Bydgoszcz, Poland
Bydgoszcz, Poland

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Sokal P.,Military Research Hospital | Harat M.,Nicolaus Copernicus University | Zielinski P.,University of Gdansk | Kieronska S.,Military Research Hospital
Journal of Pain Research | Year: 2017

Peripheral neuropathic pain (PNP) and complex regional pain syndrome (CRPS) can be effectively treated with peripheral nerve stimulation. In this clinical trial report, effectiveness of novel, miniature, wirelessly controlled microstimulator of tibial nerve in PNP and CRPS was evaluated. In this pilot study the average preoperative visual analog scale (VAS) score in six patients was 7.5, with 1, 3 and 6 months: 2.6 (p=0.03), 1.6 (p=0.03), and 1.3 (p=0.02), respectively. The mean average score in the six patients a week preceding the baseline visit was 7.96, preceding the 1, 3 and 6 month visits: 3.32 (p=0.043), 3.65 (p=0.045), and 2.49 (p=0.002), respectively. The average short-form McGill pain score before surgery was 23.8, and after 1, 3 and 6 months it was 11.0 (p=0.45), 6.3 (p=0.043), and 4.5 (p=0.01), respectively. Applied therapy caused a reduction of pain immediately after its application and clinical improvement was sustained on a similar level in all patients for six months. No complications of the treatment were observed. Intermittent tibial nerve stimulation by using a novel, miniature, wirelessly controlled device can be effective and feasible in PNP and CRPS. It is a safe, minimally invasive, and convenient neuromodulative method. © 2017 Sokal et al.


Sokal P.,Military Research Hospital | Harat M.,Nicolaus Copernicus University | Rusinek M.,Military Research Hospital | Rudas M.,Military Research Hospital | Litwinowicz A.,Military Research Hospital
Interdisciplinary Neurosurgery: Advanced Techniques and Case Management | Year: 2015

Background: Precise and accurate placement of electrodes in DBS surgery is essential in achievement of proper therapeutical effect in movement disorders. Verification of their position in the target is necessary. It can be performed postoperatively. But more convenient for the patient is an intraoperative CT imaging in the operating room. We evaluated the results of DBS electrodes implantation in patients with Parkinson's disease by intraoperative CT. Case series: 21 patients with Parkinson's diseasewere operated in 2010-2012 in the Military Clinical Hospital in Bydgoszcz, Poland. Standard procedure of electrode implantation was verified by intraoperative CT in operating room. CT scanswere fused with preoperative MRI plan of target (STN) and trajectory and accuracywere assessed. Results: Mean differences between positions of tips of electrodes implanted and intended coordinates of targets were: 0.9 mm; 1.6 mm; and 0.8 mmin horizontal line, in vertical line, and in lateral line respectively and remain within the limits of the intraoperative CT resolution. In 1 case the accuracywas not satisfying and replacement of electrodes in one stage surgery was required. Conclusions: Intraoperative CT is a helpful tool in DBS procedures and enables comparison of preoperative plans with the final trajectory and localization of the tip of electrode visualized in CT in appropriate target. It eliminates necessity of post-op verification outside the operating room. All changes can be done during the procedure. It also allows to rule out the intracerebral haematoma caused by implantation. © 2014 The Authors. Published by Elsevier B.V.


Sokal P.,Military Research Hospital | Harat M.,Military Research Hospital | Zielinski P.,Military Research Hospital | Furtak J.,Military Research Hospital | And 2 more authors.
Advances in Clinical and Experimental Medicine | Year: 2015

Background: Motor cortex stimulation is one of the neuromodulation methods of treating refractory central neurogenic pain. Objectives: The aim of this study was to retrospectively evaluate the effects of motor cortex stimulation. Material and Methods: The study group consisted of 14 consecutive patients with thalamic pain, atypical facial pain, post-brachial plexus avulsion injury pain, phantom pain and pain in syringomyelia who were treated with motor cortex stimulation at the Department of Neurosurgery of the Military Research Hospital in Bydgoszcz, Poland, from 2005 to 2013. The procedures were conducted with the use of neurosurgical navigation and intraoperative neurophysiological monitoring. The outcomes were assessed in terms of visual analog scale scores. The long-term follow-up ranged from one to six years. Results: A statistically significant reduction in the intensity of pain was noted in patients treated with motor cortex stimulation (pre-surgery median visual analog scale = 9, short-term result median visual analog scale = 3, p = 0.0009; long-term result median visual analog scale = 5, p = 0.0036). Over the long term, with follow-ups ranging from one to six years, the results were excellent (over 80% reduction in pain) in 31% of the patients and satisfactory (50-80% reduction in pain) in 23% of the patients. Unsatisfactory pain control (less than 50%) was noted in 31% of the patients and no improvement was noted in 15%. Significantly better relief of pain was observed in the early postoperative period. In this series of patients, the highest efficacy of motor cortex stimulation was observed in post-stroke or post-hemorrhagic thalamic pain (5/7 patients - 71%). Long-term outcomes were not related to the age or sex of the patient, the preoperative duration of the pain, or to the position or number of implanted electrodes. Conclusions: MCS significantly reduces the intensity of neurogenic pain. The best long-term results in the present study were achieved in patients with thalamic syndrome. No significant predictors were found for a successful final outcome. The authors consider appropriate selection of patients, accurate placement of the electrodes and frequent adjusting of the stimulation parameters to be important factors increasing the efficacy of MCS. © Copyright by Wroclaw Medical University.

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