All Conditions Treated

Minimally Invasive Solutions

For over 50% of patients who are not good candidates for resective surgery, implantation of a vagal nerve stimulator may significantly improve seizure control.The neurosurgeons of Carolina Neurosurgery & Spine Associates continue to offer advanced surgical options to alleviate epilepsy including temporal lobectomy, extra-temporal resections, corpus callosotomy and hemispherectomy. However, when surgery is not practical, our practice offers an effective alternative.

A vagal nerve stimulator (VNS) may be the solution for some of these individuals. For over 50% of patients who are not good candidates for resective surgery, implantation of a left vagal VNS may significantly improve seizure control. A VNS serves as a type of programmable pacemaker for the vagus nerve in the neck. Carolina Neurosurgery & Spine Associates has implanted these devices in patients ranging in age from six months to 40 years. After surgery, the patients’ neurologists follow them closely to make the necessary adjustments in stimulation parameters. While practice neurosurgeons feel this is an important part of their armamentarium against epilepsy, VNS results in complete freedom from seizures in only 10% to 15% of patients.

Surgical Options For Parkinson’s Disease

Of the approximately 1 million people in the United States living with Parkinson’s Disease, an increasing number are seeking surgical treatment for relief. This is due to advancements in surgical techniques as well as the fact that more patients are building up a resistance to medications which once proved effective for them.

A Debilitating Disease

The cause of Parkinson’s disease is still unknown. This chronic, progressive, nervous system disorder occurs when neurons in the deep brain structure called the substantia nigra, die or become impaired. These damaged neurons are then unable to produce dopamine, a chemical needed to transmit signals between the substantia nigra and other message centers of the brain. The lack of dopamine results in a neurochemical imbalance, which can lead to tremors in the hands, arms, legs and jaw, stiffness in the limbs, slowness of movement and impaired balance and coordination.

The Search For Relief

Parkinson’s disease, which occurs most commonly in the elderly and middle-aged individuals, is usually treated effectively with medications. These drugs relieve symptoms by restoring the brain’s neurochemical balance. However, these medications can have significant side effects and may lose effectiveness over time. In these instances, some patients may benefit from surgery.

Surgical Options

Surgical treatment for Parkinson’s disease includes pallidotomy, thalamotomy and deep brain stimulation. These procedures help relieve symptoms by either stimulating or destroying targeted deep brain cells that involve motion control.

With pallidotomy, a wire probe is inserted into the globus pallidus (in the corpus striatum) of the brain. Radio waves are then transmitted to heat the highly targeted area and destroy it. Thalamotomy uses the same energy to destroy a small area in the thalamus.

Deep brain stimulation involves implantation of small electrodes in the brain which are connected to a pacemaker-like device implanted beneath the skin. This device sends electrical stimulation to the electrodes which control messages in the brain.

In many cases, surgery can definitely contribute to a patient’s quality of life. But it’s not for everyone. Each patient is unique and surgery should only be considered if medications are either ineffective or cause unacceptable side effects.

Spasticity can make even the simplest of tasks impossible for those who suffer from it. This movement disorder, which manifests itself primarily as a stiffness in the arms and legs, is often a permanent and progressive complication of injuries to the brain or spinal cord. It is also seen in children and adults with cerebral palsy, stroke, multiple sclerosis (MS) amyotrophic lateral sclerosis (ALS), and a variety of other disorders.

Spasticity, in its milder and more localized forms, may respond to stretching exercises, the use of a variety of medications, or the local injection of Botox, a drug which partially and temporarily interferes with the way nerves cause muscles to contract. When spasticity and its accompanying involuntary, and sometimes painful, muscle spasms are severe, a more aggressive treatment program is needed.

Intrathecal Baclofen

One of these advanced options involves the use of intrathecal Baclofen, a drug which helps control the over stimulation of motor nerves which cause spasticity. Using an implantable, programmable and refillable pump, Baclofen can be delivered directly to the areas of the spinal cord where it is needed to loosen muscles and prevent spasms. This continuous infusion avoids the sedative effects commonly seen when the same drug is given orally.

To determine if a patient is a candidate for the implanted device, a single trial dose of Baclofen is administered directly into the spinal space. With the assistance of a physical therapist, changes in the patient’s muscle tone or spasm severity are then monitored for four to six hours, which is the approximate duration of the test dose’s effect. If the patient responds in a positive way, a surgical procedure can be performed to place a small pump underneath the abdominal wall and a catheter in the spinal space, thereby providing continuous delivery of Baclofen. Typically, a patient will have his or her pump refilled every four to six weeks. The pumps themselves, which are battery powered can last anywhere from seven to ten years.

The greatest advantage of this treatment option is the pump’s ability to be programmed after it is implanted. This allows us to precisely meet the patient’s need for spasticity control. In the past, the options for patients with severe spasticity were a variety of destructive and irreversible surgical procedures.

The specific causes of spasticity varies from patient to patient. These individuals range in age from 7 to 66 years old, and represent many different conditions which cause spasticity. Clinics are held in the practice’s Charlotte office on a regular basis for new and established patients.