Gamma knife tremor patient comes back to get the other side done!

Our first tremor patient treated with gamma knife radiosurgery recently came back, one year later, to have the other side treated.
He has essential tremor, which was affecting both arms.
He had undergone treatment to the left brain for right sided tremor last year.
He was so pleased with his results, he recently came to have the right brain treated to address the left sided tremor.
Here is his most recent video.
Note the action and postural tremor on the left (untreated) side, and the fact that he has almost not residual tremor on the right (treated) side.

Click here to find out more about Gamma knife radiosurgery for tremor at the Monmouth Neuroscience Institute.

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Monmouth’s Facial Pain Center on CBS News!

Click here to find out more about one of the patients featured in this story.

Find out more about headache and facial pain, and treatment options for trigeminal neuralgia, including surgical treatment.

Come to one of our trigeminal neuralgia support group meetings – check the Neuroscience Events Panel on the right side of the page.

A New Spin on The “Founder” of Neurology

Jean-Martin Charcot (1825-1893) is regarded by most scholars to be the founder of modern neurology.

charcotdemonstratinghistechnique

Known to be an excellent clinical teacjer, he was a professor at the University of Paris for 33 years and was  associated with Paris’s Salpêtrière Hospital that lasted throughout his life, ultimately becomiwas known as an excellent medical teacher, and he attracted students from all over Europe. His focus turned to neurology, and he is called by some the founder of modern neurology.

Charcot took an interest in hysteria, a mental disorder with physical manifestations, which he believed to be the result of an inherited weak neurological system, set off by a traumatic event like an accident

He learned the technique of hypnosis to evaluate these patients, and very quickly became a master of the relatively new “science.”

He believed that a hypnotized state was very similar to a bout of hysteria, and so he hypnotized his patients in order to induce and study their symptoms.

Charcot’s work also included other aspects of neurology – he was first to describe the degeneration of ligaments and joint surfaces due to lack of use or control, now called Charcot’s joint. He discovered the importance of small arteries in cerebral hemorrhage.  He described hereditary motor and sensory neuropathy.

He died in 1893 in Morvan, France.

The new movie focuses on his relationship with one hysterical patient named Agustine,

Click here to find out more about this.

Tremor Patient Markedly Improved 6-months After Gamma Knife Radiosurgery

This 73-year-old left-handed man had complained of progressively worsening tremor for more than 25 years.    He had become unable to write or (actually more of a concern to him) use chop sticks.

He was evaluated in the multidisciplinary tremor clinic at Monmouth Neuroscience Institute in March 2013.  We determined that he had already failed to respond to, or had side effects from, the oral medications usually used to treat tremor.  He was not a good candidate for deep brain stimulation because of previous bran surgery and cognitive impairment.

He  underwent gamma knife radiosurgery to the R thalamus in April 2013.  There were no side effects.

He started to see significant improvement in L sided tremor during the fall of 2013, and by October was able to use chop sticks again!

Click here to find out more about the program.
Click here for contact information.

Comparing treatment options for trigeminal neuralgia

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First line of treatment for patients with trigeminal neuralgia TGN should always be medical, usually the anticonvulsant carbamazepine (Tegretol®), which provides at least partial pain relief for 80% to 90% of patients.  Common side effects include dizziness, drowsiness, forgetfulness, unsteady gait, and nausea. However, carbamazepine and other drugs prescribed do not always remain effective over time, requiring higher and higher doses or a greater number of medications taken concurrently, causing many patients to experience side effects serious enough to warrant discontinuation.

A study from the 1980s followed 143 TGN patients treated with carbamazepine (CBZ) over a 16-year period.  The drug was effective initially with few mild side effects in 99 patients (69%). Of these, 19 developed resistance between 2 months and 10 years after commencing treatment, and required alternative measures. Of the remaining 80 (56%), the drug was effective in 49 for 1-4 years and in 31 for 5-16 years. Thirty-six patients (25%) failed to respond to CBZ initially and required alternative measures, as did 8 (6%) who were intolerant of the drug.

Surgical treatment of TGN is reserved for people who still experience debilitating pain despite best medical management. Surgical options include gamma knife “radiosurgery” (GKS) and the more invasive microvascular decompresion (MVD).

Another study from 2008 compared outcomes for 80 consecutive TGN patients treated surgically with either MVD (36 patients) or GKS (44 patients) over 4-8 years:

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TGN KMG

In sum, MVD was more likely than GKS to achieve and maintain pain-free status in TGN,but  both procedures provided similar early patient satisfaction rates.  MVD is therefore preferred for younger healthy patients, while GKS is preferred for older patients with co-morbidies or contraindications, but neither should be considered unless medical therapy has already been tried and failed.