Neuromodulation of epileptic foci in patients with non-lesional refractory motor epilepsy.

We report two cases of chronic therapeutic stimulation of epileptic foci localized in motor areas. Case 1 is an adolescent with supplementary motor area seizures whose intracranial recordings showed a right SMA focus. Case 2 is a female teenager with primary motor seizures originating in the right motor cortex in the hand area as shown by her intracranial recordings and cortical mapping.

Bilateral electrical stimulation of prelemniscal radiations in the treatment of advanced Parkinson's disease.

Objective: Tremor and rigidity have been efficiently controlled by electrical stimulation of contralateral prelemniscal radiations (Raprl) in patients with unilateral Parkinson's disease. The present study determines the effect of bilateral Raprl electrical stimulation in a group of patients with severe bilateral tremor, rigidity, and bradykinesia.

Methods: Five patients with Parkinson's disease (Hoehn and Yahr scale, Stage V) underwent bilateral stereotactic electrode implantation.

Efficacy of motor cortex stimulation in the treatment of neuropathic pain: a randomized double-blind trial.

Object: In this study the authors used a double-blind protocol to assess the efficacy of motor cortex stimulation (MCS) for treating neuropathic pain.

Methods: Eleven patients with unilateral neuropathic pain (visual analog scale [VAS] score 8-10) of different origins and topography were selected for MCS. A 20-contact grid was implanted through a craniotomy centered over the motor cortex contralateral to the painful area.

Treatment of chronic neuropathic pain by motor cortex stimulation: results of a bicentric controlled crossover trial.

Background: Chronic motor cortex stimulation (MCS) with surgically implanted epidural electrodes has been proposed as a treatment for neuropathic pain refractory compared with medical treatment. However, no prospective controlled trial has been published to provide convincing evidence of MCS analgesic efficacy.

Objective: To compare MCS analgesic efficacy between "ON"- and "OFF"-stimulation conditions in a double-blinded crossover trial.

Electrical stimulation of the hippocampal epileptic foci for seizure control: a double-blind, long-term follow-up study.

Purpose: Our aim was to evaluate the safety and efficacy of electrical stimulation of the hippocampus in a long-term follow-up study, as well as its impact on memory performance in the treatment of patients with refractory mesial temporal lobe epilepsy.

Methods: Nine patients were included. All had refractory partial complex seizures, some with secondary generalizations.

Opioid receptor binding in parahippocampus of patients with temporal lobe epilepsy: its association with the antiepileptic effects of subacute electrical stimulation.

Opioid receptor binding was evaluated in parahippocampal cortex (PHC) obtained from patients with intractable mesial temporal lobe epilepsy (MTLE) with and without subacute high frequency electrical stimulation (HFS) in this brain area. Mu, delta and nociceptin receptor binding was determined by autoradiography in PHC of five patients (ESAE group) with MTLE history of 14.8 +/- 2.

Neuromodulation of the centromedian thalamic nuclei in the treatment of generalized seizures and the improvement of the quality of life in patients with Lennox-Gastaut syndrome.

Purpose: Our aim was to evaluate the efficacy of ESCM (electrical stimulation of the centromedian thalamic nucleus) in treatment of generalized seizures of the Lennox-Gastaut syndrome (LGS) and improvement of patient disability.

Methods: Thirteen patients with LGS were studied. They had severe generalized tonic-clonic seizures (GTC) and atypical absences (AA).

Electrocortical and behavioral responses elicited by acute electrical stimulation of inferior thalamic peduncle and nucleus reticularis thalami in a patient with major depression disorder.

Objective: Our aim was to study electrocortical and behavioral responses elicited by 6, 60 and 3/s stimulation of the inferior thalamic peduncle (ITP) and nucleus reticularis thalami (Re) in a patient with of major depression disorder resistant to psychotherapy, pharmacotherapy and electroconvulsive therapy and candidate to be treated by electrical stimulation of the ITP.

Methods: In this patient, two multicontact electrodes were implanted bilaterally through frontal coronal parasagittal burr-holes with oblique trajectories aiming ITP and Re. Stimulation was performed through externalized systems.

Neurobiological background for performing surgical intervention in the inferior thalamic peduncle for treatment of major depression disorders.

Objective: To present a review of evidence for an inhibitory thalamo-orbitofrontal system related to physiopathology of major depression disorders (MDDs) and to postulate that interfering with hyperactivity of the thalamo-orbitofrontal system by means of chronic high-frequency electrical stimulation of its main fiber connection, the inferior thalamic peduncle (ITP), may result in an improvement in patients with MDD.

Methods: Experimentally, the thalamo-orbitofrontal system has been proposed as part of the nonspecific thalamic system. Under normal conditions, the nonspecific thalamic system induces characteristic electrocortical synchronization in the form of recruiting responses that mimic some sleep stages.

Double-blind, randomized controlled pilot study of bilateral cerebellar stimulation for treatment of intractable motor seizures.

Purpose: The efficacy and safety of cerebellar stimulation (CS) was reevaluated in a double-blind, randomized controlled pilot study on five patients with medically refractory motor seizures, and especially generalized tonic-clonic seizures.

Methods: Bilateral modified four-contact plate electrodes were placed on the cerebellar superomedial surface through two suboccipital burr holes. The implanted programmable, battery-operated stimulator was adjusted to 2.

Evaluation of GABA system and cell damage in parahippocampus of patients with temporal lobe epilepsy showing antiepileptic effects after subacute electrical stimulation.

Purpose: The gamma-aminobutyric acid (GABA) system and neuronal loss were evaluated in the parahippocampal cortex (PHC) of patients with intractable mesial temporal lobe epilepsy (MTLE) who received subacute electrical stimulation and showed antiepileptic effects.

Methods: GABA tissue content, GABA(A) and benzodiazepine (BZD) receptor levels, as well as neuronal density were determined in PHC of five patients (ESAE group) with an MTLE history of 14.8 +/- 2.

Motor cortex stimulation in the treatment of deafferentation pain. I. Localization of the motor cortex.

MRI and electrophysiological techniques to localize the primary motor cortex (MC) were performed on patients considered for MC stimulation for the treatment of deafferentation pain. The representation and trajectory of the rolandic fissure (RF) were accurately localized by external cranial landmarks and radiopaque fiducials superimposed on oblique MRI sections. In addition, the scalp distribution of the corticocortical responses elicited by acute epidural stimulation [motor cortex (MC) in frontal and sensory cortex (SC) in parietal scalp regions], and analgesic responses at the topographical representation of the painful periphery elicited by subacute epidural stimulation were found to be simple and reliable procedures to localize MC, SC and RF.

Temporo-spatial correlations between scalp and centromedian thalamic EEG activities of stage II slow wave sleep in patients with generalized seizures of the cryptogenic Lennox-Gastaut syndrome.

Objectives: Temporo-spatial correlations between scalp and centromedian thalamic (CM) normal and abnormal electroencephalographic (EEG) activities of stage II slow wave sleep (SWS II) were investigated in 5 patients with cryptogenic Lennox-Gastaut syndrome (CLGS).

Methods: In each patient, 8h/all-night sleep studies were performed with routine methods; and a total of 1233 normal and 206 abnormal individual activities, spontaneously occurring during 200 epochs of early and late SWS II, were analyzed. Normal activities included scalp-CM K-complexes (KC-CMKC), vertex waves (VW-CMVW), and sleep spindles (SS-CMSS).