Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 30
Filter
Add more filters










Publication year range
1.
Surg Neurol Int ; 10: 50, 2019.
Article in English | MEDLINE | ID: mdl-31528388

ABSTRACT

BACKGROUND: Our study shows that a membrane sealant/fiber fusogen polyethylene glycol (PEG) applied immediately on a sharp section of the spinal cord can mend the cord and lead to exceptional levels of motor recovery, with some animals almost normal. MATERIALS AND METHODS: Before deploying such technology in man, long-term data in large mammals that exclude delayed complications (e.g., central pain), confirm the stability of motor recovery, and provide histological evidence of fiber regrowth are necessary. Here, we provide such evidence in dogs followed up over 6 months and in 2 cases up to 1 year along with imaging and histologic data. RESULTS: We show that dogs whose dorsal cord has been fully transected recover locomotion after immediate treatment with a fusogen (PEG). No pain syndrome ensued over the long term. Diffusion tensor imaging magnetic resonance and histological, including immunohistochemical, data confirmed the re-establishment of anatomical continuity along with interfacial axonal sprouting. CONCLUSIONS: This study proves that a form of irreversible spinal cord injury (SCI) can effectively be treated and points out a way to treat SCI patients.

2.
Surgery ; 163(5): 976-983, 2018 05.
Article in English | MEDLINE | ID: mdl-29223327

ABSTRACT

BACKGROUND: Cephalosomatic anastomosis or what has been called a "head transplantation" requires full reconnection of the respective transected ends of the spinal cords. The GEMINI spinal cord fusion protocol has been developed for this reason. Here, we report the first randomized, controlled study of the GEMINI protocol in large animals. METHODS: We conducted a randomized, controlled study of a complete transection of the spinal cord at the level of T10 in dogs at Harbin Medical University, Harbin, China. These dogs were followed for up to 8 weeks postoperatively by assessments of recovery of motor function, somato-sensory evoked potentials, and diffusion tensor imaging using magnetic resonance imaging. RESULTS: A total of 12 dogs were subjected to operative exposure of the dorsal aspect of the spinal cord after laminectomy and longitudinal durotomy followed by a very sharp, controlled, full-thickness, complete transection of the spinal cord at T10. The fusogen, polyethylene glycol, was applied topically to the site of the spinal cord transection in 7 of 12 dogs; 0.9% NaCl saline was applied to the site of transection in the remaining 5 control dogs. Dogs were selected randomly to receive polyethylene glycol or saline. All polyethylene glycol-treated dogs reacquired a substantial amount of motor function versus none in controls over these first 2 months as assessed on the 20-point (0-19), canine, Basso-Beattie-Bresnahan rating scale (P<.006). Somatosensory evoked potentials confirmed restoration of electrical conduction cranially across the site of spinal cord transection which improved over time. Diffusion tensor imaging, a magnetic resonance permutation that assesses the integrity of nerve fibers and cells, showed restitution of the transected spinal cord with polyethylene glycol treatment (at-injury level difference: P<.02). CONCLUSION: A sharply and fully transected spinal cord at the level of T10 can be reconstructed with restoration of many aspects of electrical continuity in large animals following the GEMINI spinal cord fusion protocol, with objective evidence of motor recovery and of electrical continuity across the site of transection, opening the way to the first cephalosomatic anastomosis. (Surgery 2017;160:XXX-XXX.).


Subject(s)
Spinal Cord Injuries/drug therapy , Animals , Diffusion Tensor Imaging , Dogs , Drug Evaluation, Preclinical , Evoked Potentials, Somatosensory , Female , Neurosurgical Procedures , Random Allocation , Spinal Cord Injuries/diagnostic imaging , Spinal Cord Injuries/surgery
3.
Surgery ; 160(1): 5-10, 2016 07.
Article in English | MEDLINE | ID: mdl-27143608

ABSTRACT

Cephalosomatic anastomosis requires neuroprotective techniques, such as deep hypothermia, to preserve brain activity. Despite the failure of pharmacologic neuroprotection, new strategies, including ischemic pre- and postconitioning and the use of Perftoran, have to be explored to complement hypothermia. This article summarizes the field of brain protection during CSA and these promising strategies.


Subject(s)
Brain Tissue Transplantation/methods , Brain/blood supply , Animals , Fluorocarbons/therapeutic use , Humans , Hypothermia, Induced , Ischemic Preconditioning , Neuroprotective Agents/therapeutic use
4.
CNS Neurosci Ther ; 22(4): 271-4, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26880305

ABSTRACT

One of the key obstacles to a successful head transplant is the possible onset of central pain, a chronic pain condition that would impair the quality of life of the transplantee. In this review, we provide the reader with a knowledge of this neglected aspect of the head transplant initiative and outline the management should this eventuality occur.


Subject(s)
Cervical Cord/physiopathology , Cervical Cord/surgery , Head/surgery , Pain/physiopathology , Transplantation/methods , Humans , Pain Management/methods
5.
Pain Med ; 16(2): 240-8, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25040097
9.
Expert Rev Neurother ; 6(3): 429-40, 2006 Mar.
Article in English | MEDLINE | ID: mdl-16533146

ABSTRACT

Trigeminal neuralgia is a chronic pain syndrome of still unestablished origin. Its diagnosis depends on clinical grounds. Drug therapy initially helps a great majority of patients. The choice of drugs is quite large, but truly effective compounds with a tolerable side effect profile remain few. Carbamazepine (or oxcarbazepine) and lamotrigine appear to be the most effective, followed by baclofen. Several patients require further nonpharmacological treatment for which no evidence-based recommendation is possible. In the future, neuromodulation may be brought to bear, as in other chronic pain syndromes.


Subject(s)
Trigeminal Neuralgia/drug therapy , Chronic Disease , Humans , Pain/drug therapy , Pain/epidemiology , Syndrome , Trigeminal Neuralgia/epidemiology , Trigeminal Neuralgia/therapy
11.
Neuromodulation ; 9(1): 28-33, 2006 Jan.
Article in English | MEDLINE | ID: mdl-22151590

ABSTRACT

Objective. We assessed the effects of bilateral extradural motor cortex stimulation (ECS) to areas of maximal functional MRI (fMRI) activation in a male patient with plegic stroke by using multiple sequential 1-month blocks of stimulation with single-blind design in a tertiary referral hospital. Measurements. Assessments included the European Stroke Scale, Fugl-Meyer scale, and Barthel Index at baseline and at the end of each stimulation period, in a blinded fashion, over 1 year, and GABA ligand SPECT (single photon emission computed tomography) pre- and post-stimulation. Results. There was modest improvement in nonplegic arm areas and sustained improvement of aphasia. Contralateral stimulation had mixed effects to the affected arm and leg. Conclusion. ECS may modestly boost rehabilitation effects in a chronic stroke patient, with a differential effect of ipsilateral vs. contralateral stimulation.

12.
Curr Pain Headache Rep ; 9(2): 87-9, 2005 Apr.
Article in English | MEDLINE | ID: mdl-15745616

ABSTRACT

Transcranial magnetic stimulation recently has emerged as a therapeutic tool in neurology and psychiatry, with contradictory results. Central pain, a major chronic pain syndrome affecting millions of people worldwide, has been the focus of a few studies. Although transcranial magnetic stimulation has no role in the chronic management of such pain, it has potential as a screening procedure for the much more effective extradural cortical stimulation, a minimally invasive neurosurgical procedure that has emerged as the technique of choice in treating these patients.


Subject(s)
Central Nervous System Diseases/complications , Pain Management , Pain/etiology , Physical Stimulation , Transcranial Magnetic Stimulation/therapeutic use , Chronic Disease , Electric Stimulation Therapy , Humans
15.
Surg Neurol ; 60(2): 165-9; discussion 169, 2003 Aug.
Article in English | MEDLINE | ID: mdl-12900133

ABSTRACT

BACKGROUND: Neuroprotection in the setting of severe head injury (SHI) remains an unsettled problem. We tested a combination of high-dose magnesium and low-dose lidocaine, infused over 3 days, in a pilot study to assess safety. This combination appears indicated to protect both gray and white matter from secondary injury following SHI. METHODS: We studied 32 consecutive patients admitted to the emergency department of our hospital, a large tertiary referral center. RESULTS: No toxicity was observed. Mortality was lower than published statistics. CONCLUSIONS: These results open the stage to a controlled randomized study.


Subject(s)
Craniocerebral Trauma/drug therapy , Lidocaine/adverse effects , Magnesium Sulfate/adverse effects , Neuroprotective Agents/adverse effects , Adolescent , Adult , Aged , Anesthetics, Local/adverse effects , Craniocerebral Trauma/blood , Craniocerebral Trauma/complications , Drug Combinations , Female , Humans , Injury Severity Score , Lidocaine/administration & dosage , Lidocaine/blood , Magnesium Sulfate/administration & dosage , Magnesium Sulfate/blood , Male , Middle Aged , Neuroprotective Agents/administration & dosage , Neuroprotective Agents/blood , Pilot Projects , Prospective Studies , Safety , Treatment Outcome
19.
Neurol Res ; 25(2): 118-22, 2003 Mar.
Article in English | MEDLINE | ID: mdl-12635508

ABSTRACT

Extradural motor cortex stimulation was introduced in 1989 for control of central pain. In recent years this has been found useful in several patients with movement disorders. This paper attempts to bring together all the relevant literature, discuss mechanisms and lay out guidelines for future research and clinical applications.


Subject(s)
Electric Stimulation Therapy/methods , Motor Cortex/physiology , Movement Disorders/therapy , Adult , Aged , Aged, 80 and over , Dura Mater , Female , Humans , Male , Middle Aged
SELECTION OF CITATIONS
SEARCH DETAIL
...