Neuromodulation

Functional neurosurgery procedures are designed to reduce or eliminate spasticity, tremors or chronic pain, thereby improving the patient's ability to function and regain a more independent lifestyle.

To treat these patients, Allegheny General neurosurgeons in combination with specialists in neurology, anesthesiology, pain management, electrophysiology and physical medicine have joined to bring the latest medical advances to people who are disabled by spasticity, movement disorders and pain.

The Spasticity and Movement Disorder Center is designed to provide thorough coordinated care to patients with increased muscle tone and abnormal body movements resulting from Parkinson's disease, tremors, spasticity, stroke, brain injury, multiple sclerosis, dystonia, cerebral palsy and other medical causes.

Medical treatments available through this center include standard and recently approved medications. Additional experimental and investigational medications are also available for patients who do not respond to conventional medical therapies. New surgical treatments are being investigated for patients who cannot be adequately helped by medication alone.

To provide educational and emotional support to patients with Parkinson's disease and their families, Allegheny General hosts the American Parkinson Disease Information and Referral Center. One of 50 such centers nationwide funded by the American Parkinson Disease Association Center is a convenient and comprehensive source of information for area physicians who treat Parkinson's disease without local support groups and educational materials.

The current and latest surgical and medical techniques offered by the functional neurosurgery program include:

• Deep Brain Stimulation - Allegheny General's neurosurgeons were the first in the region to use deep brain stimulation to treat patients with essential tremor and tremor resulting from some forms of Parkinson's disease as well as dystonia. This therapy involves the placement of electrodes deep within the brain. The electrodes are then connected to an implantable device that can generate various amounts of electrical current to the exact areas of the brain responsible for the tremors. Using a handheld magnet, the patient can turn on the device which is implanted in the upper chest and the electrical current blocks the signals in the brain that cause the tremor.

• Direct Brain Stimulation for Chronic Head and Neck Pain - Allegheny General Hospital is the only center in western Pennsylvania with FDA permission to undertake direct brain stimulation in an attempt to relieve patients with chronic head and neck pain that has not responded to any other medical or surgical treatment. This procedure offers the potential for eliminating pain in the patients who are otherwise untreatable.

• Pain - A better understanding of pain mechanisms has led to more sophisticated approaches to pain management. Two therapies offering potential relief for intractable pain are spinal cord stimulation and the intraspinal drug delivery via implantable pumps.

  Spinal cord stimulation relieves chronic pain by electrically stimulating the spinal cord to the use of an implanted pulse generator. The low-voltage stimulation apparently closes a "gate" in a portion of the spinal cord effectively preventing transmission of specific pain signals to the brain.

  Intraspinal drug infusion employs an infusion device that precisely delivers controlled doses of medication through a small diameter tube. It is used to internally administer various pain relieving medications into the intrathecal or epidural spaces of the spinal column. Such drug infusion often reduces many of the side effects associated with oral narcotic administration. Intraspinal delivery allows for direct binding of analgesics to neuro receptors to inhibit the transmission of pain signals.

  Neurosurgeons at Allegheny General have extensive experience with these techniques. Several of the neurosurgeons on staff were among the first physicians to participate in the clinical trials for the development of these techniques.

  Advanced therapies for the treatment of unusually refractory pain syndromes are constantly being evaluated. These include deep brain stimulations for poststroke pain syndromes and peripheral nerve stimulation for phantom pain.

Research

The functional neurosurgery program is exploring the frontiers of treating functionally disabling intractable angina from otherwise surgically or medically incorrectable ischemic heart disease using an implantable spinal cord stimulator. AGH performed the first such implantation in Pennsylvania and one of the first in the country.

In addition, basic research is being undertaken to determine if deep brain stimulation of certain areas of the brain can be effective in treating massive obesity, epilepsy and depression.