PubMed · 14154765
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F A ABDOU. 1964. ELAVIL-LIBRIUM COMBINATION.. https://doi.org/10.1176/ajp.120.12.1204
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BACKGROUND: Modern pathophysiological concepts indicate that the central nervous system is important for chronification of pain in cases of neuropathic pain. Taking these concepts into consideration, what significance then do those hemisensory disorders have that appear sporadically in cases of chronic nerve root irritation syndrome? RESULTS: The typical clinical findings are illustrated by two case reports. In addition to persistent neuropathic pain, both patients experienced hemisensory impairment of the entire side of the body ipsilateral to the radicular symptoms. Perception of sensitivity to touch, pain, and temperature was decreased on the entire side of the body in contrast to the contralateral side. CONCLUSION: Hemisensory impairment in patients with chronic nerve root irritation syndromes can indicate a functional disorder in dealing with noxious impulses in the ventral posterior nucleus of the thalamus. They represent a clinical correlative to subcortical neuroplasticity, which could explain the resistance to therapy in severe chronic pain syndromes.
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OBJECT: Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is beneficial for generalized dystonia and has been proposed as a treatment for cervical dystonia. The Canadian Stereotactic/Functional and Movement Disorders Groups designed a pilot project to investigate the following hypothesis: that bilateral DBS of the GPi will reduce the severity of cervical dystonia at 1 year of follow up, as scored in a blinded fashion by two neurologists using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Secondary outcome measures included pain and disability subscores of the TWSTRS, Short Form-36 quality of life index, and the Beck Depression Inventory. METHODS: Three patients have undergone surgery in Calgary with a follow-up duration of 7.4 +/- 5.9 months (mean +/- standard deviation). One patient underwent inadvertent ineffective stimulation for the first 3 months and did not experience a benefit until DBS programming was corrected. All three patients had rapid response to stimulation, with the muscles relaxing immediately and abnormal movements improving within days. Total TWSTRS scores improved by 79%, and severity subscores improved significantly, from 15.7 +/- 2.1 to 7.7 +/- 2.9 (paired t-test, p = 0.02). Pain and disability subscores improved from 25.5 +/- 4.1 to 3.3 +/- 3.1 (paired t-test, p = 0.002) and from 13.3 +/- 4.9 to 3.3 +/- 4.2 (paired t-test, p = 0.06), respectively. CONCLUSIONS: Although it is too early to reach broad conclusions, this report of preliminary results confirms the efficacy of DBS of the GPi for cervical dystonia.