Houstonian Tries Heart-Transplant Alternative

In the news: a neurostimulator being used to help a patient's heart pump better versus having a heart transplanted. http://abclocal.go.com/ktrk/video?id=7639446

WJMC received five-star rating from HealthGrades

As reported recently by Martin Cover, Advertising Reporter for Times Picayune (http://www.timespicayune.com/), West Jefferson Medical Center in Marrero has received new five-star ratings and awards of excellence from HealthGrades, a nationally respected, independent source for information on doctors and hospitals. Amongst attending physicians to accept the hospital's Neurosurgery Excellence Award from HeathGrades were Drs. Erich Richter, Robert Dawson III and Frank Culicchia. A scan of this article (apologies for the poor quality) is available to the right.

LSU Becomes a New Center for the Treatment of Obsessive-Compulsive Disorder

Medtronic Reclaim™ DBS therapy is becoming available at the LSUHSC-NO Department of Neurosurgery as an FDA approved procedure under a Humanitarian Device Exception for the treatment of chronic, severe, treatment-resistant OCD.

A Question about Cyberknife for Trigeminal Neuralgia

"I did not know where to put this. I had a question about Cyber Knife. Has it been used at West Jefferson/LSU to treat TN successfully?I'm post Gamma Knife and am considering Cyber Knife as my next move."

Great question. Radiosurgery in general has gotten quite a bit of attention over the past several years as a treatment for Trigeminal Neuralgia (TGN), a severe disorder of facial pain.

Unfortunately, the information isn't always unbiased, and the companies that make and buy the radiosurgery units have often done a really good sell job.

That's not to say that radiosurgery isn't an important option, just that many people have chosen it out of a fear of surgery, with an unrealistic expectation from the radiosurgery.

To make things more complicated, people aren't even really clear on the term "trigeminal neuralgia" and they aren't always talking about the same thing.

Traditionally, neurosurgeons have limited the term "trigeminal neuralgia" or "classical trigeminal neuralgia" to a very specific disorder in which the pain is "lancinating" or stabbing. In classical trigeminal neuralgia, the rest of the time everything is completely normal. There is no constant pain. There is no numbness. This kind of pain usually responds fairly well to medications, particularly a seizure medicine called Tegretol. Many people, however, have side effects on the doses that they need to stop the pain. In these people, we offer surgery. There are two main kinds of surgery -- usually the cause is a small artery bumping up against the nerve, so we tend to offer "Microvascular Decompression" (MVD) where we make a small hole in the back of the skull and put a tiny foam pad alongside the nerve to protect it. This cures better than 8 out of 10 people, tends to last pretty well, and rarely causes any numbness in the face. Most of us really find this to be the best option in young healthy people.

In those who are older or not healthy enough to undergo anesthesia, the other primary options are different ways of passing a needle into the nerve under xray guidance to burn it or crush it. This leaves the face somewhat numb, but stops the pain in the high ninety percents.

Radiosurgery is more like the latter. The disadvantage over the needle procedures is that it can take up to 6 months to take effect. Since the effect typically lasts for less than 2 years, the difference is substantial. It can leave the face numb, and can lead to a condition called "anesthesia dolorosa" in which the face is numb and in pain at the same time, which is extremely difficult to treat. The biggest problem we've seen is that people get radiosurgical treatment for face pain that does not meet the criteria for classic TGN, but is now being called TGN type II. Unfortunately, the success rates in type II are very poor, essentially no benefit by 2 years.

Cyberknife and Gamma Knife each have their strong adherants who think one is better than the other, but there's essentially no data to back that up. The Cyberknife provides a comfort advantage, as you don't have to have your head pinned in a frame for the procedure.

For the type II pain, the most successful procedure appears to be none of the above, but something called motor cortex stimulation.

All in all, the answer depends on the specifics of your case. Your best bet is to talk to an expert in all the treatments for TGN, both radiosurgical and otherwise. Because of our affiliation with WJMC and the Cyberknife unit, most LSU neurosurgeons see their patients now at the Cullicchia Clinic in Marrero. We'd be happy to make an appointment and talk about your options in detail.

Neuromodulation for dystonia - moving forward!

Dr. Erich Richter has performed deep brain stimulation to treat a patient with severe dystonia. The case was performed at West Jefferson Hospital with great results! The electrode was implanted with the use of stereotactic head frame attached to the patient's skull. (This guidance system allows for accurate placement of electrode, which delivers stimulation to affected area of the brain). Patient's symptoms, that included extreme pain and muscle spasms, significantly improved. As a matter of fact, the benefits of DBS may take several months to achieve its full effect. The result achieved by neurosurgeon at LSUHSC at New Orleans looks promising and gives new hope to prospective patients!

Brodmann area 25 deep brain stimulation to control depression symptoms

An ongoing study (BROADEN™) supported by St. Jude Medical, Inc., shows promising results in the treatment of major depressive disorder. The study is based on a model of depression proposed by Helen Mayberg, in which Brodmann area 25 appears to be overactive in depressed people. 21 patients involved in this study demonstrated 92% improvement in depression symptoms at one year follow-up.

Visit http://www.medicalnewstoday.com/articles/150959.php for full article.
Usefull links: www.BROADENstudy.com; www.PowerOverYourPain.com

New Resident Physician to Join LSU Neurosurgery

The LSUHSC-NO Department of Neurosurgery is pleased to announce that Dr. Durga Sure will join the housestaff on July 1st. Dr. Sure is currently completing a two year pre-residency fellowship in neurosurgery at Harvard. We look forward to his arrival and seeing his academic development over the years to come.

Deep brain stimulation slows progression of Parkinson's disease in animal models

Researchers at the Neuroscience Institute at the University of Cincinnati and University Hospital showed that DBS not only alleviates symptoms of Parkinson's disease, but also delayes disease progression. In DBS, high-frequency stimulating electrodes can promote the release of specific neurotrophic factor, which prevents the death of dopamine-producing cells in the brain.

Please refer to the original article by clicking on the link below.

http://www.sciencedaily.com/releases/2008/09/080902171151.htm

Neurosurgery at Children's Hospital

The Institutional Review Board (IRB) has approved Children's Hospital as a second performance site to treat people suffering dystonia with the Humanitarian Use Device, known as Medtronic Active® Dystonia Therapy, an FDA-approved under Humanitarian Device Exemption (HDE).
Dr. Richter will be performing a DBS on a patient suffering severe dystonia at Children's Hospital in the near future.

Mold-induced seizures?

"Mold" is the common term for multicellular fungi that grow in a mat. Generally, they are not pathogenic to immunocompetent patients. Molds may negatively affect humans through developing the following processes: allergy, infection, and toxicity. Allergic response to indoor molds is mediated via production of specific molecules, called immunoglobulins, and is associated with development of atopic reactions, such as atopic asthma, rhinitis, and dermatitis. Other uncommon allergic reactions include bronchopulmonary aspergillosis and allergic sinusitis. Infections are potentially dangerous for individuals with weak immune system, such as cancer patients, AIDS, etc. In addition, molds are capable of producing mycotoxins. In fact, an inhalation exposure or eating moldy foods may adversely affect health. It is commonly referred as organic dust toxic syndrome which is characterized by a flu-like symptoms. Interestingly, sick building syndrome is a set of symptoms that seems to be linked to occupancy in a building. While specific causes of this syndrome remain unknown, some believe that mold contamination may be contributing factor. A critical review of literature, including a case-control study, did not show any significant correlation between exposure to mycotoxins and human disease. To address the indoor mold-induced seizure, a case control study would be needed.

A new hope for patients suffering from obsessive-compulsive disorder

The U.S FDA gave its approval for Reclaim™ Deep Brain Stimulation under a Humanitarian Device Exemption. An Humanitarian use device is a device that is intended to benefit patients by treaing a disease that affects fewer than 4,000 individuals in the U.S. per year. 
OCD is an anxiety disorder characterized by unwanted thoughts and repetitive behaviors. The DBS of specific area of the brain, called ventral striatum,  may offer therapeutic promise for alleviating symptoms of OCD.
Dr Richter has  initiated approval process for performing this procedure at WJMC.

Neuromodulation for Dystonia

The U.S. Food and Drug administration approved a Humanitarian Device Exemption for Activa® Deep Brain Stimulation for Dystonia. Dr. Richter has received an approval for the clinical use of the device in Louisiana, West Jefferson Medical Center, in particular. The first patient with severe form of dystonia will undergo the procedure in the near future.

Dystonia is a disorder characterized by involuntary spasms and muscle contractions. It is estimated to affect approximately 250,000 Americans. Currently medical treatment and various surgical procedures are available to relieve symptoms. However, the cure has yet to be found. Deep brain stimualtion gives new hope to sufferers of dystonia. The procedure involves the implantation of an electrode that delivers electrical impulses to specific areas of the brain. With neuromodulation, abnormal signals from nerve cells go away.

If you are interested in getting more information about the procedure and would like to get an opinion as to whether you may potentially be a candidate fir surgery, just call our office and make an appointment with Dr. Erich Richter.

Dr. Richter visits the Westwego Rotary

Dr. Richter recently presented an overview of new programs and community partnerships that LSU neurosurgery is bringing to the New Orleans area. He highlighted the new Movement Disorders and Deep Brain Stimulation Programs at West Jefferson Hospital, the Epilepsy Unit, which completes the only level 4 Epilepsy Center in the state, and the complex pain surgery program, which complements the existing pain services throughout the region.

If you would be interested in having an LSU faculty member speak to your community group, let us know!

CNN gives other doctor's and researcher's opinions on DBS surgery for treatment of PD

In this artcle, CNN discusses the largest study (led by Frances Weaver, Ph.D., director of the Center for Management of Complex Chronic Care at the Hines VA Hospital, in Hines, Illinois) that has been done on deep brain stimulation surgery for the treatment of Parkinson's disease.

Other researchers and doctors agree that this treatment option looks very promising.

http://www.cnn.com/2009/HEALTH/01/06/parkinsons.deep.brain.stimulation/

WGNO Interview with Dr. Richter

About a month ago, Dr. Richter made his debut on WGNO news talking about movement disorders and the current neurosurgical treatments. Parkinson's disease (PD) remains the most commonly mentioned of the movement disorders, affecting about 1.5 million Americans. Deep brain stimulation, a current treatment option for PD, is one of the main procedures that may be discussed on this blog site in the near future.

WDSU Interview with Dr. Richter

In case you missed it, last Thursday, December 18th, Dr. Erich Richter made an appearance on WDSU to talk about this blog site! It is truly exciting to have this sort of involvement from local neurosurgeons and LSU faculty members. I expect there to be a lot of Q&A over this holiday season!

Sister Websites help with Disease Specific Information.

Sister blog websites have been established for Epilepsy and Parkinson's Disease. Because the therapies associated with these disorders are so complex and involve a number of specialists working together, we have created spaces just for them. Look at www.NOParkinsons.blogspot.com for Parkinson's disease information, and www.louisianaepilepsy.blogspot.com for information about local resources for seizures. Note that links to these sites are always found in the bar on the right hand side of this page.

Neurosurgery Service to Return to University Hospital

Dr. Culicchia, chairman of LSU neurosurgery, recently unveiled plans to reestablish full neurosurgery services at University Hospital, the LSU Interim Hospital. This could be effective as early as January 1st. In the aftermath of Hurricane Katrina, and the closure of Charity Hospital, the neurosurgery service withdrew from University Hospital because the facilities could not maintain enough elective (non-emergency) cases to meet accredidation standards for educating the residents. After extensive negotiations, the chairman was pleased to announce that he has been able to arrange the operating room space to return to full services. University Hospital is the primary source of neurosurgical care for the uninsured in southeastern Louisiana.

Comments from Dr. Tender on Minimally Invasive Back Surgery

Minimally invasive spine surgery has changed the way people see their treatment options for sciatica and low back pain. Disc herniations can now be removed through half-an-inch incisions, and sciatica, in selected cases, can be cured with same-day surgery (Figure 1). For those who suffer with chronic low back pain and have exhausted most treatment options (physical therapy, medication, epidural steroid injections etc), a possible treatment may be an instrumented fusion. With state-of-the-art technology and use of the operative microscope, one or two level fusions can now be achieved via two small incisions, with minimal muscle dissection and essentially no postoperative sequelae (Figure 2). Emerging techniques may reduce the morbidity associated with spine surgery even further.

Spinal Cord Stimulation course held at LSU Center for Advanced Practice

Spinal Cord Stimulation is a procedure in which small electrodes are implanted over the Spinal Cord to deliver low voltage electrical stimulation to the nerve fibers headed to the brain. It is used to treat forms of pain for which no other good treatments exist.

It has been crucial in restoring quality of life for people with such hard-to-treat disorders as Failed Back Syndrome and Complex Regional Pain Syndrome. While the concept has been around for years, recent advances in technology have made the devices much more successful and convenient. Still, there aren't that many doctors who are familiar with the therapy.

One of the companies that makes an FDA approved spinal cord stimulation system (ANS) has partnered with several experienced physicians including an LSU faculty member, to teach area physicians about this technique. The course participants are primarily from the surrounding region, but some come from as far as Canada!

This is an important service to the area, and we hope that LSU continues to partner with outside organizations and industry to provide continuing education for our area physicians.