Overview of conditions and technology for Neurosciences
Special Interest Section (Neuro SIS)
Ruptured and unruptured intracranial
aneurysms
The common name for the treatment of ruptured
and unruptured intracranial aneurysms is ‘coiling’. This is an
endovascular alternative to the surgical treatment commonly known
as ‘clipping’. In the ISAT randomised controlled trial for
treatment of ruptured aneurysms randomisation was terminated early
as the investigators regarded it as unethical to randomise certain
categories of patients to surgery due to the improved mortality and
morbidity results shown in the endovascular arm.
One of the outcomes of the ISAT1 trial has been a
significant shift towards the endovascular treatment being the
treatment of first choice for patients who present with Sub
Arachnoid Haemorrhage (SAH) in the case of ruptured aneurysm or
other appropriate symptoms in the unruptured situation. In the NHS
around 70% of treatments for patients with aneurysms of the
intra-cranial circulation are coiled, whilst the remaining circa
30% have surgical clipping. This is one of the interventional areas
where the UK compares well with both European and US healthcare
systems.
Epilepsy
One in 130 people in the UK will have a diagnosis of epilepsy of
which 30% will be treatment resistant despite appropriate
medication. People with uncontrolled epilepsy are at 2-3
times greater risk of dying prematurely than the general
population.
Vagus Nerve Stimulation (VNS) is a treatment for people with
uncontrolled epilepsy that involves a simple hour-long operation to
implant a pacemaker like device in the patients chest. A lead
is then tunneled up to the neck where coils are wrapped around the
vagus nerve.
VNS Therapy has received a Grade A recommendation (based on
Class 1 evidence) in the recently published NICE Clinical Guideline
(20) the epilepsies: diagnosis and management of the epilepsies in
both adults and children and has been positively reviewed by NICE
under the Interventional Procedure Program (50) and the Cochrane
Library.
Parkinson’s Disease and other Movement
Disorders
The incidence of Parkinson’s disease is 17 per
100,000 and it is quoted that 120,000 people have the condition in
the UK.
Advanced forms of Parkinson’s Disease and other movement
disorders associated with dystonias, spasticity and tremor can be
effectively controlled by stimulating sites deep in the brain or
delivering drugs, such as the muscle relaxant Baclofen, into the
intrathecal space. Each treatment involves the implantation of a
programmable, battery-powered device along with a delivery system.
(Leads or catheters, as appropriate)
Pain
Most people can associate with pain from time to time, however in
its most extreme form pain is a debilitating and disabling
condition. Pain comes in many forms and from many origins but
places a huge burden on healthcare resources. For example 10% of
the population and 22% over the age of 65 years suffer from
clinically diagnosed chronic back and leg pain.
The treatment of chronic, refractory pain, from any origin can
be treated with similar technologies as those used for movement
disorders. In this case analgesics at around 1 / 300th of their
oral dose are introduced into the intrathecal space or stimulation
is performed at various sites on the spinal cord.
Incontinence
A deeply distressing condition, many forms of incontinence can be
relieved by the electrical stimulation of the sacral nerve. Systems
require the same basic hardware as that used for the treatment of
pain.
References:
1. Lancet 2002; 360: 1267-74