Comparison of Long-Term Outcomes Between 7 Days and 28 Days Albendazole Monotherapy in the Treatment of Single-Lesion Neurocysticercosis in Children

2021 ◽  
pp. 088307382110358
Author(s):  
Nameirakpam Johnson ◽  
Arushi Gahlot Saini ◽  
Prahbhjot Malhi ◽  
Niranjan Khandelwal ◽  
Pratibha Singhi
Keyword(s):  
School Performance ◽  
Cognitive Outcomes ◽  
Indian Children ◽  
Perilesional Edema ◽  
Behavioral Abnormalities ◽  
The Mean ◽  
Group B ◽  
Single Lesion

Objectives: The objective was to compare the long-term clinical, radiological, and cognitive outcomes in children with single-lesion neurocysticercosis who received 7 or 28 days of albendazole therapy. Methodology: This observational study conducted over 1 year included (1) consecutive children with single-lesion neurocysticercosis who received 7 or 28 days of albendazole therapy in the acute state and (2) completed follow-up for at least 5 years. Seizure recurrence, resolution of lesions, cognition (Malin’s Intelligence Scale for Indian Children), behavior, and school performance (National Initiative for Children Healthcare Quality Vanderbilt Assessment Scale) were assessed. Results: Group A (albendazole for 7 days) comprised 55 children, and group B (albendazole for 28 days) included 48 children. The mean age at the time of diagnosis of neurocysticercosis was 6.6 ± 1.8 years; the mean age at the time of assessment for the study was 13.2 ± 1.2 years. Focal-onset seizures were the most common clinical presentation (58.3%). The majority of lesions were ring-shaped (92.3%) or colloidal (58.2%), with perilesional edema (89.3%). In the long-term follow-up, radiological resolution of the lesions was comparable in both groups. Complete resolution was seen in 52.7% receiving 7 days and 54.2% receiving 28 days albendazole. Seizures recurred in 20% receiving 7 days and 20.8% receiving 28 days albendazole. Overall, a low intelligence quotient (IQ < 70) was seen in 55.3% cases, “somewhat problematic” school performance in 12%, and behavioral abnormalities were present in 20% of the cases. The results were comparable between the 2 groups. Conclusion: Seizure control, radiological resolution of lesion, school performance, cognitive and behavioral outcomes in the long term are comparable in children with single-lesion neurocysticercosis who have received albendazole cysticidal therapy for 7 days and 28 days. Recurrence of seizure is seen with both regimens in the long term, necessitating regular follow-up and discussion regarding the risk of recurrence before a withdrawal of anticonvulsant therapy.

Tethered cord syndrome in adults

2011 ◽  
Vol 15 (3) ◽  
pp. 258-270 ◽  
Author(s):  
Jörg Klekamp
Keyword(s):  
Spinal Cord ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Neurological Deficits ◽  
Short Term ◽  
Group A ◽  
The Mean ◽  
Group B

Object The treatment of tethered cord syndromes in adults is discussed regarding the natural history and surgical indications. The author analyzes data obtained in patients who were diagnosed with a tethered cord in adulthood and either underwent surgical or conservative therapy between 1991 and 2009. Methods Since 1991, data obtained in 2515 patients with spinal cord pathologies were entered into the spinal cord database, and prospective follow-up was performed through outpatient visits and questionnaires. Of the 2515 patients, 85 adults with a tethered cord syndrome formed the basis of this study. The tethering effect was caused either by a split cord malformation, a thick filum terminale, a conus medullaris lipoma with extradural extension, or various combinations of these mechanisms. The mean age of the patients was 46 ± 13 years (range 23–74 years) and the mean follow-up duration was 61 ± 62 months. Two groups were distinguished based on the absence (Group A, 43 patients) or presence (Group B, 42 patients) of an associated lipoma or dysraphic cyst (that is, dermoid, epidermoid, or neurenteric cyst). Surgery was recommended for patients with symptoms only. Short-term results were determined within 3 months of surgery, whereas long-term outcomes (clinical recurrences) were evaluated using Kaplan-Meier statistics. Results For all patients, pain was the most common major complaint. Severe neurological deficits were rare. In Group A, 20 of 43 patients underwent surgery, whereas in Group B 23 of 42 patients underwent surgery. Among individuals who did not undergo surgery, 17 patients refused surgery and 25 patients underwent recommended conservative treatment. Short-term postoperative results indicated a significant improvement of pain and a stabilization of neurological symptoms. Long-term results showed a good prognosis in patients in whom first-time (that is, nonrevision) surgery achieved successful untethering, with a 10-year rate of neurological stabilization in 89% of Group A and a 10-year rate of neurological stabilization in 81% of Group B patients. The benefit of secondary operations in Group B was limited, with eventual clinical deterioration occurring in all patients within 10 years. For patients treated conservatively, follow-up information could be obtained in 33 of 42 patients. Twenty-eight patients remained in stable clinical condition. Only 5 of the conservatively treated patients experienced clinical deterioration over time; in 4 of these individuals with deterioration, surgery had been recommended but was refused by the patient. The clinical recurrence rate in all conservatively treated patients was 21% after 10 years. With a recommendation for surgery this figure rose to 47% within 5 years. Conclusions Surgery in adult patients with a tethered cord syndrome should be reserved for those with symptoms. In surgically treated patients, pain relief can often be achieved, and long-term neurological stabilization tends to persist more often than it does in conservatively treated patients. A conservative approach is warranted, however, in adult patients without neurological deficits. Revision surgery in patients with complex dysraphic lesions should be performed in exceptional cases only.

scholarly journals Natural history of the enlarged ascending thoracic aorta: an observational long term study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Schroeder ◽  
B Bihin ◽  
M Buche ◽  
P.H Eucher ◽  
J Felix ◽  
...  
Keyword(s):  
Thoracic Aorta ◽  
Cumulative Incidence ◽  
Z Score ◽  
Mean Diameter ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Group D

Abstract   To assess the long-term outcome of patients with an enlarged ascending thoracic aorta (ATA), a retrospective study was performed. Methods Inclusion criteria: ATA diameter of 38 mm or more by ETT (813 consecutive cases). Inclusion period: 1.1.2003–31.12.2016. Results At baseline, the mean diameter of the ATA was 42±3 mm, the mean Z-score was 2.7±0.8. In the subgroup of patients with 2 ETT examinations (and no surgical cure of the ATA), the mean diameter was 41.9±4.8 mm, the mean Z-score 2.4±1.1 after a mean follow-up of 6 years. During the follow-up, 52 patients had an intervention on the ATA, 26 patients were operated within the first 3 months after the diagnostic echocardiogram. 26 patients were operated during FU. In the 791 remaining patients (without early intervention), the event rate (death, intervention on the ATA) were assessed by the competing risk model. In the group of patients with a baseline ATA diameter of less than 41 mm (Group A: n=254), the cumulative incidence of death at 5 and 10 y was 34% and 61%; in the group of patients with an ATA diameter of 41–42 mm (Group B: n=238) the incidence was 34% and 61% respectively, in the group of patients with an ATA diameter of 43–44 mm (Group C: n=147), the incidence was 32% and 58%, in the group of patients with a diameter of 45 and more (Group D: n=150), the incidence was 31.1% and 61% (NS). The cumulative incidence of surgical interventions on the ATA at 5 and 10 years was 0.4% and 1% in group A, 1.3 and 1.8% in group B, 0.7 and 1.4% in group C and 9.8 and 12.9% in group D (p&lt;0.05). Similar results were observed in patients according to the Z-scores. In the group of patients (221) with a Z-score &gt;3, the incidence of intervention at 5 and 10 y was respectively 7.6% and 10.7% (p=0.01). Conclusions – The mean diameter of the enlarged ATA remained nearly unchanged over a period of 6 years. – No impact of the enlarged ATA on survival was observed. – Only patients with an ATA diameter of 45 mm and more (or a Z-score of 3 and more) needed an intervention on the ATA at a rate of ± 10% at 10 y after the initial echocardiographic diagnosis. Funding Acknowledgement Type of funding source: None

Long-Term Follow up of the Beneficial Effects and of Issues in Subtotal Splenectomy for Hereditary Spherocytosis

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 276-276
Author(s):  
Thomas Pincez ◽  
Corinne Guitton ◽  
Frederic Gauthier ◽  
Guenolee Lambert ◽  
Veronique Picard ◽  
...  
Keyword(s):  
Hereditary Spherocytosis ◽  
Hemoglobin Level ◽  
Mean Delay ◽  
Group A ◽  
The Mean ◽  
Total Splenectomy ◽  
Group B ◽  
Subtotal Splenectomy

Abstract Total splenectomy is recommended in symptomatic cases of hereditary spherocytosis (HS) to reduce the severity of anemia but exposes patients to long-term infectious or thrombotic complications. Alternative strategies such as subtotal splenectomy (STS) have been developed, principally for children under the age of 6 with severe HS, who are not eligible to total splenectomy because of the high infectious risk and for older patients with mild HS complaining of chronic discomfort. Since our original report, several groups have shown that STS reduced the hemolytic rate, increased the red cell lifespan while maintaining an efficient splenic phagocytic function but the extent of follow-up has been limited. In order to define the long-term benefits of STS, we report here an update of our series that includes 90 patients who underwent STS at the Bicêtre hospital between 1985 and 2013, with a median-follow-up of 9.3 years (range 1-23 years). Two groups were defined on the basis of the disease phenotype: Group A included 42 patients for whom STS was performed because of severe/intermediate HS (transfusion requirement or hemoglobin (Hb) level <95 g/dL and Group B included 48 patients with a milder HS but presenting marked icterus, gallstones requiring cholecystectomy or chronic fatigue. At the time of STS, the mean hemoglobin level was 82 g/L in Group A vs. 110 g/L in Group B. Mean age at surgery was 7.6 ± 5.4 years (0.5-25 years), significantly lower in Group A than in Group B (4.3 vs. 10 years, p<0.0001). In all cases, STS was performed by laparotomy. Preoperative mean spleen volume was 513 ± 241% of normal. Surgery reduced by 88% the initial splenic volume. A functional assessment of the splenic remnant was performed by Howell jolly body counts and by splenic scintigraphy. Splenic function was retained in 87 of 90 patients except for 3 individuals (2 post-operative necrosis of the remnant, 1 non-functional remnant). No severe infection or thrombotic event was documented during the entire period of follow-up. A sustainable hematological response was observed in 81 patients (90%) at the end of the evaluation period. The mean increase in the hemoglobin level was 27 g/L, with a hemoglobin level after STS being still higher in group B than in group A (130 ± 3.3g/L vs. 110 ± 3.3 g/L (p<0.0001). For the whole population, the mean number of transfusions per year and per patient was 0.097 after versus 1.7 before STS (for Group A only: 0.21 after vs. 3.65 before STS, p<0.0001). Of note, STS decreased the hemolytic rate but did not abrogate it: the reticulocyte count decreased from 399 ±195 G/L to 290 ±170 G/L (p<0.001), but the bilirubin level remained unchanged. Seventeen patients (33%) developed cholelithiasis during the follow-up period. Gallstones were slightly more frequent in Group A than in Group B (47% vs. 15%, p=0.03). After an initial improvement, 8 patients (19% of patients from Group A) experienced a relapse with transfusion-dependant anemia and/or decrease of the hemoglobin level below 95g/L. Relapses occurred with a mean delay of 4.6 ± 1.2 years after STS. Assessing the remnant volume by ultrasonography and/or scintigraphy, we noticed that it increased quickly during the first year after STS but at a slower rate during the subsequent 5 years. The growth was faster in patients from Group A but there was no clear correlation at the end of the follow-up period between the hemoglobin level and the volume of the remnant. During the follow-up period twenty patients (22%) underwent total splenectomy with a mean delay of 8 ± 5.6 years after STS (range 0-20.1 years). Eight patients underwent total splenectomy for recurrence of anemia, the others for recurrent discomfort/pain of the remnant (n=7), icterus (n=3), wandering spleen (n=1) and early post-STS hemorrhage (n=1). Requirement for total splenectomy was significantly higher in Group A than Group B (40 of the patients vs. 6% at the last endpoint, p<0.0001). In summary, our results show that in the long-term, STS resulted in a decrease in the hemolytic rate in HS. In children under the age of six years with severe HS, STS decreased the transfusion rate and increased the hemoglobin to a level compatible with normal growth while retaining splenic function. However, half of these patients will require total splenectomy, but at an age where it will be much safer. In milder HS, STS removed discomfort related to the high hemolytic rate whithout exposing the patients to the risks of a total splenectomy. Disclosures No relevant conflicts of interest to declare.

scholarly journals Long-Term Prosthetic Aftercare of Two- vs. Four-Ball Attachment Implant-Supported Mandibular Overdentures

2021 ◽  
Vol 11 (19) ◽  
pp. 8974
Author(s):  
Ofir Rosner ◽  
Eran Zenziper ◽  
Hadas Heller ◽  
Joseph Nissan ◽  
Guy Melamed ◽  
...  
Keyword(s):  
Pressure Sore ◽  
The Other ◽  
Mechanical Wear ◽  
Group A ◽  
The Mean ◽  
Number Of Visits ◽  
Edentulous Patients ◽  
Group B

Little is reported about the prosthetic aftercare of implant-supported mandibular overdentures regarding the number of implants placed. The purpose of this study was to evaluate the prosthetic aftercare among edentulous patients restored with two vs. four mandibular implant-retained overdentures (MISOD). Forty-six consecutive edentulous patients treated by a new MISOD were retrospectively studied. Twenty-five patients had two-ball attachment MISOD (Group A), and 21 had four-ball attachment MISOD (Group B). The total amount of aftercare visits was recorded, as well as the type of treatments required (pressure sore spots relief, attachment liner replacement due to loss of retention, and metal ball attachment replacement due to wear). The mean follow-up duration was 93 ± 57 months (range 9–246 months). None of the implants was lost. There were significantly more visits for pressure sore spots relief in Group A vs. Group B (6.2 ± 2 in group A and 4.09 ± 1.54 in group B, p < 0.0001). Differences in the other two tested parameters (number of visits for liner replacement (2.3 ± 1.84 in group A and 2.4 ± 1.63 in group B) and attachment replacement (2.36 ± 1.85 in group A vs. 2.48 ± 1.63 in group B) yielded a non-significant outcome (p = 0.814 for liner replacement and p = 1.000 for attachment replacement). The use of four-ball attachments in MISOD was more beneficial than two-ball attachments with regards to the aftercare of pressure sore spots. The number of implants did not influence the mechanical wear.

scholarly journals Long-Term (Over Five Years) Results of Surgical Correction of Scheuermann’s Kyphosis

2021 ◽  
Author(s):  
Mikhail Mikhaylovskiy ◽  
Elena Gubina ◽  
Alina Alshevskaya ◽  
Vitaly Lukinov
Keyword(s):  
Spinal Fusion ◽  
Deformity Correction ◽  
Surgical Correction ◽  
Correction Loss ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Posterior Correction

Abstract Study design. Retrospective cohort study.Objective. The study objective is to assess long-term results of surgical correction of kyphosis due to Scheuermann’s disease.Summary of Background Data. Despite a large number of studies on surgical correction of juvenile kyphosis, articles discussing long-term (over five years) results of these interventions are very rare.Methods. The study group included 43 patients (m/f ratio, 34/9). The mean age was 19.1 (14–32) years; the mean postoperative follow-up was 6 + 10 (5–20) years. Two-stage surgery including discectomy and interbody fusion followed by posterior correction and fusion was conducted in 35 cases (group A). Eight patients (group B) underwent only posterior correction and spinal fusion. The following parameters were determined for each patient: Thoracic Kyphosis (TK); Lumbar Lordosis (LL), Sagittal Vertical Axis (SVA); Sagittal Stable Vertebra (SSV); First Lordotic Vertebra (FLV); Proximal Junctional Angle (PJA); and Distal Junctional Angle (DJA). All measurements were performed immediately before surgery, one week after surgery, and at the end of the follow-up period. All patients answered the SRS-24 questionnaire after surgery and at end of the follow-up.Results. Groups A and B were comparable in age and sex, BMI and initial Cobb angle (P < 0.05). The curve decreased from 77.8° to 40.7° in group A and from 81.7° to 41.6° in group B. The loss of correction was 9.1° and 6.0° in groups A and B, respectively. At ID < 1.2, deformity correction and correction loss were 35° (44.0 %) and 7.1°, respectively; at ID ˃ 1.2, deformity correction and correction loss were 44.5° (54.7 %) and 3.9°, respectively (P < 0.05).Proximal junctional kyphosis was detected in 21 out of 43 patients (48.8 %). The rate of PJK was 45.4 % in those patients whose upper end vertebra was included in the fusion and 60 % in individuals whose upper end vertebra was not included. PJK developed in eight (47.8 %) out of 17 patients who received ≥ 50 % kyphosis correction and in 13 (50 %) individuals who had < 50 % deformity correction. The rate of DJK development was 39.5 %. The lower instrumented vertebra (LIV) was located proximal to the sagittal stable vertebra in 16 cases, with 12 of them being diagnosed with DJK (75 %). In 27 patients, LIV was located either at the SSV level or distal to it, the number of DJK cases was 5 (18.5 %) (P < 0.05). Only two patients with complications required unplanned interventions. According to the patient questionnaires, the surgical outcome score increases between the immediate and long-term postoperative periods for all domains and from 88.4 to 91.4 in total. The same applies to answer to the question No. 24 (“Would you have the same treatment again if you had the same condition?”): rate of positive answers ranges from 82 to 86 %.Conclusions. Two-stage surgery, as a more difficult and prolonged one, has no advantages over one-stage operation in terms of magnitude and stability of the achieved effect. The problem of choosing the area of spinal fusion is far from being solved. Surgical treatment improves the quality of life of patients with Scheuermann’s disease; the improvement is also observed in the long-term postoperative period.

scholarly journals Tendoscopic versus open release for de Quervain’s disease: earlier recovery with 7.21 year follow-up

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Xiao-hui Gu ◽  
Zhe-ping Hong ◽  
Xin-ji Chen ◽  
Yu Tong ◽  
Jian-fei Hong ◽  
...  
Keyword(s):  
Return To Work ◽  
Open Release ◽  
De Quervain’S Disease ◽  
Group A ◽  
Release Group ◽  
The Mean ◽  
Group B ◽  
Finkelstein’S Test

Abstract Purpose To compare the time return to work and long-term results of tendoscopic versus open technique for de Quervain’s disease. Methods From 2005 to 2013, either tendoscopic or open decompression was performed on 56 consecutive patients (56 wrists) with symptomatic de Quervain’s disease despite a minimum of 3 months non-operative treatment. Of the 50 patients who met the inclusion criteria, 41 patients were followed-up for a mean of 7.21 years postoperatively. Among these 41 wrists, 20 underwent tendoscopic release (group A), and 21 underwent open release (group B). The clinical evaluations were performed preoperatively, 1 month postoperatively and at last follow-up visit, using visual analog scale (VAS); the Disabilities of the Arm, Shoulder and Hand (DASH) Outcome score; and the Finkelstein’s test. The Patient and Observer Scar Assessment Scale (POSAS) was used as an esthetic evaluation tool of the scar at last follow-up. Results No significant baseline differences were found between two groups. The average time return to work in group A was less than in group B (P < 0.05), The mean VAS and DASH scores improved significantly in both groups at 1 month and last follow-up visit (P < 0.001). At 1 month, the scores in group A were significantly better than in group B (P < 0.05 and P < 0.001, respectively). There was no difference between groups at last follow-up. In addition, the improvement of the mean DASH score was significantly greater in group A than in group B (34.74 ± 10.99 in group A and 23.58 ± 12.01 in group B, P < 0.01) at 1 month. For POSAS scale, both the OSAS and PSAS scores were significantly better in group A. One patient in group A had cephalic vein injury and 3 patients in group B was involved with radial sensory nerve injury. All patients showed negative on Finkelstein’s test at last follow-up. Conclusions The results of this study suggest that tendoscopic technique for de Quervain’s disease could provide earlier symptom relief and earlier recovery with fewer complications and more desirable scar, as well as equivalent successful long-term outcome, when compared with traditional open release technique.

Two-year experience with telemedicine in the follow-up of patients in home peritoneal dialysis

2007 ◽  
Vol 13 (6) ◽  
pp. 288-292 ◽  
Author(s):  
Paloma Gallar ◽  
Ana Vigil ◽  
Isabel Rodriguez ◽  
Olimpia Ortega ◽  
Magdalena Gutierrez ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Study Group ◽  
Hospital Visit ◽  
Long Term Follow Up ◽  
Group A ◽  
The Mean ◽  
Hospital Visits ◽  
Group B

We evaluated the use of telemedicine in the long-term control of stable patients undergoing peritoneal dialysis at home. From September 2003 to August 2005, patients were randomly selected from current cases and invited to join study group A, in which they had telemedicine support. Patients not selected for this group, or who refused the invitation, were placed in study group B, and used for comparison. There were 25 patients in group A and 32 patients in group B. Videoconferencing equipment was installed in each patient's home, connected to a videoconferencing unit at the hospital by three ISDN lines. Patients in group A were followed for a mean of 8 months (range 3–24) with alternate months of teleconsultations and hospital visits. A total of 172 teleconsultations were conducted. A mean of 22 min (SD 9) were spent on each teleconsultation, significantly less than in hospital consultations, which took a mean of 33 min (SD 8) ( P<0.01). In 148 teleconsultations (89%) medical treatment was modified. In 4 cases (2%) patients needed a hospital visit. In all instances (100%) the condition of the catheter exit site and the presence of oedema could be evaluated. In group A, the estimated cost of telemedicine was €198 and that of a hospital visit was €177. The mean hospitalization rate was 2.2 days/patient/year in group A and 5.7 days/patient/year in group B ( P<0.05). Home telemedicine appears to be clinically useful in the long-term follow-up of stable patients undergoing peritoneal dialysis, and the costs and savings also seem to be encouraging.

Comparative Study of effectiveness of mobilization with movement (MWM) and End range mobilization (ERM) techniques in frozen shoulder

2018 ◽  
Vol 4 (4) ◽  
pp. 519-522
Author(s):  
Jeyakumar S ◽  
Jagatheesan Alagesan ◽  
T.S. Muthukumar
Keyword(s):  
Range Of Motion ◽  
Frozen Shoulder ◽  
Type I ◽  
Mean Values ◽  
Functional Activities ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Frozen shoulder is disorder of the connective tissue that limits the normal Range of motion of the shoulder in diabetes, frozen shoulder is thought to be caused by changes to the collagen in the shoulder joint as a result of long term Hypoglycemia. Mobilization is a therapeutic movement of the joint. The goal is to restore normal joint motion and rhythm. The use of mobilization with movement for peripheral joints was developed by mulligan. This technique combines a sustained application of manual technique “gliding” force to the joint with concurrent physiologic motion of joint, either actively or passively. This study aims to find out the effects of mobilization with movement and end range mobilization in frozen shoulder in Type I diabetics. Materials and Methods: 30 subjects both male and female, suffering with shoulder pain and clinically diagnosed with frozen shoulder was recruited for the study and divided into two groups with 15 patients each based on convenient sampling method. Group A patients received mobilization with movement and Group B patients received end range mobilization for three weeks. The outcome measurements were SPADI, Functional hand to back scale, abduction range of motion using goniometer and VAS. Results: The mean values of all parameters showed significant differences in group A as compared to group B in terms of decreased pain, increased abduction range and other outcome measures. Conclusion: Based on the results it has been concluded that treating the type 1 diabetic patient with frozen shoulder, mobilization with movement exercise shows better results than end range mobilization in reducing pain and increase functional activities and mobility in frozen shoulder.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

Deep brain stimulation of the posterior limb of the internal capsule in the treatment of central poststroke neuropathic pain of the lower limb: case series with long-term follow-up and literature review

2020 ◽  
Vol 133 (3) ◽  
pp. 830-838 ◽  
Author(s):  
Andrea Franzini ◽  
Giuseppe Messina ◽  
Vincenzo Levi ◽  
Antonio D’Ammando ◽  
Roberto Cordella ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Lower Limb ◽  
Internal Capsule ◽  
Posterior Limb ◽  
Vas Score ◽  
The Mean ◽  
Deep Brain ◽  
Stimulation Of

OBJECTIVECentral poststroke neuropathic pain is a debilitating syndrome that is often resistant to medical therapies. Surgical measures include motor cortex stimulation and deep brain stimulation (DBS), which have been used to relieve pain. The aim of this study was to retrospectively assess the safety and long-term efficacy of DBS of the posterior limb of the internal capsule for relieving central poststroke neuropathic pain and associated spasticity affecting the lower limb.METHODSClinical and surgical data were retrospectively collected and analyzed in all patients who had undergone DBS of the posterior limb of the internal capsule to address central poststroke neuropathic pain refractory to conservative measures. In addition, long-term pain intensity and level of satisfaction gained from stimulation were assessed. Pain was evaluated using the visual analog scale (VAS). Information on gait improvement was obtained from medical records, neurological examination, and interview.RESULTSFour patients have undergone the procedure since 2001. No mortality or morbidity related to the surgery was recorded. In three patients, stimulation of the posterior limb of the internal capsule resulted in long-term pain relief; in a fourth patient, the procedure failed to produce any long-lasting positive effect. Two patients obtained a reduction in spasticity and improved motor capability. Before surgery, the mean VAS score was 9 (range 8–10). In the immediate postoperative period and within 1 week after the DBS system had been turned on, the mean VAS score was significantly lower at a mean of 3 (range 0–6). After a mean follow-up of 5.88 years, the mean VAS score was still reduced at 5.5 (range 3–8). The mean percentage of long-term pain reduction was 38.13%.CONCLUSIONSThis series suggests that stimulation of the posterior limb of the internal capsule is safe and effective in treating patients with chronic neuropathic pain affecting the lower limb. The procedure may be a more targeted treatment method than motor cortex stimulation or other neuromodulation techniques in the subset of patients whose pain and spasticity are referred to the lower limbs.

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