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Hi doctor I am not able to lift my hand and I am feeling numbness on my left hand one of my friend when playing caught left of my neck by mistake so suddenly numbness started. I consulted a local doctor he told it will go in 2 hours but it dint go this happened at yesterday 3 pm and still dint go what should I do doctor?
ELECTRICAL STIMULATION OF BRAIN---BRAIN PACEMAKER
Dr Amit Kumar Ghosh, Consultant Neurosurgeon,
The above picture is of brain pacemaker. Brain pacemaker is a device which consists of a battery, extension wire and electrode, by which specific nerve cell of brain can be electrically stimulated to modify its activity and to get clinical benefit of the patients suffering from Parkinsonism, dystonia etc.(1)
The concept of electrical stimulation of brain came when Giovanni Aldini (1762–1834), professor of Physics at the University of Bologna, performed electrical stimulations on the exposed human brain of decapitated prisoners. In 1804, Aldini reported that brain stimulation evoked horrible facial grimaces. This finding led him to conclude that the brain surface could be electrically stimulated and electricity could have therapeutic effects in the treatment of many neuropsychiatric disorders (Aldini, 1804). (2)
Aldini’s experimentations and hypotheses led to direct research into two strands that would later developed during the ninetieth and twentieth century: on the one hand the use of brain stimulation for neurophysiologic investigation (initially on animals and then on humans) to understand the functioning of the brain, on the other hand the use of the techniques of brain stimulation for therapeutic purposes.
In 1952, the Spanish neuroscientist José M. Delgado, based on his experience of electrical stimulation of brain nerve cells in animals, first described the technique of implantation of electrodes into human brain, indicating the importance of this method and its possible role in treatment of patients with mental disorders.(3),(4)
Gradually, different areas of brain have been experimentally stimulated in animals to get different observations and that implemented in human.(4)
Finally, today, we routinely do DEEP BRAIN STIMULATION (5), which is sometimes called in general as brain pacemaker (1). It is a surgical procedure where we put electrodes into the specific nerve cell of brain to get clinical benefit. The crippling disease like Parkinsonism, dystonia can be controlled to give a better quality of life for those patients.
In mid-twentieth century the advent of stereotactic technique added new horizon in the field of techniques of stimulation of deep nuclei of the brain for therapeutic purposes. The instrument by which electrode is implanted into the brain is called Stereotactic frame (6) (Picture 1A,1B). Stereotaxy (6),(7) is the method by which we can locate a point in the 3-dimentional space using X-Y-Z co-ordinates. By the same way any nerve cell which is microscopic in nature [vary in size from 4 microns (.004 mm) to 100 microns (.1 mm) in diameter] can be thought as a point within the skull and can be accessed by Stereotaxy.
Since ancient times, human brain had been cut after death to see the structure (Anatomy) and to know which nerve is where and what is there functions (Physiology) and also how brain looks like in the diseased state (Pathology). That was the search in the ocean. Some facts are known and many are still unknown mystery. But this search has given the idea about the location of some nerves in human brain based on which Anatomical Atlas(8) had been made which helps us to reach that specific nerve depending on X-Y-Z coordinate by the help of stereotactic instrument (frame) without directly seeing that particular nerve from outside.
The way stereotactic frame is fixed with human head for insertion of electrodes (Picture 1B)
Till now, we were talking about the era before the invention of Computer, software, CT (Computed tomography--- one kind of brain scan to see the anatomical structures), MRI (Magnetic resonance imaging--- one kind of brain scan to see the anatomical structures).
But now, we have all these tools (computer,software,CT/MRI scans etc), by which we can see those nerves and specific areas and can negotiate electrodes more accurately and safely into those areas.
There is a area in the brain called subthalamic nucleus (nerve cell). Implantation of electrode in subthalamic nucleus (STN) and its stimulation by a external programmer (like remote control) [picture 2] with specific amplitude and rate will give the desired clinical benefit to the patient with Parkinsonism.
By this way, we are able to treat selected cases of Parkinson’s disease, dystonia, psychiatric disease, chronic pain, epilepsy etc.
This article is the brief introduction about the electrical stimulation that modulates the nervous system of human body.
In this way, deep brain stimulation (DBS) was born, that, over the last two decades, has led to positive results for the treatment of medically refractory Parkinson’s disease, essential tremor, and dystonia. Finally, today, we routinely do DEEP BRAIN STIMULATION (5), which is sometimes called in general as brain pacemaker (1). It is a surgical procedure where we put electrodes into the specific nerve cell of brain to get clinical benefit. The crippling disease like Parkinsonism, dystonia can be controlled to give a better quality of life for those patients.
In recent years, the indications for therapeutic use of DBS have been extended to epilepsy, psychiatric diseases (depression, obsessive–compulsive disorder), some kinds of headache, eating disorders, and the minimally conscious state. The potentials of the DBS for therapeutic use are fascinating. It is the subject where biological science and biomedical engineering meets together.
- Dept. of IT,BMSPI (Biomedical Signal processing and Instrumentation)-(2012 -13) ,DEEP BRAIN STIMULATION- A BRAIN PACEMAKER FOR NEUROLOGICAL DISORDERS
- Aldini J. (1804). Essai théorique et expérimental sur le galvanisme, avec une série d’expériences faites devant des commissaires de l’Institut nationale de France, et en divers amphithéâtres anatomiques de Londres. Paris: Fournier Fils
- Delgado J., Hamlin H., Chapman W. (1952). Technique of intracranial electrode implacement for recording and stimulation and its possible therapeutic value in psychotic patients. Confin. Neurol. 12, 315–31910.1159/000105792
- Vittorio A. Sironi. Origin and Evolution of Deep Brain Stimulation. Front Integr Neurosci. 2011; 5: 42. (Published online 2011 Aug 18. doi: 10.3389/fnint.2011.00042)
- Rajesh Pahwa, Kelly E. Lyons, Jules M. Nazzaro, MD. Deep Brain Stimulation For Parkinson’s Disease. University of Kansas Medical Center.
- Stereotaxic Technique. The Great Soviet Encyclopedia, 3rd Edition (1970-1979).
- Spiegel E. A., Wycis H. T., Marks M., Lee A. S. (1947). Stereotactic apparatus for operation on the human brain. Science 106, 349–35010.1126/science.106.2754.349
- Schaltenbrand G, Wahren W. Atlas for Stereotaxy of the Human Brain. New York: Georg Thieme, 1977.
Brain surgery involves several medical procedures, which incorporate fixing issues with the brain, including changes in the tissues of the brain, cerebrospinal fluid and brain blood flow. Brain surgery is quite a complicated method of surgery and the type of surgery to be conducted depends on the underlying conditions.
Reasons for Brain Surgery:
Brain surgery is performed for the correction of physical brain abnormalities. These abnormalities could occur because of diseases, birth defects and injuries. A brain surgery is required when the following conditions arise in the brain:
- Abnormal blood vessels
- Blood clots in the brain
- When the protective tissue or dura is damaged
- Due to nerve damage
- Parkinson's disease
- Any kind of pressure after an injury
- Skull fractures
- In case of stroke and tumors
A surgery may not be required for all the above mentioned conditions, but in case of many, a brain surgery is very important as the conditions may worsen health problems.
Types of brain surgeries:
- Craniotomy: During this open brain surgery, an incision is made in the scalp, and a hole is created in the skull, near the area, which is being treated. After this process is complete, the hole or bone flap is secured in its place using plates or wires.
- Biopsy: This form of brain surgery helps in the removal of a small amount of brain tissues or tumors. After removal, the tissues or tumors are examined under a microscope. The creation of a small incision and a hole in the skull is indicated as a part of this process.
- Minimally invasive endonasal endoscopic surgery: This form of brain surgery enables the removal or lesions and tumors via the nose and sinuses. Private parts of the brain can be accessed without creating an incision. An endoscope is utilized in the process which is used to examine tumors all across the brain.
- Minimally Invasive neuroendoscopy: This process is similar to the minimally invasive endonasal endoscopic surgery. This method also involves the use of an endoscope for removal of brain tumors. Small, dime sized holes may be made in the skull to access some brain parts.
Brain surgeries may be associated with several risks. They may be:
- Allergic reactions to anesthesia
- Blood clot formations
- Swelling of the brain
- A state of coma
- Impairment in speech, coordination and vision.
- Problems in memory
- Strokes and seizures
- Infections in the brain
A brain surgery is a serious and very complex surgery. There are different kinds of brain surgeries, which are conducted depending on the condition and severity of the disease.
Is there any positive treatment for a girl person age 28 yrs, from Neurofibromatosis. Or medicine that can reduce the small lumps, on her hands, back and abdomen.
GB syndrome leg paralysis. ENMG NORMAL MRI NORMAL BLOOD NORMAL CSF NORMAL. BUT CAN not walk or not working legs. No strength in legs. Touch sensor in leg also normal.
Headache - Dr amit ghosh
Abstract--- headache is very common in our society. Sudden headache may be simply tension induced, but sometimes may be due to serious brain haemorrhage. Long term headache is most of the times trigger-induced, but occasionally may be due to some underlying disease. In this article, essential information about headache has been discussed.
Headache is very common in our society. It is one of the most common ailments which most people experience at some point in their life. It can affect anyone regardless of age, race and gender.
The world health organization (who) reports that around 47% of adults worldwide have experienced headache in the last year.
Let us see the statistics and few important information.
Statistics--- (source: johnston et al drugs 2010. New england journal of medicine 2010)
324 million people worldwide are suffering from headache
headache is the 19th most disabling disease
headache accounts for:
3% of emergency department visits
1.3% of outpatient clinic visits
loss of productive work time due to headache was $19.6 billion in 2010 the majority of headaches are called primary headaches and are not associated with an underlying disease
Primary headache type (source: bajwa and wootton. Evaluation of headache in adults. Up to date 2016)
1. Migraine type
2. Cluster type
3. Tension type
4. Chronic daily headache
Causes of secondary headaches (associated with underlying disease)---
2. Vascular disease (stroke, hemorrhage etc)
3. Changes in intracranial pressure
4. Some medicines
5. Substance abuse (addiction)
7. Metabolic disorders
8. Structural abnormalities (tumors, infective mass etc.)
When headache happens without any underlying disease why and how it happens?
Common triggers (which irritates)
Depression (depression is three times more common in individuals with severe headache)
Poor travel conditions
Religious fasting practice
Joint family stress
Work stress/other stress/anxiety/exertion
Henna application/hair colour
Hormonal changes in female (menstruation, menopause, pregnancy)
Visual stimulus (tv, computer, high voltage light etc)
Barometric pressure changes
Caffeine withdrawal, additives
What you need to do---
1) avoid all these triggers
2) exclude the possibility of all underlying disease from doctor (most important). You will need to do brain scan (ct/mri), few blood tests, blood pressure measurement. You may need cerebrospinal fluid test and it's pressure measurement also.
3) if required you may need some medicines and psychological counselling.
4) do not take any pain killers for long time that may give you temporary relief but will damage your stomach, kidney etc.
5) if headache is very sudden and very severe, intolerating, it could be brain hemorrhage; should be sent to hospital for brain scanning without delay.
1) elizabeth loder, m. D, m. P. H: triptan therapy in migraine:
N engl j med 2010; 363: 63-70july 1, 2010doi: 10.1056/nejmct0910887
2) mcconaghy jr. Headache in primary care. Prim care. 2007 mar; 34 (1: 83-97.
3) evaluation of headache in adults: zahid h bajwa, md, r joshua wootton, mdiv, phd: headache 2007; 47: 213. Http://www. Uptodate. Com/contents/evaluation-of-headache-in-adults
4) timothy r. Smith, md, robert a. Nicholson, phd, and james w. Banks, md: a primary care migraine education program has benefit on headache impact and quality of life: results from the mercy migraine management program: headache. 2010 apr; 50 (4): 600x2013;612.
5) http://emedicine. Medscape. Com/article/1142556-overview
6) dawn a. Marcus: headache simplified: tfm publishing ltd, shrewsbury, shrewsbury. Uk, 2008
Surgery is an alternative for some people whose seizures cannot be controlled by medications. It has been used for more than a century, but its use dramatically increased in the 1980s and 90s, reflecting its effectiveness as an alternative to seizure medicines. In the January 20, 2015 issue of the journal JAMA, Doctors Jobst and Cascino from Dartmouth and Mayo Clinic present a review of epilepsy surgery used for focal epilepsy. With a MEDLINE and Cochrane database search, 55 articles were included in this systematic review. They found two randomized clinical trials enrolling 118 people with temporal lobe epilepsy. People in those trials found greater freedom from seizures with surgery when compared with continued medical treatment, 58% vs. 8% and 73% vs. 0% for each respective trial. Nine systematic reviews and two large case series of people with medically refractory seizures treated with surgery reported seizure free outcomes in 34 to 74% of the cases. Epilepsy surgery was less effective for extratemporal lesions when the seizures were not associated with a structural lesion or both. Seizure free outcomes were similar between children and adults. Hippocampal sclerosis and benign tumors were associated with better outcomes relative to other pathologies. Similar procedures, such as selective amygdalohippocampectomy and temporal lobectomy for temporal lobe epilepsy, were associated with subtle differences in seizure and neuropsychological outcome. There was low perioperative mortality from epilepsy surgery. The most frequent complication is visual field defect occurring from temporal lobe resection. Quality of life improved after surgery but improved the most in people who were seizure free after surgery. The authors concluded that epilepsy surgery reduced seizure activity in randomized clinical trials when compared with continued medical therapy. Despite good outcomes from high quality clinical trials, referrals of patients with seizures refractory to medical treatment remain infrequent. Awareness is required in favour of Epilepsy surgical option for those patients who's life is severely disturbed by uncontrolled Epilepsy.