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Corpus callosotomy versus vagus nerve stimulation for atonic seizures and drop attacks: A systematic review.
Rolston JD, Englot DJ, Wang DD, Garcia PA, Chang EF
(2015) Epilepsy Behav 51: 13-7
MeSH Terms: Corpus Callosum, Epilepsy, Generalized, Humans, Psychosurgery, Syncope, Vagus Nerve Stimulation
Show Abstract · Added August 12, 2016
Atonic seizures are debilitating and poorly controlled with antiepileptic medications. Two surgical options are primarily used to treat medically refractory atonic seizures: corpus callosotomy (CC) and vagus nerve stimulation (VNS). However, given the uncertainty regarding relative efficacy and surgical complications, the best approach for affected patients is unclear. The PubMed database was queried for all articles describing the treatment of atonic seizures and drop attacks with either corpus callosotomy or VNS. Rates of seizure freedom, >50% reduction in seizure frequency, and complications were compared across the two patient groups. Patients were significantly more likely to achieve a >50% reduction in seizure frequency with CC versus VNS (85.6% versus 57.6%; RR: 1.5; 95% CI: 1.1-2.1). Adverse events were more common with VNS, though typically mild (e.g., 22% hoarseness and voice changes), compared with CC, where the most common complication was the disconnection syndrome (13.2%). Both CC and VNS are well tolerated for the treatment of refractory atonic seizures. Existing studies suggest that CC is potentially more effective than VNS in reducing seizure frequency, though a direct study comparing these techniques is required before a definitive conclusion can be reached.
Copyright © 2015 Elsevier Inc. All rights reserved.
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6 MeSH Terms
Thalamotomy-Like Effects From Partial Removal of a Ventral Intermediate Nucleus Deep Brain Stimulator Lead in a Patient With Essential Tremor: Case Report.
Rolston JD, Ramos AD, Heath S, Englot DJ, Lim DA
(2015) Neurosurgery 77: E831-6; discussion E836-7
MeSH Terms: Deep Brain Stimulation, Device Removal, Electrodes, Essential Tremor, Humans, Male, Middle Aged, Prostheses and Implants, Psychosurgery, Reoperation, Ventral Thalamic Nuclei
Show Abstract · Added August 12, 2016
BACKGROUND AND IMPORTANCE - The ventral intermediate nucleus of the thalamus is a primary target of deep brain stimulation (DBS) in patients with essential tremor. Despite reliable control of contralateral tremor, there is sometimes a need for lead revision in cases of infection, hardware malfunction, or failure to relieve symptoms. Here, we present the case of a patient undergoing revision after ventral intermediate nucleus (Vim) DBS failed to control his tremor. During the electrode removal, the distal portion of the lead was found to be tightly adherent to tissue within the deep brain. Partial removal of the electrode in turn caused weakness, paresthesias, and tremor control similar to the effects produced by thalamotomy or thalamic injury.
CLINICAL PRESENTATION - A 48-year-old man with essential tremor had bilateral Vim DBS leads implanted 10 years earlier but had poor control of his tremor and ultimately opted for surgical revision with lead placement in the zona incerta. During attempted removal of his right lead, the patient became somnolent with contralateral weakness and paresthesias. The procedure was aborted, and postoperative neuroimaging was immediately obtained, showing no signs of stroke or hemorrhage. The patient had almost complete control of his left arm tremor postoperatively, and his weakness soon resolved.
CONCLUSION - To the best of our knowledge, this is the first reported case of cerebral injury after DBS revision and offers insights into the mechanism of high-frequency electric stimulation compared with lesions. That is, although high-frequency stimulation failed to control this patient's tremor, thalamotomy-like injury was completely effective.
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11 MeSH Terms
Identification of neural targets for the treatment of psychiatric disorders: the role of functional neuroimaging.
Vago DR, Epstein J, Catenaccio E, Stern E
(2011) Neurosurg Clin N Am 22: 279-305, x
MeSH Terms: Brain Chemistry, History, 18th Century, History, 19th Century, History, 20th Century, History, Ancient, Humans, Mental Disorders, Models, Neurological, Nerve Net, Nervous System, Neurology, Neuropsychiatry, Neurosurgery, Neurosurgical Procedures, Phrenology, Psychosurgery
Show Abstract · Added January 4, 2020
Neurosurgical treatment of psychiatric disorders has been influenced by evolving neurobiological models of symptom generation. The advent of functional neuroimaging and advances in the neurosciences have revolutionized understanding of the functional neuroanatomy of psychiatric disorders. This article reviews neuroimaging studies of depression from the last 3 decades and describes an emerging neurocircuitry model of mood disorders, focusing on critical circuits of cognition and emotion, particularly those networks involved in the regulation of evaluative, expressive and experiential aspects of emotion. The relevance of this model for neurotherapeutics is discussed, as well as the role of functional neuroimaging of psychiatric disorders.
Copyright © 2011 Elsevier Inc. All rights reserved.
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