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All Posts Tagged: Neuromodulation

Drug-resistant Epilepsy / Parkinson’s disease / Motor disorders

 

Many patients with epilepsy, Parkinson’s disease, tremor, dystonia, and other movement disorders may not respond to medication, even with the most modern drug combinations. Their quality of life can be significantly affected. Many of these patients are young, otherwise healthy individuals, and they need to work and, above all, live a normal life. There are now special surgeries for these patients, such as Deep Brain Stimulation (DBS). These surgeries belong to the category of the so-called Functional Neurosurgery, and are based on the theory of Neuromodulation.

Neuromodulation

This means that with an external intervention, we affect a known circuit of the brain functioning in a way that causes some of the symptoms of the disease that we wish to treat. Thus, by disrupting this circuit in a controlled way, the brain re-programs itself and the symptoms subside. This is the general principle, but of course there are cases where we are even obliged to remove nerve tissue to control the symptoms, especially in some cases of epilepsy. In this case the so-called “epileptogenic tissue” is removed.

Deep Brain Stimulation (DBS)

In general, Deep Brain Stimulation is a relatively mildly invasive procedure, in which an electrode is inserted into the area of the brain that we want to “re-program”. There are extremely accurate that are used for this purpose and allow for the safe achievement of the goal. The implant is carried out via a very small hole in the skull. Local anesthesia is mainly used; usually the patient can have an immediate improvement in their symptoms, even during the operation, as soon as the electrode is activated. This is stimulated in a specific way by a special pacemaker, similar to the one used in the heart, which is also implanted in the patient’s body. The desired result is achived depending on the type, degree and area of stimulation. Stimulation systems (or even permanent micro-destruction of a specific area) are now used for certain psychiatric diseases, such as severe drug-resistant depression and obsessive-compulsive disorder.

It should be made clear that not all patients are suitable for this type of surgery. A thorough preoperative examination, and special imaging and electrophysiological examinations are required. In addition to the neurosurgeon, the team of physicians also includes a neurologist, a psychologist, a psychiatrist, a neurophysiologist and, as the case may be, other specialties such as speech therapists, physiotherapists, occupational therapists, etc.

 

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Postoperative chronic pain

 

 

This category includes a number of conditions such as the so-called failed back / failed neck pain syndrome. Many of these patients continue to suffer from pain, although clinical and imaging tests (X-rays, MRI scans, etc.) do not identify any cause of their pain.

Implantation of spinal cord stimulators in the spine

Postoperative chronic painIn selected cases , implantation of spinal cord stimulators in the spine may help.The correct diagnosis of the syndrome made by specialized doctors (anesthesiologists, neurologists, or neurosurgeons) and the correct choice of patients who may benefit from it is a prerequisite. The stimulator is implanted in the patient’s body, usually in the abdomen. After a short period of training it can be used by the patients themselves through a simple remote control, depending on the intensity and location of their symptoms. It significantly improves symptoms by controlling pain in the exact area where it occurs. The implant operation is relatively simple. The surgery lasts 30-45 minutes, under general anesthesia, and the duration of postoperative treatment is 2-3 days. The use of the system can start during the hospitalization of the patient and its beneficial effects are immediately felt. About 2 in 3 patients in this category are relieved of their symptoms and no longer need to take chronic medication with all its possible side effects.

 

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