British neurosurgeons have made a huge contribution to the development of neonatal and minimally invasive surgery. Unique technologies and techniques developed in our partner hospitals rescue premature babies with intraventricular haemorrhage and allow treatment of complex brain tumours in patients of any age.
Our partner hospital King’s College Private has a Centre of Excellence for neurology and neurosurgery and offers a complete service that covers a wide range of neurological conditions. Every year, the department sees more than 20,000 patients with diseases of the brain, spinal cord, nerves and muscles. These include cancer, epilepsy, Parkinson’s disease and multiple sclerosis, as well as rarer conditions such as Huntingdon’s.
King’s has continued to push the boundaries and challenge established ways of doing things. Their neuro-oncology service is one of the largest in the UK and Europe and sees patients referred nationally and internationally. It was a King’s neurosurgeon, Mr Richard Gullan, who in the 1990s, introduced the concept of seeing patients in a one-stop multi-disciplinary neuro-oncology clinic, something that has now become established practice throughout the UK.
Neurosciences team at Imperial Private Healthcare also offers a broad range of general neurological and neurosurgical services. On top of usual outpatient and inpatient facilities, they also offer emergency expertise in both hyper-acute stroke unit (HASU) at Charing Cross Hospital and the major trauma centre at St Mary’s Hospital (link). The group of hospitals also caters for neurorehabilitation needs to aid recovery from neurological disorders.
Towards an artificial brain: the UK created the first three-dimensional map of the human brain. (Link)
Scientists in Cambridge created a detailed three-dimensional map of the human brain. The result of many years of research is a 3D model of the brain, compiled on the basis of scans of hundreds of patients. The model corresponds to the structure of the most complex human organ in the smallest detail – so scientists can zoom in any of the fragments, up to individual nerve cells.
Paul Fletcher, one of the authors of this international research project: “This is the next step in the development of neuroscience: not so long ago we just had cortex sections available to us, but now we have the opportunity to observe individual cells. Here in Cambridge, we primarily deal with nervous disorders, in particular, eating disorders, and the interactive model based on synthetic neurons has already allowed us to understand quite a lot about how these disorders occur and how to deal with them. “
Scientists hope that such studies will reveal the veil of secrecy over the processes of brain formation and will allow us to better understand the structure of neural connections, which in the future will lead to the possibility of creating a full-fledged artificial brain.
Treatment of epilepsy through vagus nerve stimulation (Link)
The long-awaited treatment for epilepsy gives very encouraging results: in some cases, up to complete elimination of the disease.
Stimulation of the vagus nerve is based on the work of a small generator implanted in the skin under the clavicle. It is connected to a conductor with two spirals at the end, which are wrapped around the vagus nerve under the neck skin (this is done by a simple surgical procedure). The generator sends electrical impulses to the vagus nerve and to the brain, at certain intervals. In this way, it is possible to reduce the frequency and severity of seizures.
How does it work?
During the operation, the generator is programmed to send electrical pulses at intervals throughout the day. Impulses go through the conductor to the vagus nerve in the neck and the brain. This helps to prevent the high electrical activity of the brain – the cause of seizures. If necessary, the generator can be configured after the surgery in an outpatient setting (this can be done by a doctor or a specialist nurse).
The patient is also given a magnet that can be used to activate the generator and send additional pulses to the brain. The magnet sends a signal through an implanted generator and is needed when the patient feels the approach of the attack. It stops or shortens the incident, and can also weaken its strength. It can also be used by other people, like family and friends – witnesses of a seizure.
After the implantation of the device, the noticeable difference will be visible within several months. Among the benefits is a decrease in the frequency of seizures until their disappearance, rapid recovery after each episode, a sense of cheerfulness and mood improvement.
Whom is it useful for?
Stimulation of the vagus nerve is useful to all patients with poorly controlled epilepsy, regardless of age and type of seizures. About 55,000 people around the world already received these implants.
About the surgery
During 1-2 hours long surgery, two small incisions are made: one for placing the generator and the other one for the conductor. The incision for the conductor is made in the hollow on the left side of the neck, for the generator – in the upper left part of the thorax near the armpit. Following the procedure, the patient stays in the hospital for 1-2 nights and is then discharged home.
The most common side effects of vagal nerve stimulation are:
- temporary hoarseness or change of voice
- pain / sore throat
- intermittent breathing
- skin tingling sensation
Drugs for treatment of epilepsy
Antiepileptic drugs should be taken as usual within a few months after the operation. Then the doctor will suggest changing the old medication scheme.
A tiny generator battery can serve for 6 to 11 years. The time will come when it will need to be replaced. The higher the frequency and strength of stimulation, the faster the battery wears out. A doctor or nurse will determine when a replacement is due. A new battery will be placed during a short (less than 1 hour) operation. It usually does not require an overnight stay in the hospital.
Cerebral Palsy: A New Method Using Baclofen (Link)
Baclofen is medicine for muscle relaxation. It is used to relieve stiffness caused by muscle spasticity. To avoid side effects, it is injected directly into the spinal fluid through a pump implanted under the stomach.
In June 1996, the American Food and Drug Administration approved a new method of taking medication for people suffering from spastic cerebral palsy. It was called “subshell therapy with baclofen (ITB)”, but also known as “continuous infusion of baclofen.” The latter is injected directly into the spinal fluid through a pump implanted under the stomach during a two-hour long operation.
Although the pump has the size of a hockey puck, it easily enters the pancreas, from where it injects a small amount of Baclofen into the spinal fluid through a small tube. The pump is turned on by a computer, which regulates the dose of Baclofen, depending on the reaction of the patient’s body.
How does it work?
Injected directly into the spinal fluid, the drug relaxes muscles and reduces muscle spasticity in the lower extremities without side effects arising from taking the medication orally.
Whom is it useful for?
This treatment is not suitable for all patients with cerebral palsy or neurological disease. It is not helpful for patients with low muscle tone, chorea or athetosis.
There is a well-designed survey process for each particular child or adult. At the last stage, before placing the pump, potential patients are given the right dose of Baclofen directly into the spine through a waist puncture. This is necessary in order to ensure the effectiveness of treatment. For an experienced surgeon, the process of placing the pump takes about 50 minutes.
How safe is this treatment?
Among the most common side effects of Baclofen injected through the pump are muscle sagging, drowsiness, nausea, headache and dizziness. However, they are usually temporary and can be relieved with the adjustment of the administered dose.
The pump itself needs a new filling approximately every two months – this is done by inserting a fine needle through the skin.
It is important to complement treatment with additional therapies, such as physiotherapy or occupational therapy.