Important advances in epilepsy and seizure management

EpilepsyA report on long-term outcomes in patients treated with a newly approved electrical therapy for refractory seizures is among the highlights at this year’s American Epilepsy Society annual meeting here.

Also on tap: studies of a new form of laser surgery for seizure ablation, a wearable seizure detector, and a device for home monitoring of anti-epileptic drug blood levels, said Kimford Meador, MD, of Stanford University in Stanford, Calif., the organization’s scientific program committee chairman.

Another study, led by Meador himself, examines whether children of mothers taking the epilepsy drug valproate while breastfeeding suffered adverse consequences at age 6 as a result. (Answer: it was definitely not harmful and may have been beneficial.)

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Alzheimer’s Gene Effects May Show Up in Infancy

infancyInfants and toddlers with the Alzheimer’s disease-associated APOE4 genotype already showed distinctive patterns of brain structure relative to other young children, researchers said.

MRI scans carried out in 60 normally developing children, age 2 to 25 months, who carried the APOE epsilon-4 allele, showed smaller volumes of gray matter and and lower white matter myelin water fraction (MWF) compared with 102 children in the same age range whose APOE genes only include the epsilon-2 and/or epsilon-3 alleles, according to Sean C. L. Deoni, PhD, of Brown University in Providence, R.I., and colleagues.

“While our findings should be considered preliminary, this study demonstrates some of the earliest brain changes associated with the major genetic risk factor for late-onset Alzheimer’s disease,” the researchers wrote online in JAMA Neurology.

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New implantation device for intractable epilepsy

brain-epilepsyRNS for Epilepsy Has Long-Term Benefits

More than half of epilepsy patients treated with the recently approved responsive neurostimulation device (RNS) had reductions of 50% from baseline in seizure frequency lasting for up to 80 months, researchers reported here.

Among 250 participants in the pivotal trial of the implanted RNS System neurostimulator, approved last month for treating drug-resistant focal epilepsy, long-term follow-up indicated that responder rates increased steadily over the first 2 to 3 years after implant, reaching about 55%, said Martha Morrell, MD, chief medical officer of NeuroPace, based in Mountain View, Calif., which manufactures the device.

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Lower Back Pain and the Sacroiliac Joint

si-boneWhere is the sacroiliac joint?

The sacroiliac joint connects the last segment of the spine, the sacrum, to the pelvis.  The integrity of the sacroiliac joint depends on strong ligaments that encase and cover the joint.  These ligaments compress and stabilize the joint.

How the sacroiliac joint causes lower back pain?

The ligaments that encase the sacroiliac joint may be disrupted due to injury or degenerate due to age, allowing the joint to have excessive motion. This excessive motion may inflame and disrupt the joint and surrounding nerves.

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Treatment Options for Sacroiliac Joint Disorders

SI-BONETreatments can vary depending on the severity of your symptoms and how much they limit your everyday activities. Below are some of the treatment options you may want to discuss with your doctor, depending on your symptoms.

Nonsurgical Treatment for Sacroiliac Joint Disorders

As a first line of treatment, your doctor may prescribe any one or more of the following:

  • Medications like non-steroidal anti-inflammatory drugs may help relieve pain and reduce inflammation.
  • Physical therapy can help provide strengthening and pelvic stabilization exercises to reduce the movement in the SI joint.
  • SI belt wraps around the hips to help squeeze the sacroiliac joints together. This supports and stabilizes the pelvis and sacroiliac joints.
  • SI joint injections can reduce inflammation and relieve the pain.

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Technological Advancements in Pain Control & Minimally-Invasive Surgery

Technological Advancements in Pain Control & Minimally-Invasive Surgery

YOU’RE INVITED

Wednesday December 4, 2013 // 6:00 pm // Ocean Prime – Troy

The Michigan Surgical Hospital and Lakes Surgery Center present Technological Advancements in Pain Control & Minimally-Invasive Surgery

Dinner Presentation Agenda:

  • 6:30 pm: Introduction
  • 6:40 pm: Dr. Baisa presents “An Innovative & Personalized Approach to Pain Management”.
  • 7:40 pm: Dr. Ron Lederman discusses his exclusive treatment using MLS Laser Therapy. Different from current laser therapies, MLS Laser Therapy works at a cellular level using a combination of laser emissions, simultaneously decreasing swelling and pain and accelerates the healing process. MLS Laser Therapy treats neck pain to foot pain and conditions in between, including back pain, tendonitis, disc injuries, tennis and golf elbow, traumatic injuries and speeds healing after surgery.
  • 7:50pm – Dr. Lucia Zamorano provides information on her use of the cutting edge robotics system for spine surgery. The Mazor Robotics Renaissance Guidance System is exclusively available at the Michigan Surgical Hospital. Dr. Zamorano utilizes the system’s unparalleled accuracy to advance surgical procedures, such as minimally-invasive fusions for degenerative disc diseases or deformity, kyphoplasty/vertebraplasty, and also performing groundbreaking work to combine the robotics system with endoscopic discectomies – the most minimally-invasive surgical intervention available.

RSVP TO BRANDON SHIMKO
Email: b.shimko@mazorrobotics-us.com // Phone: 313.407.9947

View Invitation (PDF)

Clinical guidelines for diagnosis and treatment of lumbar disc herniation

guidelinesClinical guidelines for diagnosis and treatment of lumbar disc herniation with radiculopathy by NASS

Major Recommendations

What history and physical examination findings are consistent with the diagnosis of lumbar disc herniation with radiculopathy?

Manual muscle testing, sensory testing, supine straight leg raise, Lasegue’s sign and crossed Lasegue’s sign are recommended for use in diagnosing lumbar disc herniation with radiculopathy.

Grade of Recommendation: A

The supine straight leg raise, as compared with the seated straight leg raise, is suggested for use in diagnosing lumbar disc herniation with radiculopathy.

Grade of Recommendation: B

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Two-Level Disc Replacement Reduces Reoperation vs Fusion

cervical discPatients with 2-level symptomatic cervical disc degeneration fare better in terms of future secondary surgeries when their discs are replaced rather than fused, a new study shows.

“We found out that the results are really better,” first author Robert Jackson, MD, from Orange County Neurosurgical Associates in Laguna Hills, California, told Medscape Medical News.

Dr. Jackson presented the study, which used Mobi-C cervical disc prostheses (LDR Spine USA), here at the Congress of Neurological Surgeons (CNS) 2013 Annual Meeting.

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No Benefit From Dose-Dense Chemo in Glioblastoma

GlioblastomaIntensified chemoradiation with temozolomide for newly diagnosed glioblastoma failed to improve survival or slow disease progression, according to results of a randomized trial.

Patients randomized to conventional treatment with radiation therapy and temozolomide (Temodar) had a median overall survival (OS) of 16.6 months, whereas patients who received radiation and dose-dense temozolomide had a median survival of 14.9 months.

Median progression-free survival (PFS) was about a month longer with the dose-dense regimen, but the difference did not reach statistical significance, reported Mark R. Gilbert, MD, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues online in the Journal of Clinical Oncology.

“This study did not demonstrate improved efficacy for dose-dense temozolomide for newly diagnosed glioblastoma multiforme, regardless of [MGMT] methylation status,” the authors concluded. “However, it did confirm the prognostic significance of MGMT (methylguanine-DNA methyltransferase) methylation. Feasibility of large-scale accrual, prospective tumor collection, and molecular stratification was demonstrated.”

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Severe depression may be treated with deep Brain stimulation DBS

Deep brain stimulationAssessment of deep brain stimulation for patients with treatment-resistant depression has inched forward over the past decade with promising results but remains in its early days with a total worldwide experience of roughly 60 patients.

That total includes patients who have received deep brain stimulation (DBS) leads placed in six different brain regions. However, the results suggest that one of the better target locations for DBS in patients with treatment-resistant depression (TRD) is in the nucleus accumbens, Dr. Bruno Millet said at the annual congress of the European College of Neuropsychopharmacology.

“The nucleus accumbens is a very good target that we will continue to study. It is very safe, and the surgery is easy and rapid. The nucleus accumbens has a good benefit-to-risk ratio,” said Dr. Millet, professor of psychiatry at the University of Rennes (France). “This is a strength of this target.”

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