Conditions treated

The conditions that we treat at Barts and The London Neurostimulator Service are:

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Tremor

Tremor is rhythmic shaking. Arm tremor can be particularly disabling because the shaking prevents patients from using their arms for normal day-to-day activities. Tremor can be quite difficult to treat with medications and in some cases can be treated surgically. One option available for patients treated for tremor at the Neurostimulator Service is thalamic deep brain stimulation.

This operation is designed to "turn off" the area of the brain causing the tremor that can arise in Parkinson's disease, multiple sclerosis, stroke, trauma, or a condition called essential tremor. Patients who have a poor response to their medications, or who cannot tolerate them, have the option of surgical treatment.

Dystonia

Dystonia is a condition characterised by abnormal prolonged muscular contractions in a region of the body. There are many causes including genetic disorders, stroke, or trauma. There is a growing interest in the surgical treatment of dystonia. Pallidal deep brain stimulation is a treatment that may provide excellent improvement in generalised dystonia and in some cases of secondary dystonia and focal dystonia.

Parkinson’s disease

The annual incidence of Parkinson’s disease in the UK is 1% in those over 60, the majority of whom respond well to medication. A small proportion, however, have symptoms that are poorly controlled by such medication and can additionally be treated using deep brain stimulation. In these patients, neurostimulation may improve symptom control with fewer dyskinetic side effects and reduce “on-off” fluctuations.

Epilepsy

Epilepsy is a neurological condition that affects approximately 1% of the population of all ages. It is characterised by people suffering from recurrent spontaneous seizures. These seizures are caused by small electrical “storms” or discharges in the brain which may or may not result in loss of consciousness.

The main treatment is medication in the form of anticonvulsant drugs. These successfully control people’s seizures in the majority of cases. However some patients’ attacks are more difficult to control and the patient may need to consider other forms of treatment, such as vagus nerve stimulation.

Cervical and lumbar spondylosis

Patients with cervical or lumbar spondylosis often suffer ongoing spine or limb pain that surgery is unable to correct. These and other patients with chronic limb pain, such as those with neuropathy, ischaemic pain or post-amputation pain, may benefit from stimulation of the dorsal columns of the spine. This acts to “confuse” the pain messages travelling to the brain, so that painful sensations are replaced by a not-unpleasant tingling feeling.

Trigeminal neuralgia (facial pain)

Trigeminal neuralgia is normally an idiopathic condition characterised by brief instantaneous bursts of lancinating pain on one side of the face. These are often brought on by gentle contact to the face at so-called “trigger spots”.

Again, many patients are successfully managed by medication and the condition can spontaneously remit. However, a minority remain with intractable pain and the insertion of a neurostimulator is one of a number of possible surgical options for treatment in such cases.