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Deep brain stimulation for pain control

Hugo Massé-Alarie, Edith Elgueta Cancino, Cyril Schneider, Paul Hodges
OBJECTIVE: Paired-pulse transcranial magnetic stimulation (ppTMS) is used to probe inhibitory and excitatory networks within the primary motor cortex (M1). These mechanisms are identified for limb muscles but it is unclear whether they share properties with trunk muscles. The aim was to determine whether it was possible to test the intracortical inhibition and facilitation of the deep multifidus muscle fascicles (DM) and at which inter-stimulus intervals (ISI). METHODS: In ten pain-free individuals, TMS was applied over M1 and motor evoked potentials (MEP) were recorded using fine-wire electrodes in DM...
2016: PloS One
Scott J Sherman, Miguel Estevez, Ari B Magill, Torsten Falk
Ketamine is an FDA-approved drug with a known safety profile. Low-dose subanesthetic intravenous ketamine infusion treatment has led to long-term reduction of treatment-resistant depression and of chronic pain states. We report on low-dose subanesthetic intravenous ketamine infusion treatment in Parkinson's disease (PD) patients by 5 case studies and show a long-lasting therapeutic benefit to reduce l-DOPA-induced dyskinesia (LID), improve on time, and reduce depression. Based on the literature we hypothesize that low-dose ketamine may act as a 'chemical deep brain stimulation', by desynchronizing hypersynchronous oscillatory brain activity, including in the basal ganglia and the motor cortex...
January 2016: Case Reports in Neurology
Simone Rossi, Emiliano Santarnecchi, Gaetano Valenza, Monica Ulivelli
Neuromodulation refers to invasive, minimally invasive or non-invasive techniques to stimulate discrete cortical or subcortical brain regions with therapeutic purposes in otherwise intractable patients: for example, thousands of advanced Parkinsonian patients, as well as patients with tremor or dystonia, benefited by deep brain stimulation (DBS) procedures (neural targets: basal ganglia nuclei). A new era for DBS is currently opening for patients with drug-resistant depression, obsessive-compulsive disorders, severe epilepsy, migraine and chronic pain (neural targets: basal ganglia and other subcortical nuclei or associative fibres)...
May 13, 2016: Philosophical Transactions. Series A, Mathematical, Physical, and Engineering Sciences
Yoshinori Higuchi, Shinji Matsuda, Toru Serizawa
Functional radiosurgery has advanced steadily during the past half century since the development of the gamma knife technique for treating intractable cancer pain. Applications of radiosurgery for intracranial diseases have increased with a focus on understanding radiobiology. Currently, the use of gamma knife radiosurgery to ablate deep brain structures is not widespread because visualization of the functional targets remains difficult despite the increased availability of advanced neuroimaging technology...
March 31, 2016: Movement Disorders: Official Journal of the Movement Disorder Society
Stefan Kampusch, Eugenijus Kaniusas, Jozsef C Széles
Primary cervical dystonia is characterized by abnormal, involuntary, and sustained contractions of cervical muscles. Current ways of treatment focus on alleviating symptomatic muscle activity. Besides pharmacological treatment, in severe cases patients may receive neuromodulative intervention such as deep brain stimulation. However, these (highly invasive) methods have some major drawbacks. For the first time, percutaneous auricular vagus nerve stimulation (pVNS) was applied in a single case of primary cervical dystonia...
October 2015: Artificial Organs
Anette Schrag, Anna Sauerbier, Kallol Ray Chaudhuri
Nonmotor manifestations in Parkinson's disease (PD) encompass a range of clinical features, including neuropsychiatric problems, autonomic dysfunction, sleep disorders, fatigue, and pain. Despite their importance for patients' quality of life, the evidence base for their treatment is relatively sparse. Nevertheless, the last few years have seen a number of new trials starting that specifically address nonmotor features as an outcome measure in clinical trials. Large randomized, controlled trials in the last 3 years reported improvement of psychosis with the new selective serotonin 5-HT2A inverse agonist pimavanserin and of postural hypotension with the oral norepinephrine precursor droxidopa...
September 15, 2015: Movement Disorders: Official Journal of the Movement Disorder Society
Ryan Grant, Shaun E Gruenbaum, Jason Gerrard
PURPOSE OF REVIEW: Deep brain stimulation (DBS) is a well tolerated and efficacious surgical treatment for movement disorders, chronic pain, psychiatric disorder, and a growing number of neurological disorders. Given that the brain targets are deep and small, accurate electrode placement is commonly accomplished by utilizing frame-based systems. DBS electrode placement is confirmed by microlectrode recordings and macrostimulation to optimize and verify target placement. With a reliance on electrophysiology, proper anaesthetic management is paramount to balance patient comfort without interfering with neurophysiology...
October 2015: Current Opinion in Anaesthesiology
Bigna Lenggenhager, Carolyn A Arnold, Melita J Giummarra
Research over the past two decades has begun to identify some of the key mechanisms underlying phantom limb pain and sensations; however, this continues to be a clinically challenging condition to manage. Treatment of phantom pain, like all chronic pain conditions, demands a holistic approach that takes into consideration peripheral, spinal, and central neuroplastic mechanisms. In this review, we focus on nonpharmacological treatments tailored to reverse the maladaptive neuroplasticity associated with phantom pain...
March 2014: Wiley Interdisciplinary Reviews. Cognitive Science
C C Liu, J H Chien, J H Kim, Y F Chuang, D T Cheng, W S Anderson, F A Lenz
Cross-frequency coupling has been shown to be functionally significant in cortical information processing, potentially serving as a mechanism for integrating functionally relevant regions in the brain. In this study, we evaluate the hypothesis that pain-related gamma oscillatory responses are coupled with low-frequency oscillations in the frontal lobe, amygdala and hippocampus, areas known to have roles in pain processing. We delivered painful laser pulses to random locations on the dorsal hand of five patients with uncontrolled epilepsy requiring depth electrode implantation for seizure monitoring...
September 10, 2015: Neuroscience
Sandra G J Boccard, Erlick A C Pereira, Tipu Z Aziz
Deep brain stimulation (DBS) is a neurosurgical intervention popularised in movement disorders such as Parkinson's disease, and also reported to improve symptoms of epilepsy, Tourette's syndrome, obsessive compulsive disorders and cluster headache. Since the 1950s, DBS has been used as a treatment to relieve intractable pain of several aetiologies including post stroke pain, phantom limb pain, facial pain and brachial plexus avulsion. Several patient series have shown benefits in stimulating various brain areas, including the sensory thalamus (ventral posterior lateral and medial), the periaqueductal and periventricular grey, or, more recently, the anterior cingulate cortex...
October 2015: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Kandadai Rukmini Mridula, Rupam Borgohain, Shaik Afshan Jabeen, Gaddamanugu Padmaja, Vcs Srinivasarao Bandaru, Praveen Ankathi, Meena A Kanikannan, Mohammed Shujath Ali Khan
BACKGROUND: Non motor symptoms (NMS) of idiopathic Parkinson's disease (PD) are a major cause of disability and recognition of these symptoms and treatment is important for comprehensive health care. Deep brain stimulation of bilateral subthalamic nucleus deep brain stimulation (STN DBS) has been shown to improve motor symptoms in PD and effects on NMS are unknown. To investigate the NMS among PD patients who underwent STN DBS. METHODS: We recruited prospectively 56 patients with PD, who had undergone bilateral STN DBS and 53 age and duration of illness matched PD patients on dopaminergic therapy (controls)...
April 4, 2015: Iranian Journal of Neurology
I Sibon, B de Toffol, J-P Azulay, F Sellal, C Thomas-Antérion, J-M Léger, C Pierrot-Deseilligny
CEREBROVASCULAR DISEASES: The benefit of the thrombectomy using stents retrievers in the acute stroke phase is now demonstrated when there is a proximal occlusion of an intracranial artery, whatever its mechanism. The place of the anticoagulants in the management of cervical artery dissections remains uncertain, while the benefit of the blood pressure control in the secondary prevention of deep and lobar intracerebral hemorrhages is critical. The development of cardiac MRI, prolonged cardiac monitoring and transcranial doppler seems to improve the diagnosis of cardio-embolic sources of stroke...
June 2015: Revue Neurologique
Paweł Sokal, Marek Harat, Piotr Zieliński, Jacek Furtak, Darek Paczkowski, Marcin Rusinek
BACKGROUND: Motor cortex stimulation is one of the neuromodulation methods of treating refractory central neurogenic pain. OBJECTIVES: The aim of this study was to retrospectively evaluate the effects of motor cortex stimulation. MATERIAL AND METHODS: The study group consisted of 14 consecutive patients with thalamic pain, atypical facial pain, post-brachial plexus avulsion injury pain, phantom pain and pain in syringomyelia who were treated with motor cortex stimulation at the Department of Neurosurgery of the Military Research Hospital in Bydgoszcz, Poland, from 2005 to 2013...
March 2015: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Kenji Sugiyama, Takao Nozaki, Tetsuya Asakawa, Shinichiro Koizumi, Osamu Saitoh, Hiroki Namba
The use of electrical stimulation to treat pain in human disease dates back to ancient Rome or Greece. Modern deep brain stimulation (DBS) was initially applied for pain treatment in the 1960s, and was later used to treat movement disorders in the 1990s. After recognition of DBS as a therapy for central nervous system (CNS) circuit disorders, DBS use showed drastic increase in terms of adaptability to disease and the patient's population. More than 100,000 patients have received DBS therapy worldwide. The established indications for DBS are Parkinson's disease, tremor, and dystonia, whereas global indications of DBS expanded to other neuronal diseases or disorders such as neuropathic pain, epilepsy, and tinnitus...
2015: Neurologia Medico-chirurgica
Philipp J Slotty, Wilhelm Eisner, Christopher R Honey, Christian Wille, Jan Vesper
BACKGROUND: Motor cortex stimulation (MCS) is being offered to patients suffering from neuropathic pain. Outcome prediction, programming and especially sustaining a long-term treatment effect represent major challenges. We report a retrospective long-term analysis of our patients treated with MCS over a median follow-up of 39.1 months. OBJECTIVES: To investigate the time course of the treatment effect in MCS for neuropathic pain. METHODS: Twenty-three closely followed patients treated with MCS were retrospectively analyzed...
2015: Stereotactic and Functional Neurosurgery
Marla J S Mickleborough, Michael E Kelly, Layla Gould, Chelsea Ekstrand, Eric Lorentz, Tasha Ellchuk, Paul Babyn, Ron Borowsky
BACKGROUND AND IMPORTANCE: Functional magnetic resonance imaging (fMRI) is a noninvasive and reliable tool for mapping eloquent cortex in patients prior to brain surgery. Ensuring intact perceptual and cognitive processing is a key goal for neurosurgeons, and recent research has indicated the value of including attentional network processing in pre-surgical fMRI in order to help preserve such abilities, including reading, after surgery. CLINICAL PRESENTATION: We report a 42-year-old patient with a large cavernous malformation, near the left basal ganglia...
2015: Cerebrovascular Diseases
Bita Vaseghi, Maryam Zoghi, Shapour Jaberzadeh
BACKGROUND: Integration of information between multiple cortical regions of the pain neuromatrix is thought to underpin pain modulation. Although altered processing in the primary motor (M1) and sensory (S1) cortices is implicated in separate studies, the simultaneous changes in and the relationship between these regions are unknown yet. The primary aim was to assess the effects of anodal transcranial direct current stimulation (a-tDCS) over superficial regions of the pain neuromatrix on M1 and S1 excitability...
2015: PloS One
Alexander R Harris, Paul J Molino, Robert M I Kapsa, Graeme M Clark, Antonio G Paolini, Gordon G Wallace
Neural stimulation is used in the cochlear implant, bionic eye, and deep brain stimulation, which involves implantation of an array of electrodes into a patient's brain. The current passed through the electrodes is used to provide sensory queues or reduce symptoms associated with movement disorders and increasingly for psychological and pain therapies. Poor control of electrode properties can lead to suboptimal performance; however, there are currently no standard methods to assess them, including the electrode area and charge density...
January 6, 2015: Analytical Chemistry
Denys Fontaine, Clair Vandersteen, Delphine Magis, Michel Lanteri-Minet
Medically refractory chronic cluster headache (CH) is a severely disabling headache condition for which several surgical procedures have been proposed as a prophylactic treatment. None of them have been evaluated in controlled conditions, only open studies and case series being available. Destructive procedures (radiofrequency lesioning, radiosurgery, section) and microvascular decompression of the trigeminal nerve or the sphenopalatine ganglion (SPG) have induced short-term improvement which did not maintain on long term in most of the patients...
2015: Advances and Technical Standards in Neurosurgery
Nima Toosizadeh, Hong Lei, Michael Schwenk, Scott J Sherman, Esther Sternberg, Jane Mohler, Bijan Najafi
BACKGROUND: Postural balance and potentially fall risk increases among older adults living with neurological diseases, especially Parkinson's disease (PD). Since conventional therapies such as levodopa or deep brain stimulation may fail to alleviate or may even worsen balance, interest is growing in evaluating alternative PD therapies. OBJECTIVE: The purpose of the current study was to assess improvement in postural balance in PD patients following electroacupuncture (EA) as an alternative therapy...
2015: Gerontology
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