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Brain-Related Functional Problems

handsMany different neurologic problems affect the ability of the nervous system to control the voluntary and involuntary actions of the body.   These functions include movement and organ processes in the body.   Certain of these conditions are referred to as functional neurologic problems.   They are characterized by tremors, spasms, spasticity or loss of voluntary motion——or symptoms from direct injury to nerves.   Care of these conditions is a dedicated focus of the neurosurgical team at Virtua Our Lady of Lourdes Hospital.

Function neurologic problems include:

  • Brain disorders such as epilepsy, Parkinson’s disease, hydrocephalus or malformations of the brain present from birth.
  • Peripheral nerve injuries or compression resulting in pain, numbness, weakness, abnormal sensations or wasting in the muscles in the face, arm, hand or leg.
  • Conditions with specific abnormalities of nerve anatomy, such as carpal tunnel syndrome (in which the nerve crossing the wrist is compressed or entrapped).

The neurosurgical team at Virtua Our Lady of Lourdes Hospital can help to oversee a care plan for these conditions that emphasizes noninvasive strategies first and whenever possible.   Treatments may involve medication, various therapies including physical or occupational therapy and pain management.   When these approaches are not adequate, stereotactic surgery can be effective, even for brain conditions such as epilepsy or Parkinson’s disease.   Because of the level of risk inherent in any brain surgery, it is usually an option reserved for patients with severe or progressively debilitating disease or those who suffer severe medication-induced side effects.

Epilepsy Surgery

Epilepsy surgery, and the testing to prepare for it, have improved and supported a trend toward intervening surgically earlier in the course of care for patients who are having break-through seizures (that is, seizures despite drug therapy).   The surgery seeks to remove (resect) the area of the brain triggering the seizure, interrupt the nerve pathways that distribute the seizure pathways or implant a device that uses stimulation to block the seizures. The area of the brain where the seizures start, the seizure focus, must be identified first, and operating on it must not be deemed to endanger any critical brain functions.

Resection procedures include:

  • lobectomy (part of the temporal lobe is removed)
  • cortical excision
  • or hemispherectomy.

Interruptive procedures (such as corpus callosotomy) isolate the area of your brain where seizures begin. Some epilepsy surgery often cures the condition, while in other cases the procedures reduce the frequency and extent of seizures.

deep brainDeep Brain Stimulation

In the field of neurosurgery, various forms of implantable electric stimulation can help with pain and function.   One form is deep brain stimulation, in which the team inserts a fine electrode wire into a carefully identified location deep in the brain and the impulses from it help to block abnormal electrical signals.   Microelectrodes placed in the targeted area of the brain help the team to map electrical brain activity in these regions and adjust the location of the stimulation, which is powered by a small pacemaker-like device surgically placed under the skin in the upper chest near the collar bone.   The stimulator is connected to the electrodes by extension wires run beneath the skin of the neck.   All parts of the stimulator system are internal, with no wires coming out through the skin.   The stimulation is adjustable externally.

Deep brain stimulation is an implant therapy that can be effective for otherwise intractable seizures from conditions such as epilepsy and for the movement and muscular symptoms that characterize conditions such as Parkinson’s disease, as well as other conditions that cause severe muscle-tone or tremor problems.   It can achieve many of the benefits of successful drug therapy and reduce the movement-related side effects of drug therapy.

Unlike earlier therapies (see below), deep brain stimulation does not damage the brain and is reversible.

Radiosurgery may also be an option for some difficult-to-treat functional neurosurgical problems, such as epilepsy and Parkinson’s disease.

Other Parkinson’s Surgery

Again, surgery for function problems such as Parkinson’s disease is only done as an additional treatment when medical and other therapies fail.   Much less commonly today, neurosurgeons may choose a form of surgery for Parkinson’s in which they make a small opening in the skull and, under imaging guidance, use a very fine instrument to destry small areas of brain cells through freezing or electrical energy.

These lesioning techniques selectively damage cells in small target areas of the brain.   This serves to interrupt the faulty signals causing symptoms.

Other experimental procedures aimed at restoring dopamine-producing cells in key locations of the brain are under investigative use.

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