ABSTRACT
MR-guided focused ultrasound (MRg-FUS) is a new noninvasive method for the treatment of contralateral disabling and pharmacoresistant tremor. Clinical studies have confirmed the high efficacy and safety of using MRg-FUS in patients with essential tremor and Parkinson's disease, in short and long-term studies. Advantages of this method in comparison with currently used invasive and noninvasive technics, potential brain target areas, the possibility of bilateral intervention, indications and contraindications are discussed.
Subject(s)
Essential Tremor , Parkinson Disease , Humans , Essential Tremor/drug therapy , Tremor/drug therapy , Tremor/etiology , Parkinson Disease/complications , Parkinson Disease/therapy , Thalamus , Treatment Outcome , Magnetic Resonance Imaging/methodsABSTRACT
The authors describe dynamic MRI and clinical data after non-invasive treatment of tremor in the upper extremity. Thalamotomy by high-intensity focused ultrasound under MR-guided navigation was performed. A 57-year-old patient with Parkinson's disease underwent treatment with focused ultrasound. MRI of the brain was performed 1 and 48 hours, 47 days, 3 and 6 months later. Features of natural course of focal brain changes after treatment, data of MR tractography necessary for correction of target zone are described. The authors conclude that MR changes are characterized by presence of a focus in the area of focused exposure. Peak severity is observed on the second day after procedure with subsequent regression. MR-based analysis of predictors is promising to forecast treatment outcomes.
Subject(s)
Essential Tremor , Tremor , Essential Tremor/therapy , Follow-Up Studies , Humans , Magnetic Resonance Imaging/methods , Middle Aged , Neuroimaging , Thalamus/diagnostic imaging , Thalamus/surgery , Treatment Outcome , Tremor/diagnostic imaging , Tremor/surgeryABSTRACT
OBJECTIVE: To analyze the results of sphenopalatine ganglion stimulation in treatment of chronic headache. MATERIALS AND METHODS: Medical histories of patients who underwent sphenopalatine ganglion stimulation in 4 clinical centers have been analyzed. The analysis included the type of pain and its characteristics, methods of surgery, CT, MRI, radiography before and after surgery. The follow-up data of patients with implanted pulse generators was collected in an outpatient clinic or by telephone review. RESULTS: The study included 15 patients with chronic refractory headache, including 14 with cluster headache and one female patient with features of trigeminal autonomic cephalgia without a clear definition of the type of pain. Trial stimulation was performed in 10 patients to determine analgesic effect. Among them stimulation was favorable in 7 cases, and 6 of them underwent pulse generator implantation. In total, 11 (73%) patients underwent implantation with a follow-up from 1 to 60 months. Among them only 6 (54%) patients use stimulation, the remaining 5 (46%) cases had device-related complications (migration, infection of system). Cluster headache has a significant improvement in long-term follow-up. CONCLUSIONS: Sphenopalatine ganglion stimulation may have high potential in the treatment of chronic drug-resistant cluster headache. The complication rate demonstrates that operative technique should be improved.
Subject(s)
Cluster Headache , Electric Stimulation Therapy , Ganglia, Parasympathetic , Headache Disorders , Cluster Headache/therapy , Electric Stimulation Therapy/adverse effects , Electric Stimulation Therapy/methods , Female , Ganglia, Parasympathetic/surgery , Humans , Pain/etiologyABSTRACT
BACKGROUND: Non-invasive EEG reveals epileptogenic zone in 70% of patients. In other cases, invasive EEG monitoring is indicated. Various implantation strategies and techniques of intracranial EEG (icEEG) potentially provide different outcomes. Choosing the optimal icEEG technique may be challenging. OBJECTIVE: To analyze the results of icEEG in adults with temporal lobe epilepsy and to determine the algorithm for selection of optimal invasive EEG technique. MATERIAL AND METHODS: The study included 82 patients with temporal lobe epilepsy who underwent invasive EEG. Effectiveness of invasive EEG was determined by detection of epileptogenic zone and post-resection outcomes. Postoperative results were analyzed throughout more than 6-month follow-up period using the Engel grading system. Statistical analysis was conducted using the Fisher's exact test. RESULTS: Epileptogenic zone was revealed in 72 (88%) cases. Invasive EEG was supplemented by another modality in 3 (4%) patients. Mean follow-up period after resection was 17 months in 45 patients. Favorable outcomes were achieved in 31 (69%) cases. Statistical analysis showed that identification of epileptogenic zone depends existing of lesion and symptoms of seizures. Selection algorithm for optimal technique of invasive EEG was determined considering own results and literature data. CONCLUSION: Invasive EEG results and post-resection outcomes demonstrated favorable efficacy of original algorithm. The last one may be used in decision-making on optimal technique of invasive EEG in adults with temporal lobe epilepsy.
Subject(s)
Epilepsy, Temporal Lobe , Adult , Electrocorticography , Electroencephalography , Epilepsy, Temporal Lobe/diagnosis , Epilepsy, Temporal Lobe/surgery , Humans , SeizuresABSTRACT
OBJECTIVE: To demonstrate the results of treatment of poorly controlled deafferentation facial pain using motor cortex stimulation and to review the relevant literature. MATERIAL AND METHODS: The study included 8 patients (3 males and 5 females) with deafferentation facial pain who were implanted with a system of constant motor cortex stimulation at the Illinois University in Chicago in 2004-2016 and Novosibirsk Federal Center of Neurosurgery in 2017. The patients' age ranged from 37 to 81 years (mean age, 57.5 years). Scale-based assessment of the pain severity was performed at admission to hospital, at discharge, and during follow-up. The visual analogue pain scale, Barrow Neurological Institute pain scale (BNIPS), and McLaughlin scale were used. RESULTS: Immediately after surgery, a significant improvement in the form of pain reduction by 80-100% occurred in 4 patients. The pain intensity at discharge from the hospital decreased by 55%, on average. During the follow-up period, the efficacy of motor cortex stimulation was assessed (McLaughlin scale) as very good by 3 of the 8 patients, as good by 4 patients, and as unsatisfactory by 1 patient. CONCLUSION: Our findings and recent studies have demonstrated that motor cortex stimulation is one of the treatment options for deafferentation facial pain. Even a slight decrease in the intensity of excruciating and debilitating pain (assessed by patients as a good effect) gives grounds for application of the procedure. Further research is needed to define more precise criteria for selecting patients for this treatment and to increase the efficacy of stimulation.
Subject(s)
Deep Brain Stimulation/methods , Facial Pain/therapy , Motor Cortex/physiopathology , Neuralgia/therapy , Pain Management/methods , Adult , Aged , Aged, 80 and over , Facial Pain/etiology , Facial Pain/physiopathology , Female , Humans , Male , Middle Aged , Neuralgia/etiology , Neuralgia/physiopathology , Pain Measurement , Treatment OutcomeABSTRACT
AIM: To present own experience in surgical treatment of cervical paragangliomas. MATERIAL AND METHODS: 9 patients with cervical paragangliomas were enrolled. Endovascular embolization of supplying vessels followed by maximally radical surgery and subsequent carotid arteries repair involved into tumoral process reduces the risk of complications. RESULTS: The most careful attitude to caudal group of cranial nerves adjacent or involved into neoplasm allows to minimize postoperative neurological complications.
