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  • Deep brain stimulation for pain.

    8 December 2017

    Deep brain stimulation (DBS) is a neurosurgical intervention whose efficacy, safety, and utility have been shown in the treatment of movement disorders. For the treatment of chronic pain refractory to medical therapies, many prospective case series have been reported, but few have published findings from patients treated during the past decade using current standards of neuroimaging and stimulator technology. We summarize the history, science, selection, assessment, surgery, and personal clinical experience of DBS of the ventral posterior thalamus, periventricular/periaqueductal gray matter, and, latterly, the rostral anterior cingulate cortex (Cg24) in 100 patients treated now at two centers (John Radcliffe Hospital, Oxford, UK, and Hospital de São João, Porto, Portugal) over 12 years. Several experienced centers continue DBS for chronic pain with success in selected patients, in particular those with pain after amputation, brachial plexus injury, stroke, and cephalalgias including anesthesia dolorosa. Other successes include pain after multiple sclerosis and spine injury. Somatotopic coverage during awake surgery is important in our technique, with cingulate DBS considered for whole-body pain or after unsuccessful DBS of other targets. Findings discussed from neuroimaging modalities, invasive neurophysiological insights from local field potential recording, and autonomic assessments may translate into improved patient selection and enhanced efficacy, encouraging larger clinical trials.

  • Deep Brain Stimulation for Blood Pressure Control

    27 October 2017

    This chapter focuses on the use of deep brain stimulation (DBS) for controlling blood pressure. Hypertension and orthostatic hypotension refractory to medical treatment present a considerable disease burden, with high associated morbidity and mortality. The periaqueductal gray area (PAG) is an important region for the modulation of pain targeted by DBS electrodes during the treatment of chronic, intractable neuropathic pain. The electrical stimulation of the PAG in animals elicits defence reactions, where dorsal regions are associated with active coping and hypertensive effects and ventral regions with passive coping and hypotensive effects. Thus PAG DBS has been related to hypertensive and chronotropic cardiovascular effects. In a study of 15 chronic neuropathic pain patients (two patients having bilateral implants), blood pressure and heart rate were continuously measured while DBS parameters were altered from 10 to 50 Hz. Cardiovascular responses to stimulation were consistent, as measured on at least three occasions, for any pair of electrode contacts used. Arterial blood pressure reduced significantly overall in seven pairs of electrode contacts in seven patients. Conversely, blood pressure increased significantly in six pairs of contacts in six patients. The demonstration that PAG DBS can increase as well as decrease blood pressure raises the possibility that orthostatic or postural hypotension might be treatable by neurosurgery. © 2009 Elsevier Ltd All rights reserved.

  • The long term results of GPi stimulation for Parkinson’s disease.

    27 October 2017

    This handbook provides an overview of the use of deep brain stimulation (DBS) for the treatment of movement disorders as well as an introduction to the developing area of DBS for the management of psychiatric disease.

  • The periaqueductal grey area and the cardiovascular system

    27 October 2017

    The two volumes present the state-of-the-art in established and emerging applications for pain, spasticity, movement disorders, bladder and bowel dysfunction, cardiovascular disease, epilepsy, psychiatric illness, impairment of hearing and ...

  • Deep brain stimulation for chronic pain

    27 October 2017

    As a clinical intervention, deep brain stimulation (DBS) has provided remarkable therapeutic benefits for otherwise treatment-resistant movement and affective disorders including chronic pain. In this review, we concentrate on the experience of using DBS to treat chronic pain in Oxford. We provide a brief historical background as well as details of our methods for patient selection, surgical techniques and assessment. While the precise mechanisms of action for DBS remain uncertain, we describe how DBS can help for treatment-resistant chronic pain and have great potential to advance our general understanding of the human brain. In particular, we show how DBS can be used in conjunction with methods such as local field potentials and magnetoencephalography to map the underlying mechanisms of normal and abnormal oscillatory synchronization in the brain related to the pleasure of pain relief. © 2010 by Nova Science Publishers, Inc. All rights reserved.

  • Photothermal modelling of thulium fibre laser-tissue interactions

    13 December 2017

    A one-dimensional finite difference model has been used to investigate the temperature distribution within thulium fibre laser-irradiated tissue. Temperature-time and temperature-depth profiles are presented for various laser stimulus parameters in the 2μm region. These current calculations are aimed at determining theoretical temperature distributions in the application of relatively low power fibre lasers for thermal stimulation of cutaneous nerves in human pain processing. Theoretical skin surface temperatures are compared with those from thermal camera measurements during thulium fibre laser irradiation. The effectiveness of the thulium fibre laser for thermally stimulating cutaneous nerves is confirmed.

  • Physical training for McArdle disease.

    19 February 2018

    McArdle disease is a rare metabolic myopathy caused by a complete absence of the enzyme muscle glycogen phosphorylase. Affected people experience symptoms of fatigue and cramping within minutes of exercise and are at risk for acute muscle injury (rhabdomyolysis) and acute renal failure. If the first few minutes of exercise are paced, a 'second wind' will occur enabling exercise to continue. This is due to mobilisation and utilisation of alternative fuel substrates. Aerobic training appears to improve work capacity by increasing cardiovascular fitness. To assess the effects of aerobic training in people with McArdle disease. We searched the Cochrane Neuromuscular Disease Group Specialized Register (11 January 2011), CENTRAL (2010, Issue 4), MEDLINE (January 1966 to January 2011) and EMBASE (January 1980 to January 2011). All randomised and quasi-randomised controlled studies of aerobic exercise training in people of all ages with McArdle disease. Two authors identified possible studies for inclusion and assessed their methodological quality. Had more than one study of sufficient methodological quality been identified we would have undertaken a meta-analysis. There were no randomised or quasi-randomised controlled trials of aerobic training in people with McArdle disease. However, three open studies using small numbers of participants provided some evidence that aerobic training improves fitness without adverse events in people with McArdle disease. Evidence from non-randomised studies using small numbers of patients suggest that it would be safe and worthwhile for larger controlled trials of aerobic training to be undertaken in people with McArdle disease.

  • Physical training for McArdle disease.

    16 February 2018

    BACKGROUND: McArdle disease is a rare metabolic myopathy caused by a complete absence of the enzyme muscle glycogen phosphorylase. Affected people experience symptoms of fatigue and cramping within minutes of exercise and are at risk for acute muscle injury (rhabdomyolysis) and acute renal failure. If the first few minutes of exercise are paced, a 'second wind' will occur enabling exercise to continue. This is due to mobilisation and utilisation of alternative fuel substrates. Aerobic training appears to improve work capacity by increasing cardiovascular fitness. OBJECTIVES: To assess the effects of aerobic training in people with McArdle disease. SEARCH METHODS: We searched the Cochrane Neuromuscular Disease Group Specialized Register (11 January 2011), CENTRAL (2010, Issue 4), MEDLINE (January 1966 to January 2011) and EMBASE (January 1980 to January 2011). SELECTION CRITERIA: All randomised and quasi-randomised controlled studies of aerobic exercise training in people of all ages with McArdle disease. DATA COLLECTION AND ANALYSIS: Two authors identified possible studies for inclusion and assessed their methodological quality. Had more than one study of sufficient methodological quality been identified we would have undertaken a meta-analysis. MAIN RESULTS: There were no randomised or quasi-randomised controlled trials of aerobic training in people with McArdle disease. However, three open studies using small numbers of participants provided some evidence that aerobic training improves fitness without adverse events in people with McArdle disease. AUTHORS' CONCLUSIONS: Evidence from non-randomised studies using small numbers of patients suggest that it would be safe and worthwhile for larger controlled trials of aerobic training to be undertaken in people with McArdle disease.

  • The role of rituximab in the treatment of myasthenia gravis

    20 November 2017

    Rituximab, a chimaeric monoclonal antibody against CD20, depletes B cells. It was initially approved for the treatment of B-cell lymphomas, but more recently has been approved for use in rheumatoid arthritis. It has been used extensively 'off-label' for the treatment of other autoimmune diseases with some evidence of efficacy, but there remain some as yet unanswered concerns about safety. Myasthenia gravis is the paradigm of an antibody-mediated disorder, and B cells are believed to play a crucial role. This article reviews experience of the efficacy and safety of rituximab in myasthenia gravis and considers predictive factors for the success and failure of rituximab in this disease. © TOUCH BRIEFINGS 2010.