Evaluation of Patients with Atypical Trigeminal Neuralgia for Permanent Electrode Implant by Test Stimulation of the Ganglion gasseri

1994 ◽  
Vol 62 (1-4) ◽  
pp. 304-308 ◽  
Author(s):  
E. Waidhauser ◽  
U. Steude
Keyword(s):  
Trigeminal Neuralgia ◽  
Test Stimulation ◽  
Ganglion Gasseri ◽  
Stimulation Of

scholarly journals An age-dependent outcome analysis of microvascular decompression and percutaneous thermocoagulation in trigeminal neuralgia

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Naureen Keric ◽  
Darius Kalasauskas ◽  
Sophia L. Kreth ◽  
Martin B. Glaser ◽  
Harald Krenzlin ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Complication Rate ◽  
Age Groups ◽  
Treatment Strategies ◽  
The Elderly ◽  
Outcome Analysis ◽  
Neurovascular Compression ◽  
Duration Of Symptoms ◽  
Ganglion Gasseri

Abstract Background Trigeminal neuralgia (TN) is a severe pain condition and the most common facial neuralgia. While microvascular decompression (MVD) presents an excellent treatment in neurovascular compression cases, percutaneous thermocoagulation (PT) of the ganglion Gasseri is an alternative option. This study aimed to evaluate post-operative complication rate and outcome of both treatment strategies related to the patient’s age. Methods The medical records of all patients with the diagnosis of trigeminal neuralgia undergoing an MVD or PT of the ganglion Gasseri (between January 2007 and September 2017) were reviewed to determine the efficacy and the complication rate of both methods in regard to the patient’s age. Results Seventy-nine patients underwent MVD surgery and 39 a PT. The mean age of patients in the MVD group was 61 years and 73 years in the PT group. There were 59 (50%) female patients. Nerve-vessel conflict could be identified in 78 (98.7%) MVD and 17 (43.6%) PT patients on preoperative MRI. Charlson comorbidity index was significantly higher in PT group (2.4 (1.8) versus 3.8 (1.8) p < 0.001). The Barrow pain score (BPS) at the last follow-up demonstrated higher scores after PT (p = 0.007). The complication rate was markedly higher in PT group, mostly due to the facial hypesthesia (84.6% versus 27.8%; p < 0.001). Mean symptom-free survival was significantly shorter in the PT group (9 vs. 26 months, p < 0.001). It remained statistically significant when stratified into age groups: (65 years and older: 9 vs. 18 months, p = 0.001). Duration of symptoms (OR 1.005, 95% CI 1.000–1.010), primary procedure (OR 6.198, 95% CI 2.650–14.496), patient age (OR 1.033, 95% CI 1.002–1.066), and postoperative complication rate (OR 2.777, 95% CI 1.309–5.890) were associated with treatment failure. Conclusion In this patient series, the MVD is confirmed to be an excellent treatment option independent of patient’s age. However, while PT is an effective procedure, time to pain recurrence is shorter, and the favorable outcome (BPS 1 and 2) rate is lower compared to MVD. Hence MVD should be the preferred treatment and PT should remain an alternative in very selected cases when latter is not possible but not in the elderly patient per se.

Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders

1996 ◽  
Vol 84 (2) ◽  
pp. 203-214 ◽  
Author(s):  
Alim Louis Benabid ◽  
Pierre Pollak ◽  
Dongming Gao ◽  
Dominique Hoffmann ◽  
Patricia Limousin ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Essential Tremor ◽  
Movement Disorders ◽  
Content Type ◽  
Suppression Effect ◽  
Test Stimulation ◽  
Bilateral Surgery ◽  
Stimulation Of

✓ Tremor was suppressed by test stimulation of the thalamic ventralis intermedius (VIM) nucleus at high frequency (130 Hz) during stereotaxy in nonanesthetized patients suffering from Parkinson's disease or essential tremor. Ventralis intermedius stimulation has since been used by the authors over the last 8 years as a treatment in 117 patients with movement disorders (80 cases of Parkinson's disease, 20 cases of essential tremor, and 17 cases of various dyskinesias and dystonias including four multiple sclerosis). Chronic electrodes were stereotactically implanted in the VIM and connected to a programmable stimulator. Results depend on the indication. In Parkinson's disease patients, tremor, but not bradykinesia and rigidity, was selectively suppressed for as long as 8 years. Administration ofl-Dopa was decreased by more than 30% in 40 Parkinson's disease patients. In essential tremor patients, results were satisfactory but deteriorated with time in 18.5% of cases, mainly for patients who presented an action component of their tremor. In other types of dyskinesias (except multiple sclerosis), results were much less favorable. Fifty-nine patients underwent bilateral implantation and 14 other patients received implantation contralateral to a previous thalamotomy. Thirty-seven patients (31.6%) experienced minor side effects, which were always well tolerated and immediately reversible. Three secondary scalp infections led to temporary removal of the implanted material. There was no permanent morbidity. This tremor suppression effect could be due to the inhibition or jamming of a retroactive loop. Chronic VIM stimulation, which is reversible, adaptable, and well tolerated even by patients undergoing bilateral surgery (74 of 117 patients) and by elderly patients, should replace thalamotomy in the regular surgical treatment of parkinsonian and essential tremors.

Trigeminal neuralgia associated with seizure and syncope

1984 ◽  
Vol 61 (3) ◽  
pp. 594-595 ◽  
Author(s):  
Wishwa N. Kapoor ◽  
Peter J. Jannetta
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Mechanical Stimulation ◽  
Microvascular Decompression ◽  
Facial Pain ◽  
Loss Of Consciousness ◽  
Content Type ◽  
Vascular Decompression ◽  
Fine Print ◽  
Stimulation Of

✓ A patient with trigeminal neuralgia experienced a generalized seizure and a prolonged syncopal episode. He was found to be asystolic during the syncopal episode. There was no recurrence of loss of consciousness after implantation of a pacemaker. Mechanical stimulation of the trigeminal nerve during craniotomy for microvascular decompression of the trigeminal nerve resulted in bradycardia. Since vascular decompression of the trigeminal nerve, there has been no recurrent facial pain, and no further syncope, seizures, or bradycardia. Syncope and seizures have not been previously reported in association with trigeminal neuralgia, although they are well described with glossopharyngeal neuralgia.

Stimulation of the Gasserian Ganglion for the Treatment of Refractory Trigeminal Neuralgia. Two Case Reports

2020 ◽  
pp. 33-38
Author(s):  
Shafik Boyaji
Keyword(s):  
Trigeminal Neuralgia ◽  
Peripheral Nerve ◽  
Pulse Generator ◽  
Case Reports ◽  
Functional Improvement ◽  
Surgical Approaches ◽  
Gasserian Ganglion ◽  
Nerve Stimulator ◽  
Peripheral Nerve Stimulator ◽  
Stimulation Of

Background: Treatment of trigeminal neuralgia (TN) can be challenging for many physicians; patients who do not respond to conventional treatments and traditional surgical approaches often continue to suffer with pain. The peripheral nerve stimulator has been used to treat many chronic pain conditions, but few reports exist about its use to treat refractory TN through the stimulation of the Gasserian ganglion (GG). Case Report: We present 2 cases of patients with refractory TN who failed conventional medical and surgical management. Both patients were suitable candidates for a trial of peripheral nerve stimulation of the GG, both patients had positive results with the trials, and proceeded with permanent placement of the GG stimulator. In both cases we used deep brain stimulator leads, which were placed under fluoroscopy guidance through the foramen ovale onto the GG, and tunneled through the postauricular area to a pocket in the upper chest wall under the clavicle for the implantable pulse generator. Both of our patients experienced a significant symptomatic and functional improvement in their symptoms. The second patient was successfully weaned off her opioid pain medications after 6 months of treatment. Conclusion: Percutaneous stimulation of the GG is a promising technique for the treatment of refractory trigeminal neuropathic pain. More studies and experiences with this technique are needed to better demonstrate the efficacy and the safety profile, which potentially could allow this procedure to be considered ahead of the more invasive neurodestructive surgical treatments. Key words: Trigeminal neuralgia, Gasserian ganglion, peripheral nerve stimulator

scholarly journals Adaptation and cross-adaptation to odor stimulation of olfactory receptors in the tiger salamander.

1979 ◽  
Vol 74 (1) ◽  
pp. 37-55 ◽  
Author(s):  
F Baylin ◽  
D G Moulton
Keyword(s):  
Simple Model ◽  
Olfactory Receptors ◽  
Tiger Salamander ◽  
Conditioning Stimulation ◽  
Variable Time Delay ◽  
Test Stimulation ◽  
Cross Adaptation ◽  
Methyl Butyrate ◽  
Stimulation Of ◽  
Site Types

We have used the effects of self- and cross-adaptation on the unitary responses of olfactory receptors of the tiger salamander to odor stimulation to investigate the stimulus-specific components of these responses and to provide information about the cross-cell variations in the numbers and numbers of types of constitutent receptive sites. An olfactometer delivered sequential odorous pulses, either juxtaposed or separated by a variable time delay. We used four pairs of odorants judged to be similar within a given pair. The unitary response to the test stimulation relative to that of the conditioning stimulation varied from being unchanged to being completely eliminated. We sometimes observed substantial poststimulus increases in the firing rate following stimulation with juxtaposed odorous pulse. Except in the case of one odorant pair, cross-adaptation occurred both with juxtaposed pulses and with pulses separated in time. With the methyl butyrate/ethyl butyrate odorant pair, however, statistically significant cross-adaptation appeared only with juxtaposed pulses. We propose a simple model to aid in explaining these phenomena. The experimental observations in conjunction with this model are used to obtain estimates of the maximal and minimal number of receptive site types available for interaction with the chosen odorants.

scholarly journals Activation of the Supplementary Motor Areas Enhances Spinal Reciprocal Inhibition in Healthy Individuals

2020 ◽  
Vol 10 (9) ◽  
pp. 587
Author(s):  
Ryo Hirabayashi ◽  
Sho Kojima ◽  
Mutsuaki Edama ◽  
Hideaki Onishi
Keyword(s):  
Supplementary Motor Area ◽  
Reciprocal Inhibition ◽  
Multiple Time ◽  
Anodal Tdcs ◽  
Healthy Individuals ◽  
Test Stimulation ◽  
Reticulospinal Tract ◽  
Descending Input ◽  
Multiple Time Points ◽  
Stimulation Of

The supplementary motor area (SMA) may modulate spinal reciprocal inhibition (RI) because the descending input from the SMA is coupled to interneurons in the spinal cord via the reticulospinal tract. Our study aimed to verify whether the anodal transcranial direct current stimulation (anodal-tDCS) of the SMA enhances RI. Two tDCS conditions were used: the anodal stimulation (anodal-tDCS) and sham stimulation (sham-tDCS) conditions. To measure RI, there were two conditions: one with the test stimulus (alone) and the other with the conditioning-test stimulation intervals (CTIs), including 2 ms and 20 ms. RI was calculated at multiple time points: before the tDCS intervention (Pre); at 5 (Int 5) and 10 min; and immediately after (Post 0); and at 5, 10 (Post 10), 15, and 20 min after the intervention. In anodal-tDCS, the amplitude values of H-reflex were significantly reduced for a CTI of 2 ms at Int 5 to Post 0, and a CTI of 20 ms at Int 5 to Pot 10 compared with Pre. Stimulation of the SMA with anodal-tDCS for 15 min activated inhibitory interneurons in RIs by descending input from the reticulospinal tract via cortico–reticulospinal projections. The results showed that 15 min of anodal-tDCS in the SMA enhanced and sustained RI in healthy individuals.

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