ABSTRACT
Spasticity is amotor disorder that leads to a resistance to passive jointmovement. Cerebral palsy is the most important cause of spasticity and can be caused by several factors, including multiple gestations, alcoholism, infections, hemorrhages, drowning, and traumatic brain injuries, among others. There aremany scales that help tomeasure andmonitor the degree of impairment of these patients. The initial treatment should focus on the causal factor, such as tumors, inflammation, degenerative diseases, hydrocephalus, etc. Subsequently, the treatment of spastic musculature includes oral or intrathecal myorelaxants, spinal cord electrostimulation, neurotomies, Lissauer tract lesion, dentatotomy and selective dorsal rhizotomy. The latter is a safetechnique, possibleto beperformed inmost centers with neurosurgical support, and it is effective in the treatment of severe spasticity. In this article, the authors describe the surgical technique and conduct a review the literature.
Subject(s)
Motor Neuron Disease/surgery , Rhizotomy/rehabilitation , Muscle Spasticity/surgery , Muscle Spasticity/etiology , Cerebral Palsy/complications , Minimally Invasive Surgical Procedures/methods , Rhizotomy/methods , Laminoplasty/methods , Muscle Relaxants, Central/therapeutic useABSTRACT
Motor cortex stimulation via surgically implanted electrodes has been used as an off-label treatment for chronic neuropathic pain, but its efficacy has not been fully established. We aimed to objectively study the efficacy of motor cortex stimulation and characterize potential predictors of response. In this randomized, double-blind, sham-controlled, single centre trial, we recruited 18 patients with chronic neuropathic pain who did not adequately respond to conventional treatment and had a numerical pain rating scale (NRS) score ≥6. Patients were initially assigned to receive 3 months of active ('on') or sham ('off') stimulation in a double-blind cross-over phase. This was followed by a 3-month single-blind phase, and 6 months of open-label follow-up. A meaningful response in our trial was defined as a ≥30% or 2-point reduction in NRS scores during active stimulation. Using Bayesian statistics, we found a 41.4% probability of response towards on versus off motor cortex stimulation. The probability of improvement during active stimulation (double-blind, single-blind and open-label phases) compared to baseline was 47.2-68.5%. Thirty nine per cent of the patients were considered long-term responders, 71.4% of whom had facial pain, phantom limb pain or complex regional pain syndrome. In contrast, 72.7% of non-responders had either post-stroke pain or pain associated with brachial plexus avulsion. Thirty-nine per cent of patients had a substantial postoperative analgesic effect after electrode insertion in the absence of stimulation. Individuals with diagnoses associated with a good postoperative outcome or those who developed an insertional effect had a near 100% probability of response to motor cortex stimulation. In summary, we found that â¼40% of patients responded to motor cortex stimulation, particularly those who developed an insertional effect or had specific clinical conditions that seemed to predict an appropriate postoperative response.
Subject(s)
Chronic Pain/therapy , Electric Stimulation Therapy/methods , Motor Cortex/physiology , Neuralgia/therapy , Pain Measurement/methods , Adult , Aged , Chronic Pain/diagnosis , Chronic Pain/physiopathology , Cross-Over Studies , Double-Blind Method , Electrodes, Implanted , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neuralgia/diagnosis , Neuralgia/physiopathology , Single-Blind MethodABSTRACT
BACKGROUND: Motor cortex stimulation (MCS) is routinely used for the treatment of chronic neuropathic pain but its effect on quality of life remains uncertain. OBEJCTIVE: To systematically review the published literature on MCS and quality of life and report the effects of this therapy in a series of patients prospectively followed in our center. METHODS: The systematic literature review was conducted using the search words "motor cortex stimulation and pain and neurosurgery" and "motor cortex stimulation and pain and quality of life." Quality of life in our clinical trial was investigated in a series of 10 patients with chronic neuropathic pain prospectively followed for 12 mo after MCS. RESULTS: Two hundred eighteen nonreplicated articles were pooled for analysis. Of these, 6 described measures of quality of life in the pre- and postoperative period. In these studies, 64 patients with different clinical conditions associated with neuropathic pain were followed for 6 to 84 mo after MCS surgery. Improvement in quality of life ranged from 35% to 85%. In our clinical series, visual analog scale (VAS), SF-12 physical (PhysCS), and mental scores (MenCS) recorded 12 mo after MCS were improved by 60 ± 10% (P = .002), 50 ± 13% (P = .002), and 22 ± 6% (P = .01), respectively. No significant correlation was found between postoperative improvement in pain and either PhysCS (r = 0.18; P = .6) or MenCS (r = -0.24; P = .5). CONCLUSION: MCS improves quality of life in patients with chronic refractory neuropathic pain. Additional factors other than a simple analgesic effect may contribute to these results.
Subject(s)
Electric Stimulation Therapy , Motor Cortex , Neuralgia/therapy , Pain Management/methods , Treatment Outcome , Adult , Female , Humans , Male , Middle Aged , Motor Cortex/physiology , Quality of LifeABSTRACT
BACKGROUND: In this article, the authors described their experience in microvascular decompression for trigeminal neuralgia. METHODS: The microvascular decompression technique used in the authors' institution is described in a step by step manner with some illustrative cases as well as a cadaver dissection to highlight the differences with other previously described techniques. RESULTS: Since 2013, 107 patients were operated in the Neurosurgery Division of the University of São Paulo using the described technique, with a shorter operative time and avoiding cerebellar retractor compared with classic techniques. CONCLUSION: Our modified microvascular decompression technique for trigeminal neuralgia can be used with safety and efficiency for treating trigeminal neuralgia.
ABSTRACT
BACKGROUND: It is still unclear whether dopamine (DA) levels correlate with Parkinson's disease (PD) severity or play a role in the mechanisms of high-frequency stimulation (HFS). METHODS: We have used microdialysis to record pallidal DA in 5 patients with PD undergoing microelectrode-guided pallidotomy. RESULTS: We found that patients with more severe disease and, consequently, lower pallidal DA did poorly after pallidal lesions. In the operating room, 4 of 5 patients had a significant increase in DA levels during HFS (600%, on average). To test the hypothesis that DA was important for the effects of stimulation, we correlated the amelioration in rigidity observed in the operating room with pallidal DA release. Though rigidity was 56% better during stimulation, no correlation was found between such an improvement and DA release. CONCLUSIONS: These findings suggest that additional mechanisms not directly dependent on pallidal DA release may be involved in the clinical effects of HFS of the globus pallidus internus.
Subject(s)
Deep Brain Stimulation/methods , Dopamine/metabolism , Globus Pallidus/physiology , Parkinson Disease/therapy , Aged , Biophysics , Chromatography, Liquid , Female , Humans , Intraoperative Period , Male , Microdialysis , Middle Aged , Parkinson Disease/metabolism , Severity of Illness Index , Statistics as Topic , Time FactorsABSTRACT
Vitamin B12 deficiency can cause serious developmental regression, hypotonia and cerebral atrophy in infants. We report a 6-month-old infant, with insidious developmental regression and brain atrophy showed by CT scan, secondarily to vitamin B12 deficiency. His mother was a strict vegetarian and the patient was exclusively breastfed. The clinical symptoms and the brain CT were normalized after vitamin B12 administration.
Subject(s)
Developmental Disabilities/etiology , Diet, Vegetarian/adverse effects , Vitamin B 12 Deficiency/complications , Atrophy , Brain/diagnostic imaging , Brain/pathology , Breast Feeding , Humans , Infant , Male , Muscle Hypotonia/etiology , Radiography , Vitamin B 12/therapeutic use , Vitamin B 12 Deficiency/drug therapyABSTRACT
Objetivo: verificar a prevalência de deficiência auditiva em recém-nascidos (RN) que estiveram gravemente doentes, através de dois métodos - emissões otoacústicas evocadas transientes (EOAT) e audiometria de tronco cerebral (BERA)/ Objective: to verify the prevalence of hearing loss in critically sick newborns through evoked otoacustic potential emission (EOAT) and brainstem auditory evoked response test (BERA)...
Subject(s)
Humans , Male , Female , Infant, Newborn , Audiometry, Evoked Response , Hearing Loss , Otoacoustic Emissions, Spontaneous , Infant, Newborn , Risk FactorsABSTRACT
Objetivo: verificar a prevalência de deficiência auditiva em recém-nascidos internados em Unidade de Cuidados Intensivos Neonatais: avaliar os fatores de risco para a deficiência auditiva adquirida. Métodos: estudo de coorte prospectiva com 71 recém-nascidos, realizado no período de setembro de 2003 a março de 2004 / Objetive: to verify the prevalence of newborn hearing loss admitted in the Intensive Care Unit, to relate the risk factors with hearing loss. Methods: it was conducted a prospective cohort study with 71 newborns in the period of September 2003 until March 2004...
Subject(s)
Humans , Male , Female , Infant, Newborn , Hearing Loss , Intensive Care Units, Neonatal , Otoacoustic Emissions, Spontaneous , Risk FactorsABSTRACT
A deficiência auditiva é uma das sequelas da meningite bacteriana que ocorre com maior frequência em crianças. Este estudo descreve o perfil audiológico (periférico e central) de crianças internadas com diagnóstico de meningite bacteriana. Nas 89 crianças que compareceram ao seguimento audiológico após a alta hospitalar e foram submetidas aos testes audiológicos, os resultados evidenciaram que 85,4 por cento apresentaram acuidade auditiva normal em ambas orelhas, 10,1 por cento apresentaram deficiência auditiva neurossensorial bilateral e 4,5 por cento apresentaram deficiência auditiva neurossensorial unilateral. Nos testes que avaliaram as habilidades de processamento auditivo, os resultados mostraram que 10 por cento dessas crianças apresentaram alterações no desempenho de localização auditiva e de reconhecimento de sentenças com mensagem competitiva ipsilateral.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Hearing Loss, Bilateral/diagnosis , Hearing Loss, Bilateral/microbiology , Hearing Loss, Sensorineural/diagnosis , Hearing Loss, Sensorineural/microbiology , Meningitis, Bacterial/complications , Follow-Up Studies , Hearing TestsABSTRACT
A melatonina foi isolada e caracterizada como um hormonio produzido pela glandula pineal no final da decada de 50. A partir dai inumeros estudos trataram das funcoes da pineal e da melatonina, que surpreendentemente parece agir em praticamente todos os sistemas fisiologicos. Por ser sintetizada e secretada apenas durante o periodo de escuro, funciona como um sinalizador, para o meio interno, do dia e da noite. A producao de melatonina diminui com o envelhecimento. Devido a sua potente acao indutora de sono, a melatonina tem sido utilizada na terapeutica das perturbacoes do sono, principalmente nas insonias, nos transtornos decorrentes da mudanca de fusos horarios e nos trabalhadores com jornada noturna. Os estudos da melatonina nos disturbios do sono na infancia, sao ainda raros...
Subject(s)
Humans , Child , Sleep Wake Disorders/diagnosis , Melatonin/metabolism , Pineal Gland/metabolism , Circadian Rhythm , Sleep Wake Disorders/classification , Sleep Wake Disorders/therapy , Melatonin/administration & dosage , Melatonin/isolation & purificationSubject(s)
Humans , Male , Female , Child , Adolescent , Anticonvulsants/chemistry , Epilepsy/classification , Epilepsy/physiopathologyABSTRACT
A epilepsia reflexa ao comer é uma rara de epilepsia reflexa. Um paciente de 24 anos com crises parciais complexas reflexas ao comer foi submetido a avaliaçöes clínica, neurológica neurorradiológica e eletrencefalográfica. O exame neurológico e a tomografia de crânio foram normais. Registros de EEG, incluindo menitorizaçäo vídeo-EEG durante a refeiçäo, mostraram presença de anormalidades focais relacionadas a ambos os lobos temporais, predominando à esquerda, e sincronia bilateral secundária, predominando em regiöes anteriores. Os achados ictais säo semelhantes à sincronia bilateral secundária interictal exceto por sua maior duraçäo. Monoterapias com PB, DPH e VPA näo surtiram efeito. Monoterapia com altas doses de CBZ trouxe bons resultados porém com controle incompleto das crises. Como grande número de fatores precipitantes estava potencialmente envolvido, näo foi possível determinar com precisäo a base fisiopatológica das crises reflexas neste caso
Subject(s)
Adult , Humans , Male , Eating , Epilepsies, Partial/physiopathology , Electroencephalography , Monitoring, PhysiologicABSTRACT
Säo relatados os casos de dois irmäos com tomografia computadorizada de crânio evidenciando lesöes hipoatenuantes dos gânglios da base. No caso 1 a anormalidade é de maior dimensäo, bilateral e associa-se a quadro neurológico em que as alteraçöes mais importantes säo: presença de posturas distônicas, principalmente nos membros inferiores e reflexos patelares exaltados, com clono de rótula bilateral. No caso 2 a alteraçäo tomográfica estava presente com localizaçäo semelhante, porém menor e somente à esquerda e o exame neurológico é normal apesar do relato de quedas freqüentes. Os autores discutem o diagnóstico diferencial do ponto de vista clínico e tomográfico
Subject(s)
Child , Humans , Male , Female , Basal Ganglia Diseases/genetics , Basal Ganglia Diseases/diagnosis , Diagnosis, Differential , Tomography, X-Ray ComputedABSTRACT
Säo apresentados dois casos (irmäs) de coréia familiar benigna. O estudo do heredograma mostra padräo compatível a herança autossômica dominante com penetrância incompleta. Discute-se o diagnóstico diferencial dessa doença e faz-se breve revisäo da literatura