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Procedures

Nerve Blocks

A therapeutic nerve block is used for treatment of severe pain. The block is placed by injecting a local anesthetic substance like Bupivacaine or Lidocaine together with anti-inflammatory medication such as the steroid preparation Dexamethasone. This mixture interrupts and blocks the pain signals sent to the brain from that specific nerve, causing it to feel numb.

Nerve blocks used to treat chronic pain can work for different periods of time (weeks to months), and can be repeated as needed. They can be especially helpful for neuralgia type of pain, entrapping syndromes like carpal tunnel syndrome, or relieve a nerve irritated or damaged by chronic degenerative joint problems. Nerve blocks may also be used to avoid surgical procedures.

Therapeutic Chemodenervation Toxins Injections

- (BOTOX® & Myobloc®)

  • BOTOX® = botulinum type A
  • Myobloc® = botulinum type B

Botulinum toxin is a synthetic chemical that can be used to block nerve signals for treatment of a wide range of conditions. Although most commonly known for its cosmetic purposes as a wrinkle-fighting agent, Botox injections offer an effective treatment for many medical conditions including muscle twitching, tics, spasms, migraines, cervical dystonia and other neurological disorders.

This therapy is also used widely for treatment of hypersalivation and hyperhidrosis (excessive sweating), with 100% treatment effect. Other conditions it is effective against include writers cramp (known as dystonia ) and spasms caused by multiple sclerosis and strokes.

Botox injections are administered directly into the affected muscle. The injection effectively blocks the acetylcholine nerve transmission. This prevents the muscle from contracting and reduces pain.

The results of treatment are often most effective in two to six weeks after the injection, and the effect will continue to last for up to six months. However, for precise control over symptoms, Botox injections are required every 3 to 4 months.

Very infrequently, some patients may experience bruising or eye lid drooping as a side effect of Botox. These symptoms usually go away on their own within a short time. Patients who are pregnant or breastfeeding should not receive Botox injections.

Vagal Nerve Stimulator (VNS)

Vagal nerve stimulation is long-term treatment for epilepsy commonly used on patients who have not had successful results from anti-seizure medication and other more conservative treatment methods. This treatment involves implanting a generator device that is similar to a pacemaker in the neck. This will send regular pulses of electrical activity to stimulate the vagus nerve 

The vagus is one of twelve cranial nerves in the brain, and serves to provide function to the larynx, diaphragm, stomach, heart and sensory functions within the ears and tongue. Most patients with epilepsy experience a significant reduction in the number and frequency of seizures with this treatment.

Procedure

The stimulation generator is implanted into the upper left area of the chest during a procedure performed under general anesthesia. An incision is made in the chest to implant the device and a connecting wire that runs under the skin to the vagus nerve in the neck. This procedure usually takes one to two hours to perform.

Results

After the procedure, the generator will stimulate the vagus nerve at regular intervals determined by your doctor. If a seizure occurs in between these intervals, the patient can activate the stimulator manually. Most patients are not aware that the device is active and do not experience any unordinary sensations during stimulation.

Risks

While the implantation procedure is considered safe for most patients, there is a risk of injury to the vagus nerve, carotid artery and jugular vein. Injury to these structures may cause coughing, hoarseness, swallowing difficulties and a tingling sensation in the neck. Infection and bleeding are also possible complications from any surgical procedure.

Patients can reduce their risk of these complications by choosing an experienced doctor to perform their procedure, and by following their doctor's instructions after surgery.

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