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Novel Approaches for Brain Diseases Are Discussed at AANS Meeting

by Lynn Shapiro, Writer | May 13, 2009
This is what is called refractory depression.

He said his next step would be launch a larger trial while honing his technique. He noted that "the advantages of cortical stimulation are that it is reversible, nondestructive, less invasive than other forms of stimulation, and can be modified by adjustment of the stimulator settings after implantation."

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Every year, 200,000 patients in the United States develop shingles, for which there is no cure. Shingles (herpes zoster) is a viral infection that causes a painful rash. It often appears as a band of blisters that typically affects the torso.

Other parts of the body may be involved such as the neck, face, scalp or limbs. The pain from shingles can be excruciating, and the cause might not be immediately evident. The virus lies inactive in all persons who have been infected with chickenpox and decades later, the virus can reappear as shingles. While some patients have mild cases and recover fully, other patients suffer from post-herpetic neuralgia, a painful syndrome that often cannot be adequately treated with pain-relieving medications.

Post-herpetic neuralgia causes the skin to remain painful and ultra sensitive for months or even years after the rash has resolved. The current treatment for this painful syndrome is oral medication. However, 15 percent of shingles patients, including those on oral medications, continue to have severe pain a full year after having the shingles virus. Further, high doses of oral narcotics are often necessary to control the pain experienced by people with this condition. This may lead to side effects, such as sleepiness, which can negatively affect quality of life.

Researchers at University at Buffalo investigated the use of a surgical pump to deliver medication to patients with post-herpetic neuralgia. The results of this study were presented by Andrew J. Fabiano, MD.

A proven technique for delivering medications directly to the spinal sac is through the surgical implantation of a mechanical pump, Dr. Fabiano explained. He said that typically, the pump sits under the skin in the abdomen and has a small tube that goes into the spinal sac. Medications travel from the pump, through the tube, and enter the spinal fluid that surrounds the spinal cord and peripheral nerves.

This type of system is used to deliver medications in many conditions including multiple sclerosis and chronic back pain. So why not use it to combat neuralgia that is resistant to medication? Dr. Fabiano thought. He selected five patients with shingles and treated them with the drug-delivery device during a seven-year period. Patients' narcotic medications were delivered directly to their spinal sacs.