Other Disorders

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.

Hyperhidrosis, a condition which causes excessive, unpredictable sweating, is now curable using endoscopic sympathectomy. This minimally invasive procedure offers a dramatically shorter recovery time than traditional thoracic sympathectomy, which requires months of rehabilitation. Endoscopic sympathectomy can be performed on an outpatient basis, and patients can usually resume normal activity in about a week. The procedure has been performed in Charlotte by the neurosurgeons of Carolina Neurosurgery & Spine Associates

What Is Hyperhidrosis?

There are five million sweat glands throughout the body. Two thirds of these glands are actually located in the hands. Sweating is a natural body function controlled by the sympathetic nervous system, and is necessary for the regulation of body temperature. Yet in some people (1% of the population), these nerves are over-stimulated and an excessive amount of sweat is produced. This condition, known as hyperhydrosis, usually starts during adolescence and is lifelong. The profuse sweating of the hands, feet and armpits associated with hyperhydrosis can be episodic or continuous, and may be caused by warm weather, emotional stress, nervousness or occur without any reason.

Forms of Hyperhidrosis

Facial Hyperhidrosis: Facial sweat may cause the patient to appear overly nervous when this is not the case. Some patients may also experience excessive facial blushing.

Palmer Hyperhidrosis: The amount of hand sweating varies from patient to patient and can range from mere moisture to dripping perspiration. Many patients report that their hands also feel cold. Sweaty hands make sufferers feel very uncomfortable in business and social situations and are often the most distressing manifestation of hyperhydrosis.

Axillary, Plantar, And Other Symptoms Of Hyperhidrosis

Axillary hyperhidrosis refers to excessive sweating in the armpits resulting in embarrassing wet marks on shirts and increase body odor. Extreme sweating of the feet is known as Plantar hyperhidrosis and is a known cause of foot odor. Less commonly, patients may experience increased sweating of the trunk or thighs.

A Minimally Invasive Solution

Sympathectomy is a surgical procedure in which the nerves that transmit signals to the sweat glands are cut. These nerves that trigger sweating in the hands, face, and feet are located in the chest cavity. In the past, an open chest procedure, which involved an extended recovery, was required to access and cut these nerves. Many patients preferred to just live with their symptoms because of the magnitude of surgery required to treat the condition.

New advances in minimally invasive surgery now permit our neurosurgeons to perform this procedure on an outpatient basis. Small endoscopes similar to those used in arthroscopic knee surgery, are inserted into the chest through three, one-half inch incisions under the armpit. This procedure is termed endoscopic thoracic sympathectomy.

With this process, the neurosurgeon cuts the sympathetic nerves of the T-2 ganglion with magnification and illumination provided by a miniature fiber optic camera. The surgery takes only an hour and most patients return to work and regular physical activity within one week. The endoscopic technique is very safe and is curative in 98% of patients. Traditional thoracic sympathectomy requires months of recovery for the patient.

Non-surgical Treatment

Conservative, non-surgical treatment is often suggested and recommended before considering surgical intervention for hyperhidrosis. Non-surgical treatment options include:

Antiperspirants

This is the simplest of all treatment options and works for patients with light to moderate hyperhidrosis. The most effective antiperspirant agent is aluminum chloride.

Iontophoresis

If antiperspirants fail, Iontophoresis is sometimes recommended. This treatment consists of applying low-intensity electric current to the hands or feet immersed in an electrolyte solution. Patients must repeat this procedure regularly several times a week. The results vary, and many patients believe Iontophoresis is too time consuming and expensive. It is difficult or impossible to treat axillary or facial hyperhidrosis with this method.

Anticholinergic Drugs

Various drugs may reduce sweating. But because of side effects that include dry mouth, blurred vision and sedation, most patients prefer not to use these medications to treat their hyperhidrosis.

Botulinum Toxin Injections

Botulinum toxin is a poison that interferes with nerve conduction and is often used in low doses to prevent wrinkles by paralyzing muscles in the face or neck. It may also be used to treat hyperhidrosis by paralyzing the sympathetic nerves that cause sweating by injecting the toxin in the axilla or hands. Botulinum toxin is often beneficial for axillary and palmar hyperhydrosis. However, the treatment is temporary and has to be repeated two or more times a year. Over time, some patients feel Botulinum toxin injections are too expensive.