Background. Vagus nerve stimulation (VNS) therapy is associated with a decrease in seizure frequency in partial-onset seizure patients. Initial trials suggest that it may be an effective treatment, with few side-effects, for intractable depression.Method. An open, uncontrolled European multi-centre study (D03) of VNS therapy was conducted, in addition to stable pharmacotherapy, in 74 patients with treatment-resistant depression (TRD). Treatment remained unchanged for the first 3 months ; in the subsequent 9 months, medications and VNS dosing parameters were altered as indicated clinically.Results. The baseline 28-item Hamilton Depression Rating Scale (HAMD-28) score averaged 34. After 3 months of VNS, response rates (o50 % reduction in baseline scores) reached 37 % and remission rates (HAMD-28 score <10) 17 %. Response rates increased to 53 % after 1 year of VNS, and remission rates reached 33 %. Response was defined as sustained if no relapse occurred during the first year of VNS after response onset ; 44 % of patients met these criteria. Median time to response was 9 months. Most frequent side-effects were voice alteration (63 % at 3 months of stimulation) and coughing (23 %).Conclusions. VNS therapy was effective in reducing severity of depression ; efficacy increased over time. Efficacy ratings were in the same range as those previously reported from a USA study using a similar protocol ; at 12 months, reduction of symptom severity was significantly higher in the European sample. This might be explained by a small but significant difference in the baseline HAMD-28 score and the lower number of treatments in the current episode in the European study.
The authors report the first case of chronic globus pallidus internus (GPi) stimulation for treatment of medically intractable hemidystonia for which long-term follow-up data are available. The patient had developed left-sided low-frequency tremor and hemidystonia after a severe head trauma sustained at 15 years of age. He experienced relief of the tremor but not of the hemidystonia after a thalamotomy was performed in the right hemisphere 3 years postinjury. When the patient was 24 years old, the authors performed a magnetic resonance-guided stereotactic implantation of a monopolar electrode in the right-sided posteroventral GPi. Chronic deep brain stimulation resulted in remarkable improvement of dystonia-associated pain, phasic dystonic movements, and dystonic posture, which was accompanied by functional gain. Postoperative improvement was sustained after 4 years of follow up. Chronic GPi stimulation appears to be a valuable treatment option for posttraumatic dystonia.
Patients with gluteal and perineal/perianal hidradenitis suppurativa are usually neglected by surgeons because of lack of collaboration of general and plastic surgery departments. Most surgical treatment options described in the literature such as secondary healing after excision and skin grafting prevent patients from returning to daily life early, and cause additional morbidities. Fasciocutaneous flaps other than perforator flaps may be limited by design such that both gluteal regions may have to be used for reconstruction of large defects. SGAP and IGAP flaps have long pedicles with a wide arc of rotation. Large defects can be reconstructed with single propeller flap designs, enabling preservation of the rest of the perforators of the gluteal region.
DCS is a rewarding therapeutic option in selected patients with critical limb ischaemia. delta tcpO2 appears to reliably predict response to DCS and may obviate trial stimulation in most cases.
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