1,721,044 research outputs found
Il ruolo del doppler transcranico (TCD) nella fase diagnostica
No full textVIENE VALUTATA L'UTILITA' DEL DOPPLER TRANSCRANICO NEL PERCORSO DIAGNOSTICO DEI PAZIENTI CON CEFALEA. NELLA FATTISPECIE PARTICOLARE CURA E' DEDICATA ALLA COSIDDETTA "FINESTRA TEMPORALE
Long-Term Outcomes of Spinal Cord Stimulation With Paddle Leads in the Treatment of Complex Regional Pain Syndrome and Failed Back Surgery Syndrome COMMENT
No full text[no abstract available
Spinal cord stimulation in chronic pain management
No full textIn this article, therapeutic electrical stimulation of the spinal cord is presented as a procedure of neuromodulation. The rationale behind its proposal and its mechanisms of action are considered in light of the results achieved in clinical practice. The author's experience is intermingled with the results of the most experienced team; experimental data are reported to support speculations on the mechanism of interaction with the activity of the central nervous system and to stress the need for a multidisciplinary approach to improve the efficacy and enlarge the field of application of neuromodulation, which is to be considered as a new medical discipline
Motor cortex stimulation for chronic non-malignant pain: current state and future prospects.
No full textMotor cortex stimulation (MCS) was proposed by Tsubokawa in 1991 for the treatment of post-stroke thalamic pain. Since that time, the indications have been increased and included trigeminal neuropathic pain and later other types of central and peripheral deafferentation pain. The results reported in the literature are quite good; the mean long-term success rate is 80% in facial pain and 53% in non-facial pain. Our own results are less impressive: 4 of 14 patients (28%) experienced a greater than 40% pain relief, but in 2 of them the effect faded with time. Only few minor complications have been reported. The accurate placement of the epidural electrode over the motor cortex that somatotopically corresponds to the painful area is believed to be essential for pain relief. Predictive factors included the response to pharmacological tests, the relative sparing from the disease process of the cortico-spinal tract and the sensory system, and the analgesic response achieved during the test period of MCS. A possible predictive factor might be a test of repetitive transcranial magnetic stimulation (rTMS) of the motor cortex. MCS may act by rebalancing the control of non-nociceptive sensory inputs over nociceptive afferents at cortical, thalamic, brainstem and spinal level. In addition, it may interfere with the emotional component of nociceptive perception. Biochemical processes involving endorphins and GABA may also be implicated in the mechanism of MCS. It is time for a large multicenter prospective randomized double blind study evaluating not only the effect of MCS on pain (based on the available guidelines for assessment of neuropathic pain), but also the optimal electrode placement and stimulation parameters, and the possible relationship with the response to rTMS. New electrode design and a new generation of stimulators may help in improving the results
Considerazioni sulla neurostimoalzione spinale nella failed back surgery syndrome. [Spinal stimulation in failed back surgery syndrome].
No full text[no abstract available
Craniocervical junction instability: instrumentation and fusion with titanium rods and sublaminar wires. Effectiveness and failures in personal experience
No full textBackground. The aim of the study was to evaluate the effectiveness, pitfalls and failures of instrumentation and fusion with titanium wires and rods in 12 h patients with cramovertebral junction instability. Methods. Among nine adult patients (mean age 48.11 years) with cramovertebral junction instability, four had basilar impression, three metastatic disease, one rheumatoid arthritis and one Down's syndrome. Three children (mean age 7.33 years) with genetic (Down's syndrome, 2 cases) and metabolic (mucopolisaccarydoses type IV, i.e. Morquio Syndrome, I case) disease were studied as well. Each patient underwent preoperative radiological evaluation by means of X-Ray, CT scan and MRI of the craniocervical region. Occipitocervical instrumentation with a titanium U-shaped wired rod was performed in each patient. Autologous bone fusion was performed in all but the two cancer patients, in whom polymethylmetacrylate was used. Postoperatively, all the patients used an external orthosis for 3-6 months. Post-operative X-Ray, CT and MRI were performed on each patient. The Frankel clinical scale was used to asses the outcome at follow-up which ranged from I to 10 years. At maximum follow up, there was either clinical improvement or stabilization recorded in all but one patient. This patient with basilar impression transiently worsened from grade D to C and a spinal cord lesion was already evident before the operation on MRI examination. Interpretation. The effectiveness of surgical management of cramovertebral junction instability by instrumentation and fusion was demonstratedly in our experience. Nevertheless, the choice of the surgical technique should be made with caution when a spinal cord lesion is revealed by preoperative neuroimaging studies
Protective effect of spinal cord stimulation on experimental early cerebral vasospasm - Conclusive results
No full textIn this study we investigate the effects of cervical spinal cord stimulation (cSCS) on experimental 'early spasm' in rabbits as described in personal previous experience (Acta Neurochir 2001;143:177-185). Twenty-four adult red Burgundy rabbits wearing a cervical epidural electrode underwent cerebral blood flow (CBF) and functional monitoring of early basilar spasm before and during cSCS. CBF changes, as a consequence of cSCS, occurred in 20 control animals. No CBF changes, consistent with no basilar artery vasospasm, occurred after subarachnoid haemorrhage (SAH) up to the end of the experiments in all the stimulated animals. The role of reversible functional sympathectomy in mediating the effect of spinal cord stimulation on early spasm is discussed. cSCS is able to prevent 'early spasm' due to SAH in all the animals studied, independently from the occurrence and the sign of stimulation induced CBF variations. Copyright (C) 2002 S. Karger AG, Basel
Subacute clinical onset of postraumatic myelopathy
No full textBackground. Subacute neurological deterioration unrelated to mechanical instability is a rare event. Cases report. The authors describe two patients with subacute neurological deterioration unrelated to mechanical instability, which occurred 24 hours after spinal cord injury. The phenomenon could not be prevented by steroid therapy carried out either before or after the onset of clinical signs. An early surgical decompressive procedure performed in one of the two patients, failed to reverse the clinical symptomatology. Findings. In the first case, temporal evolution of the neurological deterioration suggested a venous thrombosis with secondary congestive ischemia. whereas ischemia involving the anterior spinal artery seems to account for the deterioration observed in the second patient. Interpretation. Spinal cord haemodynamics plays the main role in mediating the onset of descending subacute posttraumatic myelopathy. The cure and the prevention of the secondary vascular injury still remains unknown
“ Proporzionalità e Specificità del Trattamento delle Cefalee”
No full textVENGONO ANALIZZATI I CRITERI GUIDA PER LA STRUTTURAZIONE DI UN PROTOCOLLO DI GESTIONE DELLE CEFALEE. TRA QUESTI SONO IDENTIFICATI COME CRITERI PRINCIPALI QUELLI DELLA SPECIFICITA' E PROPORZIONALITA' IN OSSEQUIO ALLA DOTTRINA DELLA TERAPIA INDIVDUALIZZAT
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