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Henry H. Schmidek, Denis Fohanno, Frank R. Ervin, and William H. Sweet

A ttempts to provide pain relief without the liabilities of a destructive surgical procedure have to date resulted in the use of electrical stimulation of the peripheral nerves and dorsal column in man. Because these methods are not applicable to a wide variety of clinical problems, we used discrete brain stimulation in an attempt to find which areas altered the pain threshold. One of the most difficult experimental aspects in dealing with pain in a laboratory has been the lack of objective methods of assessing pain in an animal. Weitzman, et al., 20 have

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Neil Klinger and Sandeep Mittal

reduce seizures in appropriately selected patients include the administration of a ketogenic diet and, to a lesser degree, the use of cannabidiol, although current data are conflicting as to their efficacies. 17 , 49 , 72 Vagus nerve stimulation is less invasive than resective surgery and improves seizure control in carefully selected individuals. 16 , 25 , 47 Deep brain stimulation (DBS) is another promising treatment modality that has shown efficacy in decreasing seizure frequency in patients with refractory epilepsy. Mechanism of Action and Preclinical Data Deep

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Neurosurgical Forum: Letters to the Editor To The Editor Richard M. Lehman , M.D. Robert Wood Johnson Medical School New Brunswick, New Jersey 1162 1164 Abstract Reversibility and adaptability are preferred features of long-term therapeutic deep brain stimulation (DBS). In such therapy, a permanent stimulating electrode with four contact points is placed at the stimulation site and, generally speaking, bipolar stimulation is induced by various pairs of adjacent contact points on one electrode. The stimulation

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Pain reduction by electrical brain stimulation in man

Part 2: Chronic self-administration in the periventricular gray matter

Donald E. Richardson and Huda Akil

changes in chronic and acute pain in our patients and to rate the degree of effectiveness of brain stimulation on a long-term basis. Testing Acute Pain . For acute pain testing, four methods were employed. 1. Pinprick testing over most of the body surface. This test was most useful in the operating room and exhibited good correlation with later analgesic effectiveness. 2. A radiant heat test on the arms and legs primarily using the fingers. In this test, a radiant heat lamp was focused on a specific area of the skin by means of a concave reflector placed

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Pain reduction by electrical brain stimulation in man

Part 1: Acute administration in periaqueductal and periventricular sites

Donald E. Richardson and Huda Akil

study of electrical stimulation of the brain as an alternative approach for pain relief, which has the potential to control a variety of pain types throughout the body. This study was based on a number of practical and theoretical considerations presented below. Previous Experimentation The successful employment of brain stimulation as an analgesic tool was first reported by Heath and Mickle, 5 who described pain reduction from septal stimulation in a young woman. Later reports 3, 4 confirmed the phenomenon, although Gol 4 reported success in only two out of

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David S. Xu and Francisco A. Ponce

understanding the neurobiology of dementias, no treatments are currently available to significantly alter their natural history. An emerging avenue of therapy currently under investigation is deep brain stimulation (DBS), which has demonstrated an ability to engage and regulate dysfunctional neuronal circuits across multiple neural networks. Furthermore, cellular responses that occur after DBS may direct trophic effects to local neural tissue, potentially counteracting chronic degenerative disease processes. In this manuscript, we provide a summary of the current body of

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Nasir Raza Awan, Andres Lozano, and Clement Hamani

, Hamani C, Moro E, Lozano AM, Deep brain stimulation and movement disorder treatment, 369–373, 2009, 65 with permission from Elsevier. Movement Disorders Parkinson Disease The introduction of DBS as a therapeutic tool for advanced PD has revolutionized the clinical management of this condition. Due to its safety profile and efficacy, DBS evolved from a last-resort therapeutic option to a modality that is now routinely offered to patients. Over the years, surgical candidates and the outcome expected with this procedure became well established. In fact, there

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Kristian J. Bulluss, Erlick A. Pereira, Carole Joint, and Tipu Z. Aziz

I n the 1990s, publication of the long-term results of pallidotomy for advanced Parkinson's disease (PD) showing significant loss of dyskinesias, rigidity, and tremor led to a second resurgence of stereotactic surgery for PD. 11 However, the relatively high incidence of side effects in some series and the demonstration that bilateral subthalamic nucleus (STN) stimulation was effective and led to a significant reduction in drug requirement, unlike pallidal surgery, resulted in the procedure of choice becoming deep brain stimulation (DBS). With the

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Dan Piña-Fuentes, Martijn Beudel, Simon Little, Jonathan van Zijl, Jan Willem Elting, D. L. Marinus Oterdoom, Martje E. van Egmond, J. Marc C. van Dijk, and Marina A. J. Tijssen

basis is that dystonia is the result of abnormal activity in cortico-basal ganglia-thalamo-cortical (CBGTC) and cerebellar networks. 52 The treatment for the majority of dystonia subtypes only provides symptomatic relief, without addressing the underlying cause of the disease. Options currently available include oral medication (e.g., anticholinergic and antidopaminergic drugs, benzodiazepines, and baclofen), botulinum toxin (treatment of choice in focal dystonias), and deep brain stimulation (DBS). 4 DBS in Dystonia Given the limited efficacy and high prevalence of

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Jason M. Schwalb, Howard A. Riina, Brett Skolnick, Jurg L. Jaggi, Tanya Simuni, and Gordon H. Baltuch

, Telfeian A , Baltuch GH , et al : Long-term deep brain stimulation in a patient with essential tremor: clinical response and postmortem correlation with stimulator termination sites in ventral thalamus. Case report. J Neurosurg 93 : 140 – 144 , 2000 Boockvar JA, Telfeian A, Baltuch GH, et al: Long-term deep brain stimulation in a patient with essential tremor: clinical response and postmortem correlation with stimulator termination sites in ventral thalamus. Case report. J Neurosurg 93: 140–144, 2000 4. Lozano A