96 results found
Objectives. To determine whether deep brain stimulation is an effective treatment for neuropathic pain of varied etiology. Material and Methods. Thirty-four patients with intractable neuropathic pain were prospectively studied using visual analog scores, McGill Pain Questionnaire, and Quality of Life Questionnaires (EUROQOL EQ-5D VAS, and SF-36 v-2). Patients had either deep brain stimulation of either the periventricular gray or ventroposterolateral nucleus of the thalamus, or both. Results. Seventy-six percent of patients underwent permanent implantation. Overall reduction of pain intensity was 54%. The burning component of pain improved by 77%. Health-related quality of life improved by 38%. Conclusions. Deep brain stimulation is an effective treatment for neuropathic pain. The factors that influence outcome, including etiology and site of stimulation, are discussed.
Nandi D, Jenkinson N, Stein JF, et al., 2006, Laboratory and clinical investigations of the region of the rostral brainstem in motor control., Suppl Clin Neurophysiol, Vol: 58, Pages: 71-84, ISSN: 1567-424X
Jenkinson N, Nandi D, Aziz TZ, et al., 2005, Pedunculopontine nucleus: a new target for deep brain stimulation for akinesia., Neuroreport, Vol: 16, Pages: 1875-1876, ISSN: 0959-4965
Bittar RG, Hyam J, Nandi D, et al., 2005, Thalamotomy versus thalamic stimulation for multiple sclerosis tremor, JOURNAL OF CLINICAL NEUROSCIENCE, Vol: 12, Pages: 638-642, ISSN: 0967-5868
Bittar RG, Nandi D, Carter H, et al., 2005, Somatotopic organization of the human periventricular gray matter., J Clin Neurosci, Vol: 12, Pages: 240-241, ISSN: 0967-5868
The periventricular gray (PVG) matter is an established anatomical target for chronic deep brain stimulation (DBS) in the treatment of certain intractable pain syndromes. Data relating to the representation of pain and other somatosensory modalities within the PVG in humans are negligible. We examined the character and location of somatosensory responses elicited by electrical stimulation along the length of the PVG in a patient who underwent unilateral DBS for intractable nociceptive head pain. Consistent responses were obtained and indicated the presence of a somatotopic representation in this region. The contralateral lower limb was represented cranially, followed by the upper limb and trunk, with the face area located caudally, near the level of the superior colliculi. Bilateral representation was only observed in the forehead and scalp.
Yianni J, Bradley K, Soper N, et al., 2005, Effect of GPi DBS on functional imaging of the brain in dystonia., J Clin Neurosci, Vol: 12, Pages: 137-141, ISSN: 0967-5868
Five patients with idiopathic dystonic conditions, treated successfully with deep brain stimulation (DBS) of the globus pallidus internus (GPi), were studied using single-photon emission tomography (SPET) in order to evaluate brain perfusion in the presence and absence of DBS. Comparison was made between the "on" and "off" DBS scans on an individual basis and also as part of a group analysis. Whilst the individual data suggested great regional variation in cerebral perfusion between individuals, the results of the group analysis revealed several topographically similar areas of the brain where relative hyperperfusion in the absence of DBS was common to all patients. Based on these results we postulate on possible mechanisms for this phenomenon.
Bittar RG, Yianni J, Wang SY, et al., 2005, Deep brain stimulation for generalised dystonia and spasmodic torticollis, JOURNAL OF CLINICAL NEUROSCIENCE, Vol: 12, Pages: 12-16, ISSN: 0967-5868
Bittar RG, Yianni J, Wang S, et al., 2005, Stereotactic and Functional Neurosurgery Resident Award: deep brain stimulation for generalized dystonia and spasmodic torticollis: rate and extent of postoperative improvement., Clin Neurosurg, Vol: 52, Pages: 379-383, ISSN: 0069-4827
Jenkinson N, Nandi D, Miall RC, et al., 2004, Pedunculopontine nucleus stimulation improves akinesia in a Parkinsonian monkey., Neuroreport, Vol: 15, Pages: 2621-2624, ISSN: 0959-4965
We have studied the effects of stimulating the pedunculopontine nuclei through a fully implanted macroelectrode with a s.c. implantable pulse generator whose parameters can be programmed telemetrically, in a macaque before and after inducing Parkinsonian akinesia with MPTP. Our results show that in the normal monkey high frequency stimulation of the pedunculopontine nuclei reduces motor activity while low frequency stimulation increases it significantly over baseline. After making the monkey Parkinsonian with MPTP, unilateral low frequency stimulation of the pedunculopontine nuclei led to significant increases in activity. These results suggest that pedunculopontine nuclei stimulation could be clinically effective in treating advanced Parkinson's disease and other akinetic disorders.
Bojanic S, Sethi H, Hyam J, et al., 2004, Externalising deep brain electrodes: an increased risk of infection?, JOURNAL OF CLINICAL NEUROSCIENCE, Vol: 11, Pages: 732-734, ISSN: 0967-5868
Nandi D, Yianni J, Humphreys J, et al., 2004, Phantom limb pain relieved with different modalities of central nervous system stimulation: A clinical and functional imaging case report of two patients, NEUROMODULATION, Vol: 7, Pages: 176-183, ISSN: 1094-7159
Yianni J, Nandi D, Bradley K, et al., 2004, Senile chorea treated by deep brain stimulation: a clinical, neurophysiological and functional imaging study., Mov Disord, Vol: 19, Pages: 597-602, ISSN: 0885-3185
We report on a patient with senile chorea, treated with deep brain stimulation of the left globus pallidus internus and subsequently the left ventralis oralis posterior nucleus of the thalamus. Deep brain field potential recordings and functional imaging using single photon emission tomography enabled us to suggest pathophysiological mechanisms for the symptoms.
Yianni J, Nandi D, Shad A, et al., 2004, Increased risk of lead fracture and migration in dystonia compared with other movement disorders following deep brain stimulation, JOURNAL OF CLINICAL NEUROSCIENCE, Vol: 11, Pages: 243-245, ISSN: 0967-5868
Green AL, Shad A, Watson R, et al., 2004, N-of-1 Trials for Assessing the Efficacy of Deep Brain Stimulation in Neuropathic Pain., Neuromodulation, Vol: 7, Pages: 76-81, ISSN: 1094-7159
The objective of this study is to determine the usefulness of single-patient, randomised, controlled trials (N-of-1 trials) in assessing the efficacy of deep brain stimulation (DBS) in neuropathic pain. Seven patients with various causes of intractable neuropathic pain underwent insertion of deep brain stimulating electrodes into the periventricular gray area or ventroposterolateral nucleus of the thalamus. Preoperatively, pain was measured using Visual Analog Scales (VAS) and the McGill Pain Questionnaire (MPQ). At 6 months, these pain assessments were repeated. At this point all patients were entered into a N-of-1 trial with the DBS on and off. Data were analyzed using the Wilcoxon and Student t-tests. Following placement of the deep brain stimulator, VAS scores were significantly reduced in six of seven patients. McGill Pain Scores (MPS) showed pain reduction in four of seven. The results of the N-of-1 trials were most similar to the MPQ scores and showed that three of seven patients could accurately predict whether the DBS was on or off. In the N-of-1 trials, the time between changing the DBS from on to off (or vice versa) had an effect on the results and probably underestimated the efficacy. We conclude that N-of-1 trials are a useful tool for assessing DBS efficacy.
Nandi D, Aziz TZ, 2004, Deep brain stimulation in the management of neuropathic pain and multiple sclerosis tremor, JOURNAL OF CLINICAL NEUROPHYSIOLOGY, Vol: 21, Pages: 31-39, ISSN: 0736-0258
Yanni J, Nandi D, Hyam J, et al., 2004, Failure of chroninc palladial stimulation in dystonic patients is a medical emergency, Neuromodulation, Vol: 7(1), Pages: 9-12
Green AL, Nandi D, Armstrong G, et al., 2003, Post-herpetic trigeminal neuralgia treated with deep brain stimulation., J Clin Neurosci, Vol: 10, Pages: 512-514
Post-herpetic neuralgic affects up to 20% of patients after an attack of trigeminal Herpes Zoster infection. Past medical and surgical treatments have been unrewarding. We report the successful treatment of such a case with deep brain stimulation into the region of the contralateral periventricular grey area (PVG) and ventral posterior lateral thalamic nucleus (VPL).
Yianni J, Bain PG, Gregory RP, et al., 2003, Post-operative progress of dystonia patients following globus pallidus internus deep brain stimulation, EUROPEAN JOURNAL OF NEUROLOGY, Vol: 10, Pages: 239-247, ISSN: 1351-5101
Yianni J, Bain P, Giladi N, et al., 2003, Globus pallidus internus deep brain stimulation for dystonic conditions: A prospective audit, MOVEMENT DISORDERS, Vol: 18, Pages: 436-442, ISSN: 0885-3185
Malu S, Srinivasan S, Maiti PK, et al., 2003, IFN-gamma bioassay: development of a sensitive method by measuring nitric oxide production by peritoneal exudate cells from C57BL/6 mice, JOURNAL OF IMMUNOLOGICAL METHODS, Vol: 272, Pages: 55-65, ISSN: 0022-1759
Nandi D, Aziz T, Carter H, et al., 2003, Thalamic field potentials in chronic central pain treated by periventricular gray stimulation -- a series of eight cases., Pain, Vol: 101, Pages: 97-107, ISSN: 0304-3959
Chronic deep brain stimulation (DBS) of the periventricular gray (PVG) has been used for the treatment of chronic central pain for decades. In recent years motor cortex stimulation (MCS) has largely supplanted DBS in the surgical management of intractable neuropathic pain of central origin. However, MCS provides satisfactory pain relief in about 50-75% of cases, a range comparable to that reported for DBS (none of the reports are in placebo-controlled studies and hence the further need for caution in evaluating and comparing these results). Our experience also suggests that there is still a role for DBS in the control of central pain. Here we present a series of eight consecutive cases of intractable chronic pain of central origin treated with PVG DBS with an average follow-up of 9 months. In each case, two electrodes were implanted in the PVG and the ventroposterolateral thalamic nucleus, respectively, under guidance of corneal topography/magnetic resonance imaging image fusion. The PVG was stimulated in the frequency range of 2-100 Hz in alert patients while pain was assessed using the McGill-Melzack visual analogue scale. In addition, local field potentials (FPs) were recorded from the sensory thalamus during PVG stimulation. Maximum pain relief was obtained with 5-35 Hz stimulation while 50-100 Hz made the pain worse. This suggests that pain suppression was frequency dependent. Interestingly, we detected low frequency thalamic FPs at 0.2-0.4 Hz closely associated with the pain. During 5-35 Hz PVG stimulation the amplitude of this potential was significantly reduced and this was associated with marked pain relief. At the higher frequencies (50-100 Hz), however, there was no reduction in the FPs and no pain suppression. We have found an interesting and consistent correlation between thalamic electrical activity and chronic pain. This low frequency potential may provide an objective index for quantifying chronic pain, and may hold further clues to the mechanism of
Liu X, Ford-Dunn HL, Hayward GN, et al., 2002, The oscillatory activity in the Parkinsonian subthalamic nucleus investigated using the macro-electrodes for deep brain stimulation, CLINICAL NEUROPHYSIOLOGY, Vol: 113, Pages: 1667-1672, ISSN: 1388-2457
Nandi D, Aziz TZ, Giladi N, et al., 2002, Reversal of akinesia in experimental parkinsonism by GABA antagonist microinjections in the pedunculopontine nucleus., Brain, Vol: 125, Pages: 2418-2430, ISSN: 0006-8950
Recent studies, mainly in animals, have shown that the pedunculopontine nucleus (PPN) in the upper brainstem has extensive connections with several motor centres in the CNS. This structure has also been implicated in the akinesia seen in patients with Parkinson's disease. Here we demonstrate that microinjection of gamma-aminobutyric acid (GABA) receptor A antagonist substance, bicuculline, into the PPN of non-human primates (n = 2) rendered parkinsonian with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) results in significant improvement of akinesia. The effect of bicuculline microinjection in the PPN matches that of oral administration of L-dopa. This finding opens up new possibilities in the management of akinesia, the most intractable symptom of advanced Parkinson's disease.
Nandi D, Smith H, Owen S, et al., 2002, Peri-ventricular grey stimulation versus motor cortex stimulation for post stroke neuropathic pain., J Clin Neurosci, Vol: 9, Pages: 557-561, ISSN: 0967-5868
Central post stroke pain is often difficult to manage satisfactorily with conventional treatment modalities for pain. In the last decade functional neurosurgery has offered hope with motor cortex stimulation achieving significant alleviation of pain in some patients. Unfortunately this has led to the neglect of chronic stimulation of deep grey matter as another modality of treating this condition. In this article we present our experience with motor cortex stimulation and that with deep grey matter stimulation in patients with post stroke pain. We argue that both modalities have a significant role and that what is required are better methods of identifying particular patients who are more likely to respond to one or the other.
Nandi D, Parkin S, Scott R, et al., 2002, Camptocormia treated with bilateral pallidal stimulation - Case report - Reprinted from Neurosurg Focus vol 12, JOURNAL OF NEUROSURGERY, Vol: 97, Pages: 461-466, ISSN: 0022-3085
Nandi D, Liu XG, Joint C, et al., 2002, Thalamic field potentials during deep brain stimulation of periventricular gray in chronic pain, PAIN, Vol: 97, Pages: 47-51, ISSN: 0304-3959
Nandi D, Liu X, Winter JL, et al., 2002, Deep brain stimulation of the pedunculopontine region in the normal non-human primate, JOURNAL OF CLINICAL NEUROSCIENCE, Vol: 9, Pages: 170-174, ISSN: 0967-5868
Nandi D, Parkin S, Scott R, et al., 2002, Camptocormia treated with bilateral pallidal stimulation: case report., Neurosurg Focus, Vol: 12
The authors report the neurological, neurophysiological, and neuropsychological effects of using chronic bilateral pallidal high-frequency deep brain stimulation (DBS) in a case of disabling camptocormia. Deep brain stimulation electrodes were implanted stereotactically to target the globus pallidus internus (GPi) bilaterally. Local field potentials (FPs) were recorded using the DBS electrodes and concurrent abdominal flexor electromyography (EMG) potentials during camptocormic episodes. Videotaped assessments of the movement disorder and neuropsychological evaluation before implantation and at 6 months after initiation of pallidal stimulation were recorded. There was significant functional improvement following chronic pallidal stimulation, and some improvement was noted in neuropsychological scores. The GPi FPs showed temporal correlation with EMG-recorded rectus abdominis potentials. There were no treatment-related adverse effects. The authors have found that chronic pallidal stimulation was safe and offered functional benefit in this severely disabling condition. The physiological studies may help further the understanding of the pathophysiology of this rare entity.
Nandi D, Chir M, Liu X, et al., 2002, Electrophysiological confirmation of the zona incerta as a target for surgical treatment of disabling involuntary arm movements in multiple sclerosis: use of local field potentials, JOURNAL OF CLINICAL NEUROSCIENCE, Vol: 9, Pages: 64-68, ISSN: 0967-5868
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