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Movement disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Lower doses of levodopa reduce the tendency to develop dyskinesias. Most people would rather accept a degree of dyskinesia than suffer immobility related to underdosing. Peak dose dyskinesias may be improved by smaller, more frequent levodopa doses. Diphasic ones may be improved by using dopamine agonists in preference to levodopa. Off dystonias may be reduced by using long-acting agents overnight (e.g. CR levodopa or dopamine agonists). Deep brain stimulators (see next section) may be an option for selected people.
Electrical Brain Stimulation to Treat Neurological Disorders
Published in Bahman Zohuri, Patrick J. McDaniel, Electrical Brain Stimulation for the Treatment of Neurological Disorders, 2019
Bahman Zohuri, Patrick J. McDaniel
Deep brain stimulation is currently used to treat severe neurological conditions such as Essential Tremor, Parkinson’s Disease, Tourette’s Syndrome, and Dystonia. As with both TMS and ECT, DBS is considered a last resort treatment method, reserved only for those patients whom have undergone standard treatment options without seeing any benefits. Additionally, because DBS is still a relatively new technique, many candidates for deep brain stimulation are participants in clinical research trials (see Figure 6.12).
Examine the gait
Published in Hani TS Benamer, Neurology for MRCP PACES, 2019
Q: What is the treatment? Drugs are the main form of treatment.Dopamine agonists, especially in the early stages of the disease and in young patients (ropinirole, pramipexole and rotigotine).Levodopa is still the main and most effective treatment.Monoamine oxidase B inhibitors (rasagiline and selegiline).Catechol-O-methyl transferase (COMT) inhibitors (entacapone).Apomorphine injection and infusion.Surgery, mainly deep brain stimulation. Patient selection is crucial. Patients should have positive responsiveness to dopamine therapy with no cognitive or psychiatric problems.
Healthcare-associated ventriculitis: current and emerging diagnostic and treatment strategies
Published in Expert Review of Anti-infective Therapy, 2021
Intrathecal infusion pumps are currently used in the therapy of spasticity with baclofen or to treat pain with opiates [22–24]. The catheter of the pump is inserted intrathecally in the lumbar region. The rate of infections varies by the location of the infusion pump: 3.6% rate if it is placed underneath the fascia but up to 20% in those pumps placed subcutaneously [21]. The most common of infectious complications are post-operative wound infections with a minority of patients developing meningitis [21–24]. Deep brain stimulators can be used to treat Parkinson’s disease, intractable seizures, essential tremor, dystonia, and obsessive-compulsive disorder [25,26]. The deep brain stimulator has three components: a generator that is placed in the infra-articular area, a connector, and an intracranial lead [25]. All three components can become infected with an incidence rate that varies from 0% to 15% [2]. Two recent studies show an incidence rate of infectious complications to be 5–6% with half of them developing in the 30 days post-implantation [25,26]. The most common pathogens are staphylococci with the majority of patients requiring partial or complete removal of the device for cure. Removal of intrathecal infusion pump or deep brain stimulator with re-implantation of the device once repeats a negative CSF culture is recommended [1,2]. Intracranial pressure transducers are commonly used to monitor intracranial pressures and are universally colonized with bacteria with biofilm but are unlikely recognized as a cause of HCAVM [27].
Mapping the Dimensions of Agency
Published in AJOB Neuroscience, 2021
Andreas Schönau, Ishan Dasgupta, Timothy Brown, Erika Versalovic, Eran Klein, Sara Goering
Most end users of neural technologies are active agents who seek to express themselves—their feelings, emotions, thoughts, and desires—through goal-directed actions. Often, a neural device enables end users to regain abilities lost due to a disease or an injury. A person with Parkinson’s disease, for example, may benefit from a deep brain stimulator (DBS) that alleviates tremor and rigidity, and thus restores the ability to fluently perform movements. A person living with spinal cord injury may benefit from a brain computer interface (BCI) to control a robotic arm, or even to regain a lost sensation of touch. A person with amyotrophic lateral sclerosis (ALS) may use a BCI to communicate with loved ones through the translation of thought to computer-generated speech. A depressed person may use a DBS to improve mood, in the hope of regaining a brighter, more authentic self.
A Qualitative Analysis of Ethical Perspectives on Recruitment and Consent for Human Intracranial Electrophysiology Studies
Published in AJOB Neuroscience, 2021
Joncarmen V. Mergenthaler, Winston Chiong, Daniel Dohan, Josh Feler, Cailin R. Lechner, Philip A. Starr, Jalayne J. Arias
Recent advancements in neuroscience have expanded the use of intracranial electrophysiological research methods, such as electrocorticography and electrical stimulation mapping (Chang 2015; Engel et al. 2005; Jorgenson et al. 2015; Panov et al. 2017). Circuit-based treatments for patients with neurological and psychiatric disorders increase the potential uses for invasive application of intracranial procedures, driving an emerging area of research. Intracranial electrophysiology research involves electrodes placed on the cortical surface (as in electrocorticography and electrical cortical stimulation) or within the brain parenchyma (as in stereotactic EEG and deep brain stimulation). Studies typically take place in the clinical setting (Chiong, Leonard, and Chang 2018; Hendriks et al. 2019) with patients undergoing surgical intervention for neurological conditions such as epilepsy, brain tumors, or Parkinson’s disease. This setting enables valuable opportunities for advancing neuroscientific research related to complicated neurological and psychological conditions.