Multimodal therapeutic assessment of peripheral nerve stimulation in neuropathic pain: five case reports with a 20-year follow-up.

Neuropathic pain following peripheral nerve lesion is highly resistant to conventional pain treatments but may respond well to direct electrical peripheral nerve stimulation (PNS). In the 1980s, we treated a series of 11 peripheral neuropathic pain patients with PNS. A first outcome assessment, conducted after a 52-month follow-up, revealed that the majority of the patients were significantly improved.

Long term clinical outcome of peripheral nerve stimulation in patients with chronic peripheral neuropathic pain.

Background: Chronic neuropathic pain after injury to a peripheral nerve is known to be resistant to treatment. Peripheral nerve stimulation is one of the possible treatment options, which is, however, not performed frequently. In recent years we have witnessed a renewed interest for PNS.

Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder.

Objective: Because of the irreversibility of lesioning procedures and their possible side effects, we studied the efficacy of replacing bilateral anterior capsulotomy with chronic electrical capsular stimulation in patients with severe, long-standing, treatment-resistant obsessive-compulsive disorder.

Methods: We stereotactically implanted quadripolar electrodes in both anterior limbs of the internal capsules into six patients with severe obsessive-compulsive disorder. Psychiatrists and psychologists performed a double-blind clinical assessment.

Electrical stimulation of the brain for psychiatric disorders.

Despite advances in therapies, there remain psychiatric patients who are extremely ill and cannot be helped by classic psychiatric treatments, including psychotherapy and drug therapy. Certain of these patients may be helped by use of bilateral brain lesioning. The complication rate of standard stereotactic psychosurgery techniques is very low.

Reflections: a historical vignette.

vignette is a diminutive of vigne (vine) and at first was used in the form of a vine branch, e.g., to begin or end a chapter in a book or to frame a medieval miniature.

Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder.

Objective: Because of the irreversibility of lesioning procedures and their possible side effects, we studied the efficacy of replacing bilateral anterior capsulotomy with chronic electrical capsular stimulation in patients with severe, long-standing, treatment-resistant obsessive-compulsive disorder.

Methods: We stereotactically implanted quadripolar electrodes in both anterior limbs of the internal capsules into six patients with severe obsessive-compulsive disorder. Psychiatrists and psychologists performed a double-blind clinical assessment.

Deep brain stimulation for treatment-refractory obsessive-compulsive disorder: psychopathological and neuropsychological outcome in three cases.

Objective: Investigation of deep brain stimulation (DBS) as a last-resort treatment alternative to capsulotomy in treatment-refractory obsessive-compulsive disorder (OCD).

Method: Prospective single-case based design with evaluation of DBS impact on emotions, behaviour, personality traits and executive function in three patients with OCD.

Results: Two patients experienced sustained improvement of OCD symptoms with DBS.

Effects of electrical stimulation or lesion in nucleus accumbens on the behaviour of rats in a T-maze after administration of 8-OH-DPAT or vehicle.

Electrical brain stimulation may be a therapeutic alternative for irreversible lesions in treatment-resistant patients with obsessive-compulsive disorder (OCD). We compared the effects of electrical stimulation and lesion in the nucleus accumbens (n acc) on the behaviour of rats in a model for OCD. Rats were tested for spontaneous alternation behaviour (AB) in a T-maze and assigned to four groups: an electrode implant group with stimulation 'ON' (stimON) or 'OFF' (stimOFF), a lesion or a sham group.

Effect of the serotonin agonist 8-OH-DPAT on the sensorimotor system of the rat.

8-Hydroxy-2-(di-n-propylamino)-tetralin hydrobromide (8-OH-DPAT, 2 mg/kg) is used to induce perseverative behavior in rats in a T-maze as a model for obsessive-compulsive disorder (OCD). Using the open-field test, radiant heat test, and the test with von Frey filaments, we examined whether alterations in sensorimotor functioning could contribute to the perseverative tendencies in this model by measuring differences in left versus right hind paw reactions after 8-OH-DPAT administration (2 mg/kg, sc). Also, the effect of repeated 8-OH-DPAT administration on sensorimotor functioning was tested every third day.

Thalamic stimulation in neuropathic pain: 27 years later.

An overview is given of CNS mechanisms which are behind the beneficial effects of VPL-VPM thalamic stimulation in the treatment of neuropathic pain. Further research in this field is urgently needed and the recent possibility to combine Deep Brain Stimulation with positron emission tomography (PET) will certainly help to unravel the brain circuitry implicated in stimulation-produced analgesia. Brain stimulation is an artificial way to activate nervous tissue that is reversible and, when correctly applied, has few complications.

Targeting the basal ganglia for deep brain stimulation in Parkinson's disease.

The revitalization of surgery for Parkinson's disease (PD) has fueled discussion about the best methodology to define the target. Placement of electrodes for deep brain stimulation (DBS) requires the usual stereotactic technique but the argument is mainly centered on whether or not microrecording neuronal activity is necessary. We compared the accuracy of calculating the coordinates X (medio-lateral) and Y (rostro-caudal) considered by the classic stereotactic method, i.

Positron emission tomography study of a chronic pain patient successfully treated with somatosensory thalamic stimulation.

Previous neuroimaging studies suggested that the neuronal network underlying the perception of chronic pain may differ from that underlying acute pain. To further map the neural network associated with chronic pain, we used positron emission tomography (PET) to determine significant regional cerebral blood flow (rCBF) changes in a patient with chronic facial pain. The patient is implanted with a chronic stimulation electrode in the left ventroposterior medial thalamic nucleus with which he can completely suppress his chronic pain.

Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder.

Chronic electrical stimulation instead of bilateral capsulotomy was done in four selected patients with long-standing treatment-resistant obsessive-compulsive disorder. In three of them beneficial effects were observed.

[The placebo effect: classes of explanation].

The placebo effect is a frequent phenomenon in medicine, but very little is known about its mechanisms. An overview is given of the different classes of explanation of the placebo effect in analgesia and in particular the role of endogenous opioids, classical conditioning and expectations. Then the question is raised which are the properties of placebo for which a theory has to provide answers in order to be coherent.

Stimulation of human thalamus for pain relief: possible modulatory circuits revealed by positron emission tomography.

Stimulation of human thalamus for pain relief: possible modulatory circuits revealed by positron emission tomography. J. Neurophysiol.

Estimation of fiber diameters in the spinal dorsal columns from clinical data.

Lack of human morphometric data regarding the largest nerve fibers in the dorsal columns (DC's) of the spinal cord has lead to the estimation of the diameters of these fibers from clinical data retrieved from patients with a new spinal cord stimulation (SCS) system. These patients indicated the perception threshold of stimulation induced paresthesia in various body segments, while the stimulation amplitude was increased. The fiber diameters were calculated with a computer model, developed to calculate the effects of SCS on spinal nerve fibers.

Clinical evaluation of paresthesia steering with a new system for spinal cord stimulation.

Objective: The goal was to evaluate, in a clinical study, the predicted performance of the transverse tripolar system for spinal cord stimulation, particularly the steering of paresthesia, paresthesia coverage, and the therapeutic range of stimulation.

Methods: Six transverse tripolar electrodes were implanted in the lower thoracic region in four patients experiencing chronic neuropathic pain. Electrode positions, relative to the spinal cord, were estimated from computed tomographic scans.

[Image-guided surgery].

Initially, stereotactic surgery was developed to treat functional brain diseases only. The localisation of targets was based on stereotactic atlases and radiographs. The introduction of computer based imaging techniques, such as CT and MRI, have offered the possibility to "see" anomalies and to approach them stereotactically.

Production of tumor necrosis factor in spinal cord following traumatic injury in rats.

Production of tumor necrosis factor (TNF) in the spinal cord following traumatic injury has been studied. In these experiments, the level of TNF was examined in the homogenate of the spinal cord, cerebrospinal fluid (CSF) and serum (n = 56). TNF could be detected in the injured spinal cord but not in the normal spinal cord.

The use of magnetic resonance angiography in stereotactic neurosurgery.

The authors discuss the advantages and disadvantages of the use of magnetic resonance (MR) angiography images in stereotactic neurosurgery. Current computer programs designed to assist the neurosurgeon in the planning of stereotactic neurosurgical interventions use intraarterial digital subtraction angiography images to visualize the blood vessels. Magnetic resonance angiography is a recent technique with a number of advantages over the digital subtraction method: it is less invasive and less prone to complications; it provides truly three-dimensional data sets that can be viewed from any direction; and it can visualize both stationary and flowing tissues with the same imaging device and localizer frame.

The consumption of fentanyl is increased in rats with nociceptive but not with neuropathic pain.

The question whether opioids relieve neuropathic pain remains a controversial issue. Experimental as well as clinical studies report contradictory results. This study investigated the consumption of fentanyl, a short-acting opioid, in rats with neuropathic pain, induced by partial sciatic nerve injury.

Protocol for the clinical functionality assessment of a workstation for stereotactic neurosurgery.

The objective of this study is to establish a protocol for the technical and clinical evaluation of a workstation for the planning of stereotactic neurosurgical interventions that has been developed in the framework of a joint European research project. Although several such workstations have been proposed before, they lacked the final and most important step, that of clinical validation. They failed to rigorously prove that their product was useful.