GLG News by Surgeons who Perform Spinal Fusions

Luc JasminAttending Neurosurgeon and a Research ScientistCedars-Sinai Medical Center

Brain stimulation for high blood pressure?

February 6, 2011

Analysis of:Deep brain stimulation relieves refractory hypertension | www.neurology.org

In the past few years there has been a few reports of an anti-hypertensive effect of deep brain stimulation with Medtronic quadripolar electrodes in patients treated for pain syndromes.  Interestingly the antihypertensive effect appears independant of the analgesic effect.  The blood pressure is normalized and all anti-hypertensive medications stopped.  The reduction of blood pressure appears at the time of the surgery and is still present 27 months later.  up. 

Luc JasminAttending Neurosurgeon and a Research ScientistCedars-Sinai Medical Center

Duloxetine is not for all pains

December 27, 2010

Analysis of:Duloxetine in patients with central neuropathic pain caused by spinal cord injury or stroke: A randomized, double-blind, placebo-controlled trial. | www.ncbi.nlm.nih.gov

When faced with a patient with central pain we use drugs approved for peripheral neuropathy.  Some class I evidence support the use of gabapentin, pregabalin, lamotrigine, and tramadol for central pain. Hence, Vranken and his colleagues tested the analgesic effect on central pain of the mix noradrenergic-serotoninergic antidepressant duloxetine (Cymbalta). Unfortunately, their study confirms previous data showing that a mix noradrenergic-serotoninergic antidepressant is not an effective analgesic for central pain.

Luc JasminAttending Neurosurgeon and a Research ScientistCedars-Sinai Medical Center

The first trial of mini spinal cord stimulators in early 2011

December 15, 2010

Analysis of:New miniature smart chip implant to combat chronic pain | www.physorg.com

After much talk in the past years, a new generation of neurostimulators will be tested in 2011 in Australia.  Because of miniaturisation, electrodes and the Implantable Pulse Generator (IPG) are now a single unit that can be directly implanted over the spinal cord or a peripheral nerve.  Now that's would be a prime example of minimally invasive surgery.

Luc JasminAttending Neurosurgeon and a Research ScientistCedars-Sinai Medical Center

Botox gets the green light for migraine, but does it work?

November 17, 2010

Analysis of:OnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial | cep.sagepub.com

Chronic migraine is a subtype of migraine, which is defined by 15 or more headaches days per month with 8 or more migraine days for at least 3 months.  For the PREEMT2 recruited in 66 sites. 347 patient received Botox and 358 received placebo. The double blind phase lasted 24 weeks, which was followed by an open-label period of 32 weeks.  Botox was injected every 12 weeks. The primary endpoint was the incidence of headache day, was significantly lower in the Botox and placebo group.

Luc JasminAttending Neurosurgeon and a Research ScientistCedars-Sinai Medical Center

Spinal cord stimulation (SCS) for Parkinson’s disease? We're not there yet.

November 8, 2010

Analysis of:Spinal cord stimulation failed to relieve akinesia or restore locomotion in Parkinson’s disease | www.ncbi.nlm.nih.gov

Spinal cord stimulation (SCS) in dopamine-depleted mice and rats reverses the akinesia and improves locomotion (see Fuentes et al, Science 2009). Because SCS is much less invasive than deep brain stimulation, it is worth testing in Parkinson’s patients. Thevathasan and colleagues (2010) tested SCS in two patients with Parkinson’s disease.  There findings show no evidence that SCS improves the motor symptoms of Parkinson’s disease.

Luc JasminAttending Neurosurgeon and a Research ScientistCedars-Sinai Medical Center

TRPs as Analgesic Drug Targets: Using HC-030031 to Probe the Role of TRPA1

September 28, 2009

Analysis of:The 3rd Annual Pain Therapeutics Summit | click.bsftransmit1.com

Transient receptor potential cation channel, subfamily A, member 1 (TRPA1) is a cold receptor, somewhat the opposite of the capsaicin receptor (TRPV1), which is a heat receptor. TRPA1 is a chemosensor and it has an abundance of agonists, exogenous (cigarette smoke, etc...) and endogenous (prostaglandins, etc…). All neurons that express TRPA1 also express TRPV1. Stimulating TRPA1 causes pain. Hydra Biosciences is developing TRPA1 antagonists (receptor blocker) to block pain and inflammation.

Luc JasminAttending Neurosurgeon and a Research ScientistCedars-Sinai Medical Center

TRPV1 Agonists: 500 Years in Development

September 28, 2009

Analysis of:The 3rd Annual Pain Therapeutics Summit | click.bsftransmit1.com

Qutenza is a flexible film that wraps on the skin and leads to a rapid release of 8% capsaicin. Possible applications: OA, Post-herpetic neuralgia, HIV neuropathy, and diabetic neuropathy. The results show efficacy in both post-herpetic neuralgia and HIV neuropathy as determine by 30% decrease in pain. More trials are being presently conducted. NeurogesX is developing a liquid form is that is works in a much shorter time (5 min instead of the current 30 to 60 min).

Luc JasminAttending Neurosurgeon and a Research ScientistCedars-Sinai Medical Center

Antagonists: Are They Too Hot to Handle?

September 28, 2009

Analysis of:The 3rd Annual Pain Therapeutics Summit | click.bsftransmit1.com

Merck TRPV1 Antagonists MK-2295: Results of clinical studies and reasons why it will not make it to market MK-2295 was administered to normal individuals for 14 days. The investigator tested for heat sensitivity by applying a heat probe to the skin or the subjects having taken MK-2295 or placebo.  They also immersed their hands in hot water (48 degree C) or asked them to drink hot water. The results were impressive with the subjects taking MK-2295 displaying a raised threshold to heat.  The problem is that often they did do not find unpleasant temperatures around 48 degree C.

Luc JasminAttending Neurosurgeon and a Research ScientistCedars-Sinai Medical Center

Responsive vs unresponsive depressive patients have similar electrode sites

September 7, 2009

Analysis of:Deep brain stimulation of the subcallosal cingulate gyrus for depression: anatomical location of active contacts in clinical responders and a suggested guideline for targeting | thejns.org

Based on an association between successful and unsuccessful clinical response, the authors present stereotaxic coordinates, allowing standardization of the implantation site.The post-implantation analysis position of the intracerebral quadripolar electrodes was analyzed in twenty patients. Eleven out of 20 patients achieved a significant reduction of their depression scores at 1 year. The responder's electrodes were only slightly more ventral by 1-2 mm. See J Neurosurg (on line) / May 29, 2009. 

Wayel KaakajiChief Executive Officer and Medical DirectorSpinal and Neurosurgical Institute

Sales of Infuse product will likely decline with closer scrutiny of off-label use

December 1, 2008

Analysis of:Medtronic Says Device for Spine Faces Probe | online.wsj.com

Medtronic might see a significant drop in its sales as a result of closer scrutiny of off-label use of its products.  Infuse has been a cash cow for Medtronic, and if sales drop, it will reflect deeply in the sales numbers.

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