Relief of pain by transcutaneous stimulation

1975 ◽  
Vol 42 (3) ◽  
pp. 308-314 ◽  
Author(s):  
John D. Loeser ◽  
Richard G. Black ◽  
Amalia Christman
Keyword(s):  
Chronic Pain ◽  
Sensory Input ◽  
Therapeutic Modality ◽  
Short Term ◽  
Content Type ◽  
Transcutaneous Stimulation ◽  
Painful Area ◽  
Fine Print ◽  
Stimulation Of

✓ A series of 198 patients with chronic pain of diverse etiology was carefully analyzed for epidemiologic and descriptive factors which might influence the response to transcutaneous stimulation. The overall series included 12½% with long-term success, and 68% with partial or short-term relief. There were no consistent specific diagnoses, or epidemiologic or descriptive factors that made good results from stimulation predictable. Stimulation of the painful area itself was not always necessary for pain relief. Favorable responses to transcutaneous stimulation were usually correlated with the continued existence of significant sensory input from the painful region. The authors conclude that transcutaneous stimulation is a valuable therapeutic modality for some patients with chronic pain.

CSF Pulse Pressure and B Waves

2005 ◽  
Vol 103 (4) ◽  
pp. 767-768 ◽  
Author(s):  
Zofia Czosnyka ◽  
Marek Czosnyka ◽  
John D. Pickard
Keyword(s):  
Pulse Pressure ◽  
Pressure Coefficient ◽  
Joint Effect ◽  
Physical Parameters ◽  
Wave Analysis ◽  
Short Term ◽  
Content Type ◽  
Pulse Pressure Method ◽  
Fine Print

Abstract Object. The appearance of numerous B waves during intracranial pressure (ICP) registration in patients with idiopathic adult hydrocephalus syndrome (IAHS) is considered to predict good outcome after shunt surgery. The aim of this study was to describe which physical parameters of the cerebrospinal fluid (CSF) system B-waves reflect and to find a method that could replace long-term B-wave analysis. Methods. Ten patients with IAHS were subjected to long-term registration of ICP and a lumbar constant-pressure infusion test. The B-wave presence, CSF outflow resistance (Rout), and relative pulse pressure coefficient (RPPC) were assessed using computerized analysis. The RPPC was introduced as a parameter reflecting the joint effect of elastance and pulsatory volume changes on ICP and was determined by relating ICP pulse amplitudes to mean ICP. Conclusions. The B-wave presence on ICP registration correlates strongly with RPPC (r = 0.91, p < 0.001, 10 patients) but not with CSF Rout. This correlation indicates that B waves—like RPPC—primarily reflect the ability of the CSF system to reallocate and store liquid rather than absorb it. The RPPC-assessing lumbar short-term CSF pulse pressure method could replace the intracranial long-term B-wave analysis.

Electrical stimulation of the brain in treatment of chronic pain

1985 ◽  
Vol 62 (3) ◽  
pp. 389-396 ◽  
Author(s):  
Ronald F. Young ◽  
Richard Kroening ◽  
Wayne Fulton ◽  
Robert A. Feldman ◽  
Israel Chambi
Keyword(s):  
Chronic Pain ◽  
Electrical Stimulation ◽  
Gray Matter ◽  
Pain Treatment ◽  
Psychiatric Evaluation ◽  
Content Type ◽  
The Brain ◽  
Fine Print ◽  
Stimulation Of

✓ Forty-eight patients underwent electrical stimulation of the brain for treatment of chronic pain between 1978 and 1983. Average pain duration prior to treatment was 4.5 years. Before selection for this procedure patients underwent pain treatment in a multidisciplinary pain center, intensive psychological and psychiatric evaluation, and assessment of pain responsiveness to intravenous administration of placebo, morphine, and naloxone. A total of 71 electrodes were placed in the 48 patients at a variety of stimulating targets, including the periaqueductal gray matter, periventricular gray matter, thalamus, and internal capsule. Seventy-two percent of patients experienced complete or partial pain relief. In addition, 59% of patients were able to discontinue narcotic usage. Twenty-five percent of patients returned to normal physical activities and another 33% showed marked improvement in functional capacity. Follow-up periods ranged from 2 to 60 months; with a mean follow-up period of 20 months. A variety of relatively minor complications occurred, but no mortality or permanent sequelae were experienced. No patient's pain was made worse as a result of electrical stimulation. Electrical stimulation of the brain offers a safe and relatively effective method for the treatment of chronic pain in appropriately selected patients, who are unresponsive to other forms of therapy.

Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: long-term results

2004 ◽  
Vol 101 (2) ◽  
pp. 189-194 ◽  
Author(s):  
Philippe Coubes ◽  
Laura Cif ◽  
Hassan El Fertit ◽  
Simone Hemm ◽  
Nathalie Vayssiere ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Globus Pallidus ◽  
Globus Pallidus Internus ◽  
Long Term Results ◽  
Content Type ◽  
Generalized Dystonia ◽  
Fine Print ◽  
Stimulation Of

Object. Primary generalized dystonia (PGD) is a medically refractory disease of the brain causing twisting or spasmodic movements and abnormal postures. In more than 30% of cases it is associated with the autosomal DYT1 mutation. Continuous electrical stimulation of the globus pallidus internus (GPi) has been used successfully in the treatment of PGD. The aim of this study was to examine the long-term efficacy and safety of deep brain stimulation (DBS) in the treatment of PGD in children and adults with and without the DYT1 mutation. Methods. Thirty-one patients with PGD were selected for surgery. Electrodes were bilaterally implanted under stereotactic guidance and connected to neurostimulators that were inserted subcutaneously. Efficacy was evaluated by comparing scores on the clinical and functional Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) before and after implantation. The efficacy of stimulation improved with time. After 2 years, compared with preoperative values, the mean (± standard deviation) clinical and functional BFMDRS scores had improved by 79 ± 19% and 65 ± 33%, respectively. At the 2-year follow-up examination the improvement was comparable in patients with and without the DYT1 mutation in both the functional (p = 0.12) and clinical (p = 0.33) scores. Children displayed greater improvements in the clinical score than adult patients (p = 0.04) at 2 years of follow up. In contrast, there was no significant difference in functional scores between children and adults (p = 0.95). Conclusions. Electrical stimulation of the GPi is an effective, reversible, and adaptable treatment for PGD and should be considered for conditions refractory to pharmaceutical therapies.

Prediction of short-term verbal memory disturbance after ventrolateral thalamotomy

1971 ◽  
Vol 35 (2) ◽  
pp. 203-211 ◽  
Author(s):  
George A. Ojemann ◽  
Katharine Blick Hoyenga ◽  
Arthur A. Ward
Keyword(s):  
Verbal Memory ◽  
Relative Magnitude ◽  
Short Term ◽  
Content Type ◽  
Acute Change ◽  
Ventrolateral Thalamus ◽  
Memory Disturbance ◽  
Time Of Operation ◽  
Fine Print ◽  
Stimulation Of

✓ The acute change in short-term verbal memory following ventrolateral thalamotomy in patients with dyskinesia was measured by the technique of Peterson and Peterson. Performance on this test of short-term verbal memory deteriorated following left but not right ventrolateral thalamotomy. This deterioration could not be accounted for solely by disturbance in speech mechanisms after left thalamotomy (although these were present), but may be related to disturbance in retrieval mechanisms of short-term verbal memory. The relative magnitude of this deterioration in performance after left thalamotomy could be partially predicted at the time of operation by some of the effects of electrical stimulation of the ventrolateral thalamus on the same test. A large decrease in recall errors with stimulation during the presentation of material to be later recalled, and a small increase in recall errors with stimulation at the time of recall, correlated with little disturbance of short-term verbal memory following left thalamotomy.

Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: a 20-year literature review

2004 ◽  
Vol 100 (3) ◽  
pp. 254-267 ◽  
Author(s):  
Tracy Cameron
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Literature Review ◽  
Spinal Cord Stimulation ◽  
Exclusion Criteria ◽  
Safety And Efficacy ◽  
Content Type ◽  
Long Term Effect ◽  
Fine Print

Object. The purpose of this report was to examine the available literature to determine the safety and efficacy of spinal cord stimulation (SCS) for the treatment of chronic pain of the trunk and limbs. Methods. The author identified 68 studies that fulfilled the efficacy inclusion/exclusion criteria, grouped on the basis of pain indication, with an overall population of 3679 patients. Fifty-one studies fulfilled all safety inclusion/exclusion criteria. Based on the literature review, the author found that SCS had a positive, symptomatic, long-term effect in cases of refractory angina pain, severe ischemic limb pain secondary to peripheral vascular disease, peripheral neuropathic pain, and chronic low-back pain, and that, in general, SCS was a safe and effective treatment for a variety of chronic neuropathic conditions. Conclusions. Despite the positive findings, there is an urgent need for randomized, controlled, long-term studies on the efficacy of SCS involving larger patient sample sizes.

Long-term neurological, visual, and endocrine outcomes following transnasal resection of craniopharyngioma

2005 ◽  
Vol 102 (4) ◽  
pp. 650-657 ◽  
Author(s):  
Indro Chakrabarti ◽  
Arun P. Amar ◽  
William Couldwell ◽  
Martin H. Weiss
Keyword(s):  
Short Term Memory ◽  
Gh Deficiency ◽  
Memory Loss ◽  
Magnetic Resonance Images ◽  
Endocrine Function ◽  
Short Term ◽  
Term Memory ◽  
Content Type ◽  
Fine Print

Object. The authors report on a cohort of patients with craniopharyngioma treated principally through transnasal (TN) resection and followed up for a minimum of 5 years. More specifically, they evaluate the role of the TN approach in the management of craniopharyngioma. Methods. Between 1984 and 1994, 68 patients underwent TN resection of craniopharyngiomas at the University of Southern California. The tumor was at least partially cystic in 88% of cases. Four tumors were purely intrasellar, 53 had intra- and suprasellar components, and 11 were exclusively suprasellar. During the same period, 18 patients underwent transcranial (TC) resection of purely suprasellar craniopharyngiomas. Long-term neurological, visual, and endocrine outcomes were reviewed for all patients. In 61 (90%) of 68 patients in the TN group, total resection was achieved, according to 3-month postoperative magnetic resonance images, although four patients suffered a recurrence. Three (43%) of the seven tumors that had been partially resected were enlarged on serial imaging. Fifty-four (87%) of 62 patients with preoperative visual loss experienced improvement in one or both eyes, but two patients (3%) with exclusively suprasellar tumors experienced postoperative visual worsening in one or both eyes. New instances of postoperative endocrinopathy (that is, not present preoperatively) occurred as follows: hypogonadism (eight of 22 cases), growth hormone (GH) deficiency (four of 18 cases), hypothyroidism (11 of 49 cases), hypocortisolemia (nine of 52 cases), and diabetes insipidus (DI; four of 61 cases). One case each of hypocortisolemia and hypothyroidism resolved after surgery. Hyperphagia occurred in 27 (40%) of 68 patients. One patient had short-term memory loss. Postoperative complications included one case of cerebrospinal fluid leak. Among the 18 patients in the TC group, 11 had complete resections. In one case (9%) the tumors recurred. Three (43%) of the seven subtotally resected tumors grew during the follow-up interval. Vision improved in 11 (61%) of 18 cases and worsened in three (17%) as a result of surgery. New instances of postoperative endocrinopathy occurred as follows: hypogonadism (one of six cases), GH deficiency (four of seven cases), hypothyroidism (11 of 14 cases), hypocortisolemia (eight of 15 cases), and DI (nine of 16 cases). No instance of preoperative endocrinopathy was corrected through TC surgery. Four patients (22%) exhibited short-term memory loss and 11 (61%) had hyperphagia after surgery. When compared with those in the TC group, patients in the TN group had shorter hospital stays. Conclusions. Use of the TN approach can render good outcomes in properly selected patients with craniopharyngioma, particularly when the tumor is cystic. Even in mostly suprasellar cases, an extended TN approach can afford complete resection. Note that endocrine function often worsens after surgery and that postoperative obesity can be a significant problem.

Principles of preparation of vein bypass grafts to maximize patency

1987 ◽  
Vol 66 (2) ◽  
pp. 172-180 ◽  
Author(s):  
Thoralf M. Sundt ◽  
Thoralf M. Sundt
Keyword(s):  
Vitamin K Antagonists ◽  
Coronary Bypass ◽  
Short Term ◽  
Aneurysmal Dilatation ◽  
Content Type ◽  
Vein Bypass ◽  
Harvesting Techniques ◽  
Fine Print ◽  
Vein Harvesting

✓ Experience in cardiovascular and peripheral vascular surgery with saphenous vein bypass conduits is reviewed. It is clear that meticulous technique and graft preparation are crucial to short-term and long-term patency. The risk of early thrombosis is related to damage to the graft 's native intima, graft flow, and coagulability of the patient 's blood. Attention to atraumatic harvesting techniques and perfection of anastomoses are crucial to minimizing intimal damage. Graft inflow and outflow are fundamental principles. The use of vitamin K antagonists and platelet inhibitors may improve graft survival. Subacute occlusion is related to structural alterations in the grafts themselves. These include intimal hyperplasia and medial fibrosis as the grafts become “arterialized,” valve fibrosis, aneurysmal dilatation, clamp stenosis, and suture stenosis. Long-term patency is threatened primarily by atherosclerosis in the graft itself. There is some evidence that care in vein harvesting and implantation as well as the use of anticoagulant agents affect the development of this complication. A technique for graft preparation is presented that is based on the experience of the authors in harvesting grafts for both cerebral and coronary bypass conduits.

Stimulation of internal capsule for relief of chronic pain

1974 ◽  
Vol 41 (6) ◽  
pp. 740-744 ◽  
Author(s):  
John E. Adams ◽  
Yoshio Hosobuchi ◽  
Howard L. Fields
Keyword(s):  
Central Nervous System ◽  
Chronic Pain ◽  
Internal Capsule ◽  
Spontaneous Pain ◽  
Physiological Basis ◽  
Content Type ◽  
Posterior Limb ◽  
The Central Nervous System ◽  
Fine Print ◽  
Stimulation Of

✓ The severe spontaneous pain associated with lesions of the central nervous system has been successfully suppressed by electrical stimulation of the posterior limb of the internal capsule. The physiological basis for this result is not understood but the authors's hypothesis is that the pain suppression is due to stimulation of parietal corticofugal inhibitory fibers.

Long-term stimulation of the subthalamic nucleus in hemiparkinsonian rats: neuroprotection of dopaminergic neurons

2004 ◽  
Vol 100 (4) ◽  
pp. 679-687 ◽  
Author(s):  
Satoshi Maesawa ◽  
Yoshiki Kaneoke ◽  
Yasukazu Kajita ◽  
Naotaka Usui ◽  
Nobuaki Misawa ◽  
...  
Keyword(s):  
Subthalamic Nucleus ◽  
Motor Function ◽  
Dopaminergic Neurons ◽  
Content Type ◽  
Group A ◽  
Group B ◽  
The Right ◽  
Fine Print ◽  
Stimulation Of

Object. The goal of this study was to evaluate the neuroprotective effects conferred by long-term electrical stimulation of the subthalamic nucleus (STN) against degeneration of dopaminergic neurons by assessing motor functional and immunohistological findings in hemiparkinsonian rats. Methods. In 13 of 25 rats, a concentric microelectrode was stereotactically implanted into the right STN under the guidance of extracellular microelectrode recording. After this had been done the animals were given an injection of 6-hydroxydopamine (6-OHDA) into the right striatum. Seven of the rats received continuous stimulation (frequency 130 Hz, intensity 80–100 µA) for 2 weeks (Group A); the other six did not receive any stimulation during this period (Group B). Twelve rats did not receive electrode implantation and underwent 6-OHDA injection only; these animals served as a control group (Group C). After 2 weeks, motor function in the rats was evaluated by conducting an amphetamine-induced rotation test. Finally, tyrosine hydroxylase—immunoreactive neurons in the pars compacta of the substantia nigra (SNc) were counted to evaluate the extent of degeneration of dopaminergic neurons. Ipsilateral rotation was significantly decreased in Group A, regardless of the effects of stimulation delivered during the test (p < 0.05). Rats in Group B demonstrated typical circling as did those in Group C, except that on stimulation Group B rats immediately stopped circling or changed direction. Tyrosine hydroxylase—immunoreactive neurons in the SNc were significantly preserved in the animals in Group A, whereas neurons in animals in Groups B and C were moderately depleted (p < 0.01). Conclusions. Acutely, STN stimulation improved rotation symmetry in rats with moderate SNc degeneration. When STN stimulation had been applied for the preceding 2 weeks, motor function was better and SNc neural degeneration was significantly milder. Subthalamic nucleus stimulation thus appears to protect dopaminergic neurons in this hemiparkinsonian model, in addition to improving motor function in these animals.

Dual-isotope single-photon emission computerized tomography scanning in patients with glioblastoma multiforme: association with patient survival and histopathological characteristics of tumor after high-dose radiotherapy

1998 ◽  
Vol 89 (1) ◽  
pp. 60-68 ◽  
Author(s):  
Richard B. Schwartz ◽  
B. Leonard Holman ◽  
Joseph F. Polak ◽  
Basem M. Garada ◽  
Marc S. Schwartz ◽  
...  
Keyword(s):  
Survival Rate ◽  
Glioblastoma Multiforme ◽  
Single Photon ◽  
Photon Emission ◽  
High Dose ◽  
Term Survival ◽  
Content Type ◽  
Dual Isotope ◽  
Fine Print

Object. The study was conducted to determine the association between dual-isotope single-photon emission computerized tomography (SPECT) scanning and histopathological findings of tumor recurrence and survival in patients treated with high-dose radiotherapy for glioblastoma multiforme. Methods. Studies in which SPECT with 201Tl and 99mTc-hexamethypropyleneamine oxime (HMPAO) were used were performed 1 day before reoperation in 47 patients with glioblastoma multiforme who had previously been treated by surgery and high-dose radiotherapy. Maximum uptake of 201Tl in the lesion was expressed as a ratio to that in the contralateral scalp, and uptake of 99mTc-HMPAO was expressed as a ratio to that in the cerebellar cortex. Patients were stratified into groups based on the maximum radioisotope uptake values in their tumor beds. The significance of differences in patient gender, histological characteristics of tissue at reoperation, and SPECT uptake group with respect to 1-year survival was elucidated by using the chi-square statistic. Comparisons of patient ages and time to tumor recurrence as functions of 1-year survival were made using the t-test. Survival data at 1 year were presented according to the Kaplan—Meier method, and the significance of potential differences was evaluated using the log-rank method. The effects of different variables (tumor type, time to recurrence, and SPECT grouping) on long-term survival were evaluated using Cox proportional models that controlled for age and gender. All patients in Group I (201Tl ratio < 2 and 99mTc-HMPAO ratio < 0.5) showed radiation changes in their biopsy specimens: they had an 83.3% 1-year survival rate. Group II patients (201T1 ratio < 2 and 99mTc-HMPAO ratio of ≥ 0.5 or 201Tl ratio between 2 and 3.5 regardless of 99mTc-HMPAO ratio) had predominantly infiltrating tumor (66.6%); they had a 29.2% 1-year survival rate. Almost all of the patients in Group III (201Tl ratio > 3.5 and 99mTc-HMPAO ratio ≥ 0.5) had solid tumor (88.2%) and they had a 6.7% 1-year survival rate. Histological data were associated with 1-year survival (p < 0.01); however, SPECT grouping was more closely associated with 1-year survival (p < 0.001) and was the only variable significantly associated with long-term survival (p < 0.005). Conclusions. Dual-isotope SPECT data correlate with histopathological findings made at reoperation and with survival in patients with malignant gliomas after surgical and high-dose radiation therapy.

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