jan 2007
Review Clinical TrialMotor cortex stimulation for neuropathic pain.
Since the initial publication of Tsubokawa in 1991, epidural motor cortex stimulation (MCS) is increasingly reported as an effective surgical option for the treatment of refractory neuropathic pain although its mechanism of action remains poorly understood. The authors review the extensive literature published over the last 15 years on central and neuropathic pain. Optimal patient selection remains difficult and the value of pharmacological tests or transcranial magnetic stimulation in predicting the efficacy of MCS has not been established. ⋯ In general, the efficacy of MCS depends on: a) the accurate placement of the stimulation electrode over the appropriate area of the motor cortex, and b) on sophisticated programming of the stimulation parameters. A better understanding of the MCS mechanism of action will probably make it possible to adjust better the stimulation parameters. The conclusions of multicentered randomised studies, now in progress, will be very useful and are likely to promote further research and clinical applications in this field.
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Acta Neurochir. Suppl. · Jan 2007
ReviewCicerone: stereotactic neurophysiological recording and deep brain stimulation electrode placement software system.
Stereotactic neurosurgery and neurophysiological microelectrode recordings in both humans and monkeys are typically done with conventional 2D atlases and paper records of the stereotactic coordinates. This approach is prone to error because the brain size, shape, and location of subcortical structures can vary between subjects. Furthermore, paper record keeping is inefficient and limits opportunities for data visualization. ⋯ Intra-operatively, Cicerone allows entry of the stereotactic microdrive coordinates and MER data, enabling real-time interactive visualization of the electrode location in 3D relative to the surrounding neuroanatomy and neurophysiology. In addition, the software enables prediction of the VTA generated by DBS for a range of electrode trajectories and tip locations. In turn, the neurosurgeon can use the combination of anatomical (MRI/CT/3D brain atlas), neurophysiological (MER), and electrical (DBS VTA) data to optimize the placement of the DBS electrode prior to permanent implantation.