Upstate Medical University neurosurgeons treat movement disorders and intractable pain with procedures specifically aimed at altering the activity of the abnormal neural circuits. Medical intractable movement disorders, such as those associated with Parkinson's disease, essential tremor and dystonia, are amenable to such modulation.
The neurosurgeon will place active electrodes (deep brain stimulation (DBS) or small ablations deep within the brain. Precise targeting is necessary to ensure that the activity of the appropriate nerve cells is altered, thus obtaining optimal results. Stereotactic techniques and electrophysiological monitoring (usually with microelectrodes) are used to obtain the necessary degree of precision.
To manage severe medically-intractable spasticity, secondary to cerebral palsy, multiple sclerosis or spinal cord injury, Upstate neurosurgeons can implant drug pumps that deliver anti-spacticity medication intrathecally, directly around the spinal cord. An alternative therapy (selective dorsal rhizotomy) is also offered for spacticity.
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Intractable pain can be treated with procedures that alter the activity of the central nervous system. Stimulation of the dorsal spinal column, thalamus or motor cortex can modulate and control pain impulses. A neurosurgeon can implant intrathecal drug pumps that deliver medications directly to the pain-producing circuits. This is useful in a wide variety of painful conditions, including those seen in patients with severely degenerated spines.
Selective ablations can can also interrupt the painful impulses. Examples include dorsal spinal cord (DREZ) lesions for pain after plexus injuries, anterolateral cordotomy for cancer pain and trigeminal radiofrequency ganglioysis, microballoon compression or Gamma Knife radiosurgery for treatment of trigeminal neuralgia.
Seizure DisordersPatients whose disabling seizures fail to respond to medication may be candidates for surgical intervention. The patient is evaluated by a multidisciplinary team relying heavily on video EEG monitoring, high resolution MRI functional imaging, and, as needed, EEG recordings with implanted intracranial electrodes. These technologies can often locate the epileptogenic tissue that is not apparent on traditional CT scans or MRIs.
When pharmacological treatment of seizures is ineffective, certain surgical procedures are available including partial temporal lobotomy, resection of an epileptic focus or corpus callostomy. Multiple subpial transections can can also be performed safely in patients whose seizures arise from the eloquent cortex. When indicated, functional mapping of the eloquent cortex is carried out extraoperatively through subdural grids or introperatively under local anesthesia. Investigation into associative and sensimotor functions of the brain are also carried out during craniotomy.
University Hospital's Epilepsy Center is also investigating new options such as cell transplantation to control seizure foci, as well as deep brain stimulation which places neural stimulators deep in the brain to prevent seizures.
Selecting the most appropriate treatment is a team decision and the patient and patient's family are critical members of this team.
Pacemaker For the Brain: The Vagal Nerve Stimulator
When seizures cannot be controlled by antiepilepsy drugs or the neurosurgical procedures described above, they can often be supressed by another type of nerve stimulator, the vagal nerve stimulator (VNS.) The VNS power source, which is the size of a stopwatch, is implanted in the neck. Electrical stimuli from the VNS are relayed through the vagus nerve in the neck. Electrical stimuli from the VNS are relayed through the vagus nerve in the brain, where these impulses appear to "reset" electrical activities in the brain areas where the seizures start. This can prevent seizures.