ABSTRACT
BACKGROUND: Facial chronic neuropathic pain (FCNP) is a disabling clinical entity, its incidence is increasing within the chronic pain population. There is indication for neuromodulation when conservative treatment fails. Motor cortex stimulation (MCS) has emerged as an alternative in the advanced management of these patients. The aim of this work is to review the worldwide literature on MCS for FCNP. METHODS: A PubMed search from 1990 to 2012 was conducted using established MeSH words. A total of 126 relevant articles on MCS focused on chronic pain were selected and analysed. Series of cases were divided in (1) series focused on MCS for FCNP, and (2) MCS series of FCNP mixed with other chronic pain entities. RESULTS: A total of 118 patients have been trialed for MCS for FCNP, 100 (84.7%) pursued permanent implantation of the system, and 84% of them had good pain control at the end of the study. Male: female ratio was about 1:2 in the whole group of studies; mean age was 58 years (range, 28-83), and mean pain duration was 7 years (range, 0.6-25). Four randomized controlled studies have been reported, all of them not focused on MCS for FCNP. The most common complication was seizure followed by wound infection. Preoperative evaluation, surgical techniques, and final settings varied among the series. CONCLUSION: MCS for FNCP is a safe and efficacious treatment option when previous managements have failed; however, there is still lack of strong evidence (larger randomized controlled multicentre studies) that MCS can be offered in a regular basis to FNCP patients.
ABSTRACT
BACKGROUND/OBJECTIVE: Globus pallidus internus (GPi) and subthalamic nucleus (STN) have successfully been targeted independently for deep brain stimulator (DBS) placement in medically intractable Parkinson's disease (PD). Bilateral implantation of STN DBS in a patient with preexisting, functioning GPi DBS to specifically treat motor fluctuations is, to our knowledge, yet unreported. CLINICAL PRESENTATION: We present a case of PD who had well-placed bilateral GPi DBS that controlled dyskinesia effectively and improved the motor symptoms like rigidity and akinesia. It did not improve her motor fluctuations and failed to reduce her medications. METHODS: We implanted bilateral STN DBS, which improved her 'on' time, reduced her medications and improved her motor scores. RESULTS/CONCLUSION: In this report we discuss the rationale, technical issues, programming nuances and outcome in a patient with preexisting bilateral GPi DBS who was implanted with bilateral STN DBS.
Subject(s)
Deep Brain Stimulation/methods , Globus Pallidus/physiology , Implantable Neurostimulators , Parkinson Disease/therapy , Subthalamic Nucleus/physiology , Deep Brain Stimulation/instrumentation , Dyskinesias/pathology , Dyskinesias/physiopathology , Female , Globus Pallidus/pathology , Humans , Magnetic Resonance Imaging , Middle Aged , Motor Activity/physiology , Neurosurgical Procedures/instrumentation , Neurosurgical Procedures/methods , Parkinson Disease/pathology , Parkinson Disease/physiopathology , Subthalamic Nucleus/pathology , Treatment OutcomeSubject(s)
Head Injuries, Closed/diagnostic imaging , Hematoma, Epidural, Cranial/diagnostic imaging , Hematoma, Subdural, Acute/diagnostic imaging , Tomography, X-Ray Computed , Accidental Falls , Adult , Brain/diagnostic imaging , Craniotomy , Glasgow Coma Scale , Head Injuries, Closed/complications , Hematoma, Epidural, Cranial/etiology , Hematoma, Epidural, Cranial/surgery , Hematoma, Subdural, Acute/etiology , Hematoma, Subdural, Acute/surgery , Humans , MaleABSTRACT
El objetivo del trabajo fue describir el curso de la cistitis hemorrágica posradioterapia pélvica con la terapia de oxígeno hiperbárico (OTHB). Se hizo un estudio descriptivo retrospectivo, en el que se revisaron las historias de diez pacientes atendidos en el Servicio de Medicina Hiperbárica del Hospital Militar Central de Bogotá, remitidos del Servicio de Urología de la misma institución con el diagnóstico de cistitis hemorrágica postradioterapia, en un período comprendido entre enero de 2001 a febrero de 2007. Los resultados se tabularon con las variables preestablecidas y se procesaron en Excel. El 70 por ciento de los pacientes fueron hombres, la edad promedio fue 74,3 años (63-88), el 70 por ciento tuvo cistitis y proctitis posradioterapia y el restante sólo cistitis. Todos los hombres fueron irradiados por cáncer de próstata y las mujeres por cáncer de cérvix. El 40 por ciento recibió braquiterapia y el promedio de sesiones de OTHB fue de doce, en un rango entre siete y quince. El tiempo promedio de inicio de los síntomas fue de 16,4 meses y el de seguimiento después de iniciada la OTHB fue de 1,6 años. Al final del seguimiento todos los pacientes estuvieron asintomáticos, lo que permite concluir que la del OTHB es una alternativa útil y segura en el tratamiento de los pacientes con cistitis hemorrágica posradioterapia.
