Vagus nerve stimulation for epilepsy activates the vocal folds maximally at therapeutic levels.

PURPOSE: Vagus nerve stimulation (VNS) for medically refractory epilepsy can give hoarseness due to stimulation of the recurrent laryngeal nerve. For a group of VNS-therapy users this side-effect interferes severely with their daily activities. Our goal was to investigate the severity of intra-operative VNS-related vocal fold contraction at different pulse widths and current output parameters. We investigated electromyographic and morphometric alterations on the vocal folds during VNS. METHODS: Vocal fold EMG experiments were conducted intra-operatively during the implantation of a VNS system. During surgery the VNS pulse generator was programmed to stimulate at different pulse durations. At each pulse width the EMG-threshold current was determined by electrical stimulation of the vagus nerve with increasing stimulation currents. Laryngostroboscopic examination was performed after surgery to analyze the effects of spontaneous stimulation on the larynx. RESULTS: The vocal fold EMG and morphodynamic changes in the larynx have been analyzed in eight patients. In all patients left vocal fold EMG-threshold was between 0.25 and 0.50 mA. Pulse duration had little influence on the EMG-threshold level. Vocal fold EMG saturation levels were reached between 0.75 and 1.00 mA. Video stroboscopic monitoring showed that stimulation induced an adductory spasm of either the ipsilateral vocal fold or the vestibular fold, and was present remarkably irrespective of the presence of hoarseness. CONCLUSIONS: VNS causes pronounced effects on the vocal folds even at low stimulation amplitudes. At therapeutic levels even at the lowest stimulation pulse durations, the vocal fold contract, however, this does not necessarily give hoarseness.

Intracerebral haemorrhage in neurofibromatosis type I.

Neurofibromatosis type I patients usually present themselves with multiple neurofibromas and cafe-au-lait spots. We report a case with an intracerebral haemorrhage as an uncommon feature of the disease. The clinical, radiological, neurosurgical and histological features of this case are discussed and a review of the literature on the broad spectrum of neurofibromatosis is presented. The etiological factors and clinical consequences of this and other cerebrovascular features are briefly discussed.

Is leg length discrepancy associated with the side of radiating pain in patients with a lumbar herniated disc?

STUDY DESIGN: The association between leg length discrepancy and the side of the radiating pain in lumbar disc herniation was investigated in a case series. OBJECTIVES: To investigate whether pain tends to radiate into the longer or shorter leg in patients with a lumbar herniated disc. SUMMARY OF BACKGROUND DATA: No previous studies have investigated the association between leg length discrepancy and side of radiating pain in patients with a herniated disc. Results of studies of low back pain with radiation and leg length discrepancy are inconsistent concerning this association. METHODS: Of 132 consecutive patients admitted to a district hospital for surgical management of a lumbar herniated disc, leg length discrepancy was assessed using the indirect method as described by Calliet. RESULTS: Seventy-three patients (55%) were men, and 59 (45%) were women. The mean age was 40 years, and 99% of all herniated discs appeared at L4-L5 (n = 60) or L5-S1 (n = 71). In 64 (62%) of the 104 patients with a leg length discrepancy of 1 mm or more, the pain radiated in the shorter leg (P = 0.02). In subgroups of patients with larger leg length discrepancies, similar results were found but because of smaller sample sizes, these findings did not each statistical significance. In 32 of the 57 men (56.1%), the pain radiated to the shorter leg (P = 0.43); this was observed in 33 of the 47 women (70.2%; P = 0.01). CONCLUSION: The results of this study showed a statistically significant association between leg length discrepancy and the side of radiating pain in a case series of patients with lumbar herniated discs. The relation was more pronounced and statistically significant in women only.

Sacral anterior root stimulation for bladder control: clinical results.

The Brindley bladder stimulator delivers intermittent stimulation to the anterior sacral roots. The stimulus parameters can be adjusted and set specifically for individuals. Its primary purpose is to improve bladder emptying, thereby to eliminate urinary infection and to preserve kidney function. It also assists in defecation and enables male patients to have a sustained full erection. In our unit so far 38 patients with a complete spinal cord lesion have received a Brindley bladder stimulator implant. One patient died 2 weeks after the surgery due to pulmonary embolism. Two other patients died due to unrelated causes during the follow up period. They used their implants for less than 1 year. Results relating to these 2 patients and the remaining 35 patients who regularly use their implant are presented. The follow-up period ranged from 3 months to 12 years. Residual urine volumes are substantially reduced in all patients; in 24 patients the residual urine volume is less than 30 ml. All patients have increased bladder capacity. Thirty-one patients are continent. Out of 33 males 29 can achieve a sustained full erection using the stimulator. Twenty-seven patients use the implant for bowel function. The following complications were encountered: (1.) Cerebro-spinal fluid collection occurred around the implant in 3 patients during the post-operative period; (2.) Receiver failure occurred in 3 patients. A successful replacement with a new receiver block was carried out in these cases. It is concluded that the use of a bladder stimulator in selected patients gives long term favourable results.

A comparative trial of the analgesic effect of tiaprofenic acid and indomethacin in post-operative pain following spinal surgery in patients with radicular syndrome.

A randomized double-blind trial was carried out in 80 patients with post-operative pain after discectomy to relieve chronic radicular syndrome, to compare the analgesic effectiveness and tolerance of tiaprofenic acid and indomethacin. Patients received either 600 mg tiaprofenic acid or 75 mg indomethacin per day, in 3 divided doses, on the day of the operation and for the next 4 days. The results of patient assessment of pain severity showed a statistically significant greater relief on the day of operation in the tiaprofenic acid group and lower pain scores were recorded on each of the 4 following days than in patients receiving indomethacin, although the difference did not reach statistical significance on any of these days. Fewer patients reported side-effects after tiaprofenic acid treatment but once again the difference between the two groups was not significant.