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Neuromodulation is the alteration of the nervous system electrically by the implantation of implanted devices.
Functional neurosurgery procedures are designed to reduce or eliminate spasticity, tremors or chronic pain, thereby improving the patient's ability to function and regain a more independent lifestyle.
To treat these patients, Allegheny General neurosurgeons in combination with specialists in neurology, anesthesiology, pain management, electrophysiology and physical medicine have joined to bring the latest medical advances to people who are disabled by spasticity, movement disorders and pain.
The Spasticity and Movement Disorder Center is designed to provide thorough coordinated care to patients with increased muscle tone and abnormal body movements resulting from Parkinson's disease, tremors, spasticity, stroke, brain injury, multiple sclerosis, dystonia, cerebral palsy and other medical causes.
Medical treatments available through this center include standard and recently approved medications. Additional experimental and investigational medications are also available for patients who do not respond to conventional medical therapies. New surgical treatments are being investigated for patients who cannot be adequately helped by medication alone.
To provide educational and emotional support to patients with Parkinson's disease and their families, Allegheny General hosts the American Parkinson Disease Information and Referral Center. One of 50 such centers nationwide funded by the American Parkinson Disease Association Center is a convenient and comprehensive source of information for area physicians who treat Parkinson's disease without local support groups and educational materials.
The current and latest surgical and medical techniques offered by the functional neurosurgery program include:
- Deep Brain Stimulation - Allegheny General Hospital's Department of Neurosurgery was the first in the region to use Deep Brain Stimulation (DBS) to treat patients with essential tremor and Parkinson's disease, dystonia, and other tremors. DBS surgery involves placement of electrodes within the brain to transmit electrical impulses to specific areas within the brain. DBS often allows patients to obtain relief from their symptoms including tremors, rigidity, slowness of movement, stiffness, and may help with balance problems.
Deep brain stimulation involves the insertion of a very thin wire (lead) which has four contacts on the end of it into the brain. The lead is placed through a small opening in the skull and is connected to an extension wire. The extension wire is connected to an impulse generator which is much like a pacemaker which is implanted under the skin in the chest. Once implanted, the system can be adjusted to treat the patients as their symptoms change over time.
The surgeon is aided by a computerized brain-mapping system which works like a GPS for the brain, helping to target the precise location in the brain where nerve signals generate the tremors and other symptoms. The patient is awake during the surgery to allow the surgical team to assess the patient's brain functions. To begin the process, the surgeon makes a small opening in the skull. Before this is done, a local anesthetic (much like the anesthetic used during dental procedures) is administered. While the electrode is being advanced through the brain, the patient does not feel any pain because the brain does not feel pain.
Most times a DBS patient is in the hospital for about three days. The stimulators are implanted below the collarbone either at the time of electrode implantation or at a later time. General anesthesia is used for this part of the procedure. The stimulators are turned on soon after surgery.
Many times deep brain stimulation is very effective for the treatment of Parkinson's disease and other movement disorders. However, as with all surgical procedures, there is a risk. These risks should be discussed with your doctor to see if this procedure might be beneficial for you.
- Pain - A better understanding of pain mechanisms has led to more sophisticated approaches to pain management. Two therapies offering potential relief for intractable pain are spinal cord stimulation and the intraspinal drug delivery via implantable pumps.
- Spinal cord stimulation relieves chronic pain by electrically stimulating the spinal cord to the use of an implanted pulse generator. The low-voltage stimulation apparently closes a "gate" in a portion of the spinal cord effectively preventing transmission of specific pain signals to the brain.
- Intraspinal drug infusion employs an infusion device that precisely delivers controlled doses of medication through a small diameter tube. It is used to internally administer various pain relieving medications into the intrathecal or epidural spaces of the spinal column. Such drug infusion often reduces many of the side effects associated with oral narcotic administration. Intraspinal delivery allows for direct binding of analgesics to neuro receptors to inhibit the transmission of pain signals.
Neurosurgeons at Allegheny General have extensive experience with these techniques. Several of the neurosurgeons on staff were among the first physicians to participate in the clinical trials for the development of these techniques.
Advanced therapies for the treatment of unusually refractory pain syndromes are constantly being evaluated. These include deep brain stimulations for post stroke pain syndromes and peripheral nerve stimulation for phantom pain.
The functional neurosurgery program is exploring the frontiers of treating functionally disabling intractable angina from otherwise surgically or medically incorrectable ischemic heart disease using an implantable spinal cord stimulator. AGH performed the first such implantation in Pennsylvania and one of the first in the country.
In addition, research is being undertaken by our physicians to begin to explore the safety and effectiveness to use deep brain stimulation for obesity.