RESUMO
To identify factors predictive of effective bilateral subthalamic nucleus (STN) stimulation for PD with severe motor complications, pre- and postoperative Unified PD Rating Scale (UPDRS) scores were analyzed in a series of 54 patients who received bilateral STN stimulation. Younger age and levodopa responsiveness predict a favorable response to bilateral STN stimulation. For individual PD symptoms, those that improve with a suprathreshold dose levodopa challenge are likely to improve with stimulation.
Assuntos
Terapia por Estimulação Elétrica/estatística & dados numéricos , Doença de Parkinson/cirurgia , Núcleo Subtalâmico/cirurgia , Adulto , Fatores Etários , Idoso , Terapia por Estimulação Elétrica/métodos , Feminino , Humanos , Levodopa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/fisiopatologia , Cuidados Pré-Operatórios/estatística & dados numéricos , Análise de Regressão , Estatísticas não ParamétricasRESUMO
Seventy-seven patients with chronic, refractory, low back and radicular pain underwent implantation of a spinal cord stimulator between 1984 and 1992. Most patients had failed back surgery syndrome. In every case, an epidural quadripolar "Resume" electrode was implanted surgically. Results were evaluated after three months then after six to 98 months (mean follow-up 42 months). Long-term efficacy was good in 63.6% of cases, fair in 22%, and poor in 6.5%; treatment failure occurred in 7.9% of cases. Adverse events included one case of meningitis, two cases of local infection, and one case each of cerebrospinal fluid fistula and necrosis of the skin overlying the stimulator. The main causes of treatment failure were complications, inappropriate patient selection, and the escape phenomenon. The results of this study demonstrate that spinal cord stimulation is effective for the treatment of chronic low back and radicular pain in carefully selected patients; scrupulous application of restrictive selection criteria is essential to the success of the method.
Assuntos
Terapia por Estimulação Elétrica , Dor Lombar/terapia , Dor Intratável/terapia , Medula Espinal , Raízes Nervosas Espinhais , Adulto , Idoso , Doença Crônica , Terapia por Estimulação Elétrica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoAssuntos
Infarto Cerebral/patologia , Transtornos Mentais/etiologia , Transtornos dos Movimentos/etiologia , Transtornos de Sensação/etiologia , Ataxia/etiologia , Ataxia/patologia , Tronco Encefálico/patologia , Núcleo Caudado/patologia , Infarto Cerebral/complicações , Corpo Estriado/patologia , Disartria/etiologia , Disartria/patologia , Hemiplegia/etiologia , Hemiplegia/patologia , Humanos , Transtornos Mentais/patologia , Transtornos dos Movimentos/patologia , Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/patologia , Ponte/patologia , Transtornos de Sensação/patologia , Tálamo/patologiaRESUMO
We present a multicentric randomized double-blind study of the curative effect of intravenous Nimodipine on the post hemorrhagic vasospasm after aneurysmal rupture. On 122 validated cases out of 188 analyzed patients, the study demonstrates a significative effect on the mortality and severe morbidity related to vasospasm: the reduction of the risk is appreciated to 72%. The major effect is obtained on the mortality risk. A selective effect can be demonstrate on the isolated vasospasm.