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Piero Perucca, Ingrid E Scheffer, Michelle Kiley
The International League Against Epilepsy has recently published a new classification of epileptic seizures and epilepsies to reflect the major scientific advances in our understanding of the epilepsies since the last formal classification 28 years ago. The classification emphasises the importance of aetiology, which allows the optimisation of management. Antiepileptic drugs (AEDs) are the main approach to epilepsy treatment and achieve seizure freedom in about two-thirds of patients. More than 15 second generation AEDs have been introduced since the 1990s, expanding opportunities to tailor treatment for each patient...
March 19, 2018: Medical Journal of Australia
P Riedel, M N Smolka, M Bauer
More than half of the patients diagnosed with schizophrenia and a subgroup of patients diagnosed with bipolar disorder show impairment in neurocognitive and social cognitive performance. The degree of impairment varies from person to person. An improvement of cognitive impairment results in increased subjective quality of life and increased psychosocial functioning, to a much greater extent than successful treatment of other symptoms. Therefore, it is reasonable to not only recognize and bear decreased cognitive functioning in mind but also to offer specific treatment of impairments...
March 13, 2018: Der Nervenarzt
Hyunsu Park, Pavel Takmakov, Hyowon Lee
Advancements in microfabrication has enabled manufacturing of microscopic neurostimulation electrodes with smaller footprint than ever possible. The smaller electrodes can potentially reduce tissue damage and allow better spatial resolution for neural stimulation. Although electrodes of any shape can easily be fabricated, substantial effort have been focused on identification and characterization of new materials and surface morphology for efficient charge injection, while maintaining simple circular or rectangular Euclidean electrode geometries...
March 12, 2018: Scientific Reports
Martin Holtkamp, Lars Büntjen, Friedhelm C Schmitt
New treatment approaches in epilepsy - such as novel antiepileptic drugs and neurostimulation - generally at first are assessed in animal models in regard to feasibility, efficacy and safety. The aim of this review was to elucidate and summarize the available literature on in vivo experimental studies on radiofrequency thermoablation and laser interstitial thermal therapy. We have found two in vivo studies on radiofrequency ablation of an acute seizure focus, one assessed the conventional transcranial and the other one a transvenous approach...
March 3, 2018: Epilepsy Research
Andrei D Sdrulla, Yun Guan, Srinivasa N Raja
The field of spinal cord stimulation (SCS) owes its inception to the concept of gate control theory (GCT), put forth by Wall and Melzack in their landmark 1965 paper, which proposed that "control of pain may be achieved by selectively activating the large, rapidly conducting fibers". The first reported clinical application of dorsal column stimulation came 2 years later, and the field has gradually expanded ever since. Today, an estimated 50,000 spinal cord neurostimulators are implanted annually...
March 11, 2018: Pain Practice: the Official Journal of World Institute of Pain
J-M Wattier
A major symptom of endometriosis is pelvic pain with a wide range of intensity, rhythm, type, and expression, without clearly established relationship between pain and the disease. Endometriosis-associated pain has physical, psychological/behavioral and social consequences with a significant impact on patient quality-of-life in relation with the biopsychosocial model of chronic pain. Pain assessment in all of its dimensions, as well as assessing the consequences of pain is therefore a crucial part of therapeutic management...
March 3, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
Paul Boon, Elien De Cock, Ann Mertens, Eugen Trinka
PURPOSE OF REVIEW: Neurostimulation is becoming an increasingly accepted treatment alternative for patients with drug-resistant epilepsy (DRE) who are unsuitable surgery candidates. Standardized guidelines on when or how to use the various neurostimulation modalities are lacking. We conducted a systematic review on the currently available neurostimulation modalities primarily with regard to effectiveness and safety. RECENT FINDINGS: For vagus nerve stimulation (VNS), there is moderate-quality evidence for its effectiveness in adults with drug-resistant partial epilepsies...
April 2018: Current Opinion in Neurology
Bjørn G Hallsson, Hartwig R Siebner, Oliver J Hulme
Fairness, the notion that people deserve or have rights to certain resources or kinds of treatment, is a fundamental dimension of moral cognition. Drawing on recent evidence from economics, psychology, and neuroscience, we ask whether self-interest is always intuitive, requiring self-control to override with reasoning-based fairness concerns, or whether fairness itself can be intuitive. While we find strong support for rejecting the notion that self-interest is always intuitive, the literature has reached conflicting conclusions about the neurocognitive systems underpinning fairness...
February 24, 2018: Neuroscience and Biobehavioral Reviews
Andy Zhou, Benjamin C Johnson, Rikky Muller
Closed-loop and responsive neuromodulation systems improve open-loop neurostimulation by responding directly to measured neural activity and providing adaptive, on-demand therapy. To be effective, these systems must be able to simultaneously record and stimulate neural activity, a task made difficult by persistent stimulation artifacts that distort and obscure underlying biomarkers. To enable simultaneous stimulation and recording, several techniques have been proposed. These techniques involve artifact-preventing system configurations, resilient recording front-ends, and back-end signal processing for removing recorded artifacts...
February 19, 2018: Current Opinion in Neurobiology
André Aleman, Stefanie Enriquez-Geppert, Henderikus Knegtering, Jozarni J Dlabac-de Lange
BACKGROUND: Negative symptoms in schizophrenia concern a clinically relevant reduction of goal-directed behavior that strongly and negatively impacts daily functioning. Existing treatments are of marginal effect and novel approaches are needed. Noninvasive neurostimulation by means of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are novel approaches that may hold promise. OBJECTIVES: To provide a quantitative integration of the published evidence regarding effects of rTMS and tDCS over the frontal cortex on negative symptoms, including an analysis of effects of sham stimulation...
February 19, 2018: Neuroscience and Biobehavioral Reviews
K Murray, C Reardon
Inflammatory bowel disease negatively affects the quality of life of millions of patients around the world. Although the precise etiology of the disease remains elusive, aberrant immune system activation is an underlying cause. As such, therapies that selectively inhibit immune cell activation without broad immunosuppression are desired. Inhibition of immune cell activation preventing pro-inflammatory cytokine production through neural stimulation has emerged as one such treatment. These therapeutics are based on the discovery of the cholinergic anti-inflammatory pathway, a reflex arc that induces efferent vagal nerve signaling to reduce immune cell activation and consequently mortality during septic shock...
March 2018: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Alvin Y Chan, Lilit Mnatsakanyan, Mona Sazgar, Indranil Sen-Gupta, Jack J Lin, Frank P K Hsu, Sumeet Vadera
BACKGROUND: Responsive neurostimulation (RNS) is a relatively new treatment option that has been shown to be effective for patients with medically refractory focal epilepsy when resection is not possible, especially in bilateral mesial temporal onset. Robotic devices are becoming increasingly popular for use in stereotactic procedures such as stereoelectroencephalography, but have yet to be used when implanting RNS devices. OBJECTIVE: To show that these 2 forms of advanced technology were compatible and could be used effectively in patient care...
March 1, 2018: Operative Neurosurgery (Hagerstown, Md.)
Manuela Galli, Caterina Vicidomini, Ana F Rozin Kleiner, Laura Vacca, Veronica Cimolin, Claudia Condoluci, Fabrizio Stocchi, Maria F DE Pandis
BACKGROUND: The shuffling steps pattern is a typical feature of gait in patients affected by Parkinson's Disease (PD), which progressively reduces their quality of life, being related to the risk of falls in this population. Recently, Automated Mechanical Peripheral Stimulation (AMPS) was presented as an integrative rehabilitative treatment based on peripheral stimulation able to improve the gait spatiotemporal parameters in PD patients. AIM: To evaluate the effects of AMPS on shuffling steps pattern by analyzing the kinematic and spatio-temporal gait parameters...
February 19, 2018: European Journal of Physical and Rehabilitation Medicine
Aysegul Gunduz, Kelly D Foote, Michael S Okun
Deep brain stimulation (DBS) is a neurosurgical technique, which consists of continuous delivery of an electrical pulse through chronically implanted electrodes connected to a neurostimulator, programmable in amplitude, pulse width, frequency, and stimulation channel. DBS is a promising treatment option for addressing severe and drug-resistant movement disorders. The success of DBS therapy is a combination of surgical implantation techniques, device technology, and clinical programming strategies. Changes in device settings require highly trained and experienced clinicians to achieve maximal therapeutic benefit for each targeted symptom, and optimization of stimulation parameters can take many visits...
December 2017: Current Opinion in Biomedical Engineering
Didier Bouhassira, Nadine Attal
Neuropathic pain represents a highly unmet medical need because most of the available treatments have a modest efficacy or dose-limiting side effects. Hence, novel therapeutic perspectives are warranted. Many compounds acting on new pain targets are in preclinical or early clinical development. Only few clinical trials have suggested their clinical relevance in neuropathic pain. This concerns in particular NaV1.7 antagonists and angiotensin type II inhibitors. Another type of emerging drug therapy in neuropathic pain is represented by drugs largely used for other indications, such as botulinum toxin A and the antiepileptic oxcarbazepine, which have recently found to be effective in peripheral neuropathic pain...
March 2018: Pain
Daniel Weiss, João Massano
No abstract text is available yet for this article.
February 14, 2018: Neurology
Mats De Jaeger, Robbert-Jan van Hooff, Lisa Goudman, Alexis Valenzuela Espinoza, Raf Brouns, Martine Puylaert, Wim Duyvendak, Maarten Moens
Background: Spinal cord stimulation (SCS) is a proven and effective treatment for neuropathic pain conditions such as failed back surgery syndrome (FBSS). The hypothesis that different settings for SCS parameters activate unique, pain-relieving mechanisms has boosted the development of various SCS paradigms. High density spinal cord stimulation (HD-SCS) is one of those promising, novel stimulation forms characterized by subthreshold stimulation, delivering more pulses per second and a higher pulse density to the spinal cord than conventional SCS...
June 2017: Anesthesiology and Pain Medicine
Dario J Englot
Epilepsy surgery has seen numerous technological advances in both diagnostic and therapeutic procedures in recent years. This has increased the number of patients who may be candidates for intervention and potential improvement in quality of life. However, the expansion of the field also necessitates a broader understanding of how to incorporate both traditional and emerging technologies into the care provided at comprehensive epilepsy centers. This review summarizes both old and new surgical procedures in epilepsy using an example algorithm...
February 1, 2018: Epilepsy & Behavior: E&B
Paul Muhle, Inga Claus, Thomas Marian, Jens B Schröder, Andreas Wollbrink, Christo Pantev, Tobias Warnecke, Rainer Dziewas, Sonja Suntrup-Krueger
BACKGROUND/AIMS: Performing neurophysiological and functional imaging studies in severely affected patients to investigate novel neurostimulation techniques for the treatment of neurogenic dysphagia is difficult. Therefore, basic research needs to be conducted in healthy subjects. Swallowing is a motor function highly dependent on sensory afferent input. Here we propose a virtual peripheral sensory lesion model to mimic pharyngeal sensory impairment, which is known as a major contributor to dysphagia in neurological disease...
January 25, 2018: Neuro-Signals
Malgosia A Kokoszka, Fedor Panov, Maite La Vega-Talbott, Patricia E McGoldrick, Steven M Wolf, Saadi Ghatan
The responsive neurostimulation (RNS) system, an adjunctive treatment for pharmacoresistant partial-onset seizures with 1 or 2 foci, has been available to patients aged 18 years or older since the device's FDA approval in 2013. Herein, the authors describe their off-label application of this technology in 2 pediatric patients and the consequent therapeutic benefit without surgical complications or treatment side effects. A 14-year-old nonambulatory, nonverbal male with severe developmental delay was considered for RNS therapy for medically and surgically refractory epilepsy with bilateral seizure onsets in the setting of a normal radiological examination and a known neuropathological diagnosis of type I cortical dysplasia...
February 2, 2018: Journal of Neurosurgery. Pediatrics
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