Articles: treatment.
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Partial seizures of extratemporal origin may present unique challenges in the patient with medically refractory seizures. The efficacy of an extratemporal focal cortical resection may be less effective than an anterior temporal lobectomy for intractable epilepsy. The potential operative complications may be increased in individuals with extratemporal epilepsy because of functional cerebral cortex involvement and the need for a large cortical resection to significantly reduce seizure tendency. ⋯ Chronic intracranial EEG monitoring may be necessary to confirm the localization of the ictal onset zone before epilepsy surgery. Patients with normal neuroimaging studies and extratemporal epilepsy are unlikely to be rendered seizure-free with focal cortical resection and should be considered candidates for other alternative forms of treatment for intractable partial epilepsy. Patients with non-substrate-directed extratemporal epilepsy should undergo a preoperative evaluation and surgical treatment at a comprehensive epilepsy center with extensive experience in chronic intracranial EEG monitoring and contemporary neuroimaging procedures because of the inherently high acuity associated with the operative management clinical disorder.
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Postherpetic neuralgia (PHN) remains a difficult pain problem for patients and physicians alike. This review describes the epidemiology and pathophysiology of PHN and discusses proposed mechanisms of pain generation and the various treatments currently available. Evidence is scant for the value of surgical and procedural interventions in general, although there are numerous small studies supporting the use of specific interventions such as nerve blocks, neurosurgical procedures and neuroaugmentation. ⋯ Interventions with low risk, such as TENS are appropriate. Although prevention of postherpetic neuralgia appears to be an appropriate strategy, there is little evidence to support the position that medical or interventional approaches (nerve blocks) will prevent PHN after a patient develops acute herpes zoster (HZ). Although antivirals are appropriate for acute HZ, and the use of neural blockade and sympathetic blockade may be helpful in reducing pain in selected patients with HZ, there is little evidence that these interventions will reduce the likelihood of developing PHN.
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Transforaminal epidural steroid injections are provided frequently for patients with lumbar radiculopathy, having demonstrated efficacy and safety. We present a patient who developed methicillin-resistant Staphylococcus aureus epidural abscess 11 days after a transforaminal epidural steroid injection. ⋯ Fortunately, the patient made a full recovery, and continues to do well one year later. The incidence, etiology and treatment of epidural injection-related infections are reviewed.
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Minim Invasive Ther Allied Technol · Apr 2004
Epidural spinal cord stimulation in chronic non-reconstructible limb ischemia.
For patients with chronic non-reconstructible limb ischemia (chronic CLI), spinal-cord stimulation (SCS) has been advocated for the treatment of ischemic pain and prevention of amputation. The present clinical report was performed to evaluate the long-term effects of SCS on limb survival. A retrospective review was performed of 21 patients who had undergone SCS between December 1997 and July 2002 due to chronic CLI. ⋯ Major amputation could be avoided in 15 (71%) of 21 patients. Two electrode dislocation, one pulse-generator dislocation, and one wire disconnection occurred; no other complications were observed. SCS represents a safe and effective therapy for patients with chronic non-reconstructible critical limb ischemia.
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The high prevalence of persistent neck pain due to involvement of cervical facet joints has been described in controlled studies. Therapeutic interventions utilized in managing chronic neck pain of facet joint origin include intraarticular injections, medial branch nerve blocks, and neurolysis of medial branch nerves by means of radiofrequency. ⋯ Cervical medial branch blocks were an effective modality of treatment in managing chronic neck pain secondary to facet joint involvement confirmed by controlled, comparative local anesthetic blocks.