1/3. deep brain stimulation of the centre median-parafascicular complex in patients with movement disorders.The centre median-parafascicular (CM-Pf) complex of the thalamus is considered to be a possible target for deep brain stimulation (DBS) in patients with movement disorders. In a prospective study on the effect of CM-Pf DBS versus somatosensory thalamic DBS on chronic neuropathic pain, three of 12 patients had additional movement disorders. Bifocal quadripolar electrodes were implanted by computed tomography guided stereotactic surgery under local anaesthesia contralaterally to the side of the pain for test stimulation. Two of the three patients with movement disorders had permanent implantation of CM-Pf electrodes. During test stimulation of the left CM-Pf complex for several days, a 67 year old woman received no benefit with respect to the neuropathic pain, but the choreoathetotic movements of her right foot ceased. As the pain syndrome was not improved, she decided not to have permanent implantation. A 74 year old man with postzoster neuralgia and allodynia enjoyed excellent relief from his pain with chronic CM-Pf DBS. In addition, improvement in the tremor at rest was noted. A 72 year old man had sustained reduction in his stump dyskinesias. Further evaluation of the possible role of the "forgotten" central and medial thalamic nuclei in the treatment of movement disorders may be warranted.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Anaesthesia and rett syndrome: a case report.rett syndrome is a neurological disorder of females characterized by dementia, autism, movement disorders and an abnormality of respiratory control. A 14-year-old girl with rett syndrome underwent spinal fusion surgery under general anaesthesia. No exacerbation of the respiratory control defect with surgery and anaesthesia was observed. hypothermia, ongoing blood loss and a normal anion gap acidosis were encountered, but were not attributable to features of this disorder.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
3/3. Trigemino-abducens synkinesis: an unusual case of aberrant regeneration.An unusual case of major head trauma is described involving injury to the right third, fifth, sixth and seventh cranial nerves in a basal skull fracture in a young woman. Two years later there persisted a total voluntary abducens nerve palsy, right facial hemianaesthesia and right temporalis and masseter palsy. However, involuntary abduction of the involved eye occurred on eating or chewing. electromyography of the lateral rectus muscle documented aberrant reinnervation to support the clinical findings. Extraocular muscle surgery improved the compensatory head posture and minimized the chewing-induced abduction. The mechanisms for acquired synkinesis and the anatomy of the involved nerves are reviewed. It is postulated that regenerating motor fibres of the trigeminal nerve were misdirected along proprioceptive channels to the lateral rectus in the case reported here.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |