Short- and Long-term Effectiveness of Sacral Nerve Stimulation in Patients with Overactive Bladder

BACKGROUND: Sacral nerve stimulation (SNS) approved for use in North America since 1997 despite the fact that the concept of using SNS to treat patients with voiding dysfunction discussed first almost 50 years ago. AIM: The objectives of the study were to assess the effectiveness of SNS the short and long term for patients with overactive bladder (OAB) dysfunction and its relation to age, gender, and causes. PATIENTS AND METHODS: This is a clinical prospective study that involved 50 cases (32 females and 18 males) with OAB. It was carried out at Ibn Sina Hospital, and the neurosciences hospital in Baghdad/Iraq from April 2015 to April 2018. All the patients were assessed preoperatively and certain inclusion criteria were used. The patients went through the 2 stage implantations of the Medtronic InterStim®. The patients were assessed at 6 months (short term) and 2 years (long term) postoperatively. RESULTS: The results of our patients were analyzed with respect to age, gender, causes of OAB, and post-operative complications. We found that younger age patients, female patients, and patients with neurogenic causes of OAB showed a better response in both the short- and long-term follow-up. CONCLUSION: Considerable progress has been made in the surgical management of OAB. Proper selection of patients is the key to the success of SNS, and female patients have better results compared to male patients. Furthermore, younger patients and patients with neurogenic causes did better than older patients and patients with idiopathic causes. SNS is a safe minimally invasive surgery with a low complication rate, and the 2 stages procedure has better results than the percutaneous nerve evaluation

Functional Outcome Following Synthetic Vertebral Body Implantation in the Management of Spinal Disorders

OBJECTIVE: Synthetic vertebral body replacement has been widely used recently to treat different spinal conditions affecting the anterior column. They arrange from trauma, infections, and even tumor conditions. In this study, we assess the functional outcome of this modality in different spinal conditions. PATIENTS AND METHODS: Thirty-six cases operated from October 2010 to December 2017. Twelve patients had spinal type A3 fractures, 11 cases with spinal tuberculosis (TB), and 13 cases with spinal tumors. They were followed clinically for a mean period of 2.4 years. RESULTS: All the cases were approached anteriorly. Seven cases had a post-operative infection. No neurological worsening reported. We had dramatic neurological improvement in all spinal TB cases. Mortality recorded in only 4 cases with metastatic spinal tumor during the mean period of follow-up. Karnofsky performance status scale showed statistically significant change for spinal TB, and tumor cases during the follow-up period, but there was no significant change in cases of spinal type A3 fractures. CONCLUSION: The positive outcome of this surgery makes it recommended for properly selected patients, especially with spinal TB and tumors

Short Term Effectiveness of Gamma Knife Radiosurgery in the Management of Brain Arteriovenous Malformation

AIM: To evaluate the short-term effectiveness of Gamma knife radiosurgery as a modality of treatment of brain arteriovenous malformation. METHODS: Sixty-three patients with arteriovenous brain malformations underwent Gamma knife radiosurgery included in this prospective study between April 2017 and September 2018 with clinical and radiological with MRI follow up was done at three months and six months post-Gamma knife radiosurgery. By the end of the 12th-month post-Gamma knife radiosurgery, the patients were re-evaluated using digital subtraction angiography co-registered with M.R.I. During the 12 months follow up, CT scan or MRI was done at any time if any one of the patients᾽ condition deteriorated or developed signs and symptoms of complications. The mean volume of the arteriovenous malformations treated was 26.0 ± 5 cm3 (range 12.5–39.5 cm3) in The Neurosciences Hospital, Baghdad/Iraq. RESULTS: By the end of the 12th month of follow up, the overall obliteration of the arteriovenous malformations was seen in six patients only (9.5%), while shrinkage was noticed in 57 patients (90.5%). Improvement or clinical stability was found in 24 out of 39 patients (61.5%) presented with epilepsy as a chief complaint before Gamma knife radiosurgery and 21 out of 24 patients (87.0%) complained of a headache before Gamma knife radiosurgery. Post-Gamma knife radiosurgery bleeding was found in only three patients (5.0%). CONCLUSION: Even with the short term follow up, Gamma knife radiosurgery has an excellent clinical outcome in most patients with arteriovenous brain malformations. The clinical symptoms like headache and seizure were either diminished or controlled with the same medical treatment dose before Gamma knife radiosurgery. Long term clinical and radiological follow up is recommended

Autonomic symptoms in patients with migraine

Introduction: migraine is a prolonged neurovascular illness. The features by sporadic bouts of acute headache associate with aura or not associated contain various combinations of neurological, gastrointestinal tract, and autonomic variations, with no any indication of main organizational anomalies. Autonomic nervous structure consists of numerous signs and symptoms; nausea, frequent bowel motion, constipation coolness in the upper and lower limbs, tachycardia and thoracic pain. The aim of study to evaluate autonomic purposes in patients with migraine and to assess the autonomic loss function either sympathetic, parasympathetic, or a combination of both. Also, to correlate the severity of this dysfunction with age, sex and migraine kind. Methods: This is a prospective study between May 2009 and May 2019 in the headache clinic at the neuroscience hospital /Baghdad /Iraq. One hundred and twenty person have migraine (84 women and 36 men), the age 15-50 years old, and 60 normal persons as controller collection. The survey paper consist of nervous system debility gauge, cardiovascular reactions examination also done. Results: patients with migraine have incapacitating bouts are disposed to autonomic nervous organism hypo task, which also is a danger feature for migraine headache, or be a value of common incapacitating bouts. Furthermore, autonomic nervous system loss function and migraine may part a public neural substrate. Rendering to Ewing arrangement of autonomic task examinations, the parasympathetic portion extra exaggerated than the sympathetic portion, significant difference between control group and patients’ group, 27% of patients have positive dysautonomia (>2) whereas (73.3%) patients are normal. Tachycardia besides postural faintness are the best recurrent indications in patients have migraine. Migraine and Autonomic abnormal function is more usual also extend sequence of the disease is powerfully connected with autonomic abnormal function which disturbs parasympathetic portion high than sympathetic, for these reasons the autonomic symptoms should be evaluated when assessing the patients with migraine since most of these symptoms are disabling. Conclusions: In patients with migraine, the evaluation of autonomic functions should be a routine work. The cardiac pulse reaction to powerful breath besides valsalva exercise are humble plus useful to assess the parasympathetic portion of autonomic nervous schem