Stefanos Korfias

University of Piraeus, Le Pirée, Attica, Greece

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Publications (47)102.08 Total impact

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    Full-text · Dataset · Oct 2015
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    ABSTRACT: Introduction: The purpose of this study was to evaluate the efficacy of Intrathecal Baclofen Therapy (ITB) for the treatment of painful spasms in a patient with Friedrich Ataxia. Materials/Methods: A 65-year old female patient was referred from her neurologist to our outpatient department in August 2014 due to drug-resistant painful spasms. The patient had a history of Friedreich Ataxia, diagnosed by DNA analysis at the age of 45, while the last 15 years has been wheelchair-bound. Her spasms were frequent, painful, located in the lower limbs and trunk, awakening her during the night and elicited by coughing, sneezing or exposure to cold environments. On clinical examination, dysarthria, 4-limb ataxia, absent tendon reflexes, normal muscle tone and paraparesis were evident. Results: The patient received an intrathecal baclofen test of 50μgr with a considerable improvement in the severity and frequency of her spasms and no side-effects. Specifically, the patient was spasm-free for the following 16 hours while the usual provoking factors did not elicited a painful spasm. Subsequently, the patient underwent implantation of an intrathecal programmable pump at a dose of 80μgr. Her post-operative course was uneventful. The patient experienced a remarkable pain relief, reduced frequency of spasms and an improved sleep continuity. Discussion: The impact of intrathecal Baclofen (ITB) therapy, via an implanted pump, for both spinal and cerebral spasticity, such as cerebral palsy, multiple sclerosis, traumatic brain and spinal cord injury, has been well documented in various studies over the years. However, less is known about the effect of ITB in other conditions such as in painful spasms in Freidreich Ataxia. A satisfactory and lasting clinical effect on the aforementioned spasms was accomplished via ITB therapy in this case. To our knowledge, this is the third reported case of spasm treatment via ITB in the context of Friedreich ataxia. Conclusions: ITB baclofen therapy may be considered as a symptomatic treatment for the drug- resistant painful spasms in Friedreich Ataxia.
    Full-text · Conference Paper · Jun 2015
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    ABSTRACT: Introduction: Intrathecal baclofen therapy is a widely used treatment option in patients with intractable spasticity of various origins (cerebral palsy, multiple sclerosis, traumatic brain injury etc.). The treatment has been proven effective though it is often related with complications, mainly attributed to the pump catheter integrity. Kinking, migration or fracture of the catheter results to ineffective treatment and surgical revision. The purpose of this study is to evaluate a new catheter (Ascenda, Medtronic, Minneapolis, MN, USA) in patients who underwent intrathecal baclofen therapy and to assess its efficacy and complications rate. Materials/Methods: We retrospectively analyzed all patients with an implanted pump, (Synchromed II pump, Μedtronic, Minneapolis, MN, USA) in our institution from 2006 to 2014. A total of 73 patients (40 males- 33 females, mean age 43 years) received the pump with the older catheter circuit. Underlying pathology was cerebral palsy in 34%, multiple sclerosis in 25%, trauma in 20% and other aetiologies in 21%. The new catheter was implanted in 10 patients (6 males, 4 females), either as a new procedure ( 6 patients) or as a replacement of the old catheter ( 4 patients). The new catheter was first introduced at our institution in 2012. Results: From the 73 patients who received the old catheter circuit we documented 16 catheter related complications concerning 13 patients (18%). Three patients (n=3) patients experienced complications twice in different periods. The catheter complications documented were 9 fractures, 4 migrations and 3 blockages. All patients underwent surgical revision of the catheter either with an old circuit or with the new catheter (n=4). Not surprisingly, all patients were ambulatory, an observation that matches our clinical suspicion that these patients experience a higher complication rate compared to bed ridden patients. In the subgroup with the newer catheter circuit no complication has been documented. All 10 patients experienced a good clinical response not necessitating further investigation of the catheter function. Discussion: From the preliminary results, the new catheter is related with lower complication rate compared to the older catheter system. We consider a disadvantage the radiolucency of the catheter that probably will prevent the localization of any discontinuity of the circuit without migration. Conclusions: The new catheter’s efficacy and complications profile appear satisfactory, though longer follow up periods, more patients and experience with the new catheter are necessary to confirm our initial findings.
    Full-text · Conference Paper · Jun 2015

  • No preview · Article · Oct 2014 · Neurological Sciences
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    ABSTRACT: Introduction: One of the rare but devastating complications of neuromodulation techniques is the implantable device infection. In the majority of the cases removal of the device is required, despite appropriate antibiotic therapy. We demonstrate that eradication of an implantable device infection is feasible without removal of the device. Methods: Between 2002-2013, we implanted 531 neuromodulation devices in 450 patients. We report our experience in treating 13 patients; 7 patients suffering from infection of the internal pulse generator (IPG) who underwent deep brain stimulation for advanced Parkinson’s Disease, 4 patients with infection of the intrathecally-delivering pump and 2 patients with infection of the spinal cord stimulator. Patients were treated with antibiotic therapy, surgical revision of the wound, intraoperative disinfection of the IPG and relocation of the subcutaneous pocket. In 11 cases (83%), the infection was eradicated and therapy was continued uninterrupted. Results/conclusion: Although not generally recommended, neuromodulation devices may be salvaged in selected cases of superficial infection. Our experience suggests that it is possible to treat an infection without removing the device. Our experience indicates that if the treatment is offered promptly, according to our protocol, it is possible to treat infection without removing the device. With this approach, the patients may be spared of therapy interruptions and additional procedures for the replacement of the device.
    Full-text · Conference Paper · Sep 2014
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    ABSTRACT: Introduction: The impact of intrathecal Baclofen (ITB) therapy, via an implanted pump, for both spinal and cerebral spasticity has been well documented in various studies over the years. Although there are trials assessing the accuracy and efficacy of the Prometra programmable pump system for intrathecal administration of morphine sulfate to treat chronic pain, none has done so for ITB administration in treating spasticity. Consequently, we set out to determine the efficacy, safety and complication profile of the aforementioned programmable pump (Flowonix). Methods: This is a retrospective observational study using data collected from case notes and existing departmental databases of Evangelismos Hospital, Athens, Greece. Specifically, patients with intractable spasticity who responded positively to a trial dose of baclofen and treated with ITB therapy via the Prometra programmable pump (20ml) (n=40), between December 2011 and May 2014, were included in the study. A predefined data extraction form was applied to extract pertinent study information (gender, age, underlying pathology, follow-up period, daily concentration) and outcome measures (pre- and post-operative modified Ashworth scale values, technical considerations/difficulties during the operation or refilling procedure, revisions, complications). Results: 40 patients (24M/16F) with a mean age of 43.3y (range=18-79) underwent implantation of the programmable pump. Spastic paraparesis was encountered in 22 patients, spastic quadriparesis in 11 and spastic hemipareis in 7 of them. Underlying aetiologies of the spasticity were cerebral palsy (n=12, 30%), multiple sclerosis (n=10, 25%), cerebral vascular accident (n=5, 12.5%), hereditary spastic paraparesis (n=3, 7.5%), CNS infection (n=3, 7.5%), traumatic spinal injury (n=2, 5%), neglected cervical or thoracic spondylosis (n=2, 5%), traumatic brain injury (n=1, 2,5%), posterior fossa mass lesion (n=1, 2,5%) and idiopathic spasticity (n=1, 2,5%). The mean follow- up period was 16.7 months. All 40 patients experienced improvement in their spasticity as evidenced by reduction in the modified Ashworth scales (MAS) scores. The mean daily concentration of intrathecal baclofen administration was 90􏱎gr (40-220 range). Operative technical difficulties considering the introduction, advancement and anchoring of the catheter were not an issue in any of the included participants. 􏱙he refilling procedure and programming were uncomplicated in all patients and no case of over-infusion has been reported. 4 patients underwent 6 catheter revisions due to catheter fracture and one patient underwent explantation of the device due to implant site infection. Seroma of the wound site (absorbed over 3 weeks period) was documented in one patient. Conclusion: The Prometra programmable pump was shown to provide effective ITB therapy in all included patients. The reported complication profile, particularly the device-related complications were consistent with complications documented in our department’s database and in other studies involving various programmable pumps for ITB therapy. Finally , its intra-operative ease of handling combined with its convenient manipulation during the refiling procedure and programming render its use simple.
    Full-text · Conference Paper · Sep 2014
  • Nikitas Nanidis · Stefanos Korfias · Damianos E Sakas
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    ABSTRACT: Background: A novel flow-regulated external drain (FRED) was devised to overcome the problems of the pressure-regulated systems and serial lumbar taps. Methods: Eleven patients who underwent lumbar external drainage received a flow-regulated system using simple and inexpensive materials available in most hospital settings. Results: The system proved to be reliable at removing a set amount of cerebrospinal fluid (CSF). We did not encounter any serious complications in its application. Conclusions: The FRED system offered better patient compliance and comfort, providing them with greater mobility, while maintaining a safer steady removal of a set amount of CSF. In opposition to the pressure-regulated systems, we describe the possible indications, advantages and disadvantages of a flow regulated device. Extensive clinical trials are needed to study the use of FRED in patients with different CSF circulation physiology, pressure and composition.
    No preview · Article · Sep 2014 · Acta Neurochirurgica
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    ABSTRACT: Objective: We study the effectiveness and safety of intrathecal baclofen therapy for the treatment of spasticity and gait improvement in patients suffering from hereditary spastic paraplegia. Methods: Sixteen patients diagnosed with hereditary spastic paraplegia (mean age: 43 years) were enrolled in this open prospective study. The main inclusion criteria were: spastic paraparesis with a negative laboratory and imaging work-up (apart from spinal cord atrophy), unsuccessful trial of oral anti-spasticity drugs. An intrathecal baclofen trial was initially performed and a pump for the intrathecal administration of baclofen was implanted to the patients who responded favorably to the baclofen trial. The patients were followed for lower limbs' spasticity, walking performance and complications. Results: Fourteen patients had a positive baclofen trial and were submitted to the implantation of the baclofen pump. The average follow-up period was 25.8 months. All patients had a reduction in lower limbs' spasticity measured in the modified Ashworth scale from 2.6 (±0.8) to 0.7 (±0.9) (p=.000). Walking ability was improved in a modified version of the functional walking scale of the Gillette Functional Assessment Questionnaire from 5.9 (±1.7) to 7.4 (±2.0) (p=.001). Two patients had to be re-operated due to a catheter fracture. Conclusions: Intrathecal baclofen can offer an improvement in spasticity and in the walking performance in patients suffering from hereditary spastic paraplegia. The underlying residual motor function and the patient's adherence to the rehabilitation program might contribute to the post-operative improvement of gait.
    No preview · Article · Jun 2014 · Clinical Neurology and Neurosurgery
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    ABSTRACT: Objective We study the effectiveness and safety of intrathecal baclofen therapy for the treatment of spasticity and gait improvement in patients suffering from hereditary spastic paraplegia. Methods Sixteen patients diagnosed with hereditary spastic paraplegia (mean age: 43 years) were enrolled in this open prospective study. The main inclusion criteria were: spastic paraparesis with a negative laboratory and imaging work-up (apart from spinal cord atrophy), unsuccessful trial of oral anti-spasticity drugs. An intrathecal baclofen trial was initially performed and a pump for the intrathecal administration of baclofen was implanted to the patients who responded favorably to the baclofen trial. The patients were followed for lower limbs’ spasticity, walking performance and complications. Results Fourteen patients had a positive baclofen trial and were submitted to the implantation of the baclofen pump. The average follow-up period was 25.8 months. All patients had a reduction in lower limbs’ spasticity measured in the modified Ashworth scale from 2.6 (±0.8) to 0.7 (±0.9) (p = .000). Walking ability was improved in a modified version of the functional walking scale of the Gillette Functional Assessment Questionnaire from 5.9 (±1.7) to 7.4 (±2.0) (p = .001). Two patients had to be re-operated due to a catheter fracture. Conclusions Intrathecal baclofen can offer an improvement in spasticity and in the walking performance in patients suffering from hereditary spastic paraplegia. The underlying residual motor function and the patient’s adherence to the rehabilitation program might contribute to the post-operative improvement of gait.
    No preview · Article · Jan 2014
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    ABSTRACT: Intrathecal baclofen (ITB) pump is a therapeutic option for persistent vegetative state and minimal conscious state patients that have associated spasticity. We investigated whether this treatment modality can affect their level of consciousness. In this prospective, open label, observational study, we implanted ITB pumps for the treatment of spasticity in eight patients with disorders of consciousness (vegetative state and minimally conscious state) and we followed them with the Coma Recovery Scale-Revised, the Eastern Cooperative Oncology Group (ECOG) performance scale, and the Modified Ashworth spasticity scale. Baclofen dose and complications also were noted. The offending pathologies were traumatic brain injury in six, anoxia due to cardiac arrest in one, acute obstructive hydrocephalus in one. Two of the patients showed a marked, persistent improvement that fulfilled the criteria of emergence from minimally conscious state. Two of patients had their ITB pumps prematurely removed because of complications. The ECOG score was 4 for all patients and did not change during the study. ITB might be associated with a significant improvement in the disorder of consciousness of two patients from a total of six that had a chronic ITB treatment.
    No preview · Article · Dec 2013 · Neuromodulation

  • No preview · Article · Apr 2013 · Clinical neurology and neurosurgery
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    ABSTRACT: Objective: To present a case involving a discrepancy in the presurgical data of a patient suffering from pharmacoresistant mesial temporal lobe epilepsy. Clinical presentation and intervention: A 47-year-old, female patient with complex partial seizures since her twenties came to be evaluated in the Epilepsy Surgery Unit. The ictal electroencephalogram suggested a left temporal epileptogenic zone and the magnetic resonance image showed an abnormality in the right mesial temporal lobe. Intracranial monitoring revealed a pacemaker zone in the right hippocampus that discharged fast spreading to the left mesial temporal lobe, a phenomenon known as 'burned-out hippocampus'. Conclusion: The intracranial recording, even though it is an invasive procedure, was necessary for the presurgical evaluation of our patient. This case demonstrates the risks of using surface electroencephalography to determine localization of epileptogenic zones.
    No preview · Article · Aug 2012 · Medical Principles and Practice
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    ABSTRACT: The diagnosis and assessment of brain damage is currently based on the clinical examination and the modern neuro-imaging techniques. Electrophysiology, haemodynamic monitoring and invasive neuromonitoring constitute additional tools for monitoring of the brain function and clinical course of the patient. However, despite the substantial progress, clinical and neuro-monitoring methods are quite often not sufficient to evaluate and quantify the severity of the initial and secondary destructive processes and hence they cannot guide efficient therapeutic measures and prognosticate effectively the outcome. During the last decades, researchers and clinicians have focused on specific markers of brain cell damage to improve the diagnosis and monitoring of neurological insults. Lactate dehydrogenase, creatine kinase, neuron specific enolase, have been proposed as potential markers of brain injury. More recently, other glial markers such as the Myelin Basic Protein, the glial fibrillary acidic protein and the S-100B protein have been measured in blood and used as surrogate biochemical markers for brain injury. This review summarizes published findings on the above brain specific serum biochemical markers with emphasis on those with clinical utility.
    No preview · Article · Mar 2009 · Mini Reviews in Medicinal Chemistry
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    ABSTRACT: The aim of this study was to establish a head trauma registry to (a) examine demographics, etiology, severity, clinical course, and outcome; (b) compare results with previous published series; (c) identify causes of bad outcomes; and (d) propose methods to improve therapy and prognosis. The following data were collected on 1,000 consecutive victims with head injury over 14 years of age admitted during a 4-year period: demographic characteristics, cause of injury, clinical variables, neuroimaging, therapy data, and outcome in 6 months. Seventy-four percent were men, and mean age was 43 years. Seventy-one percent suffered injuries due to road crashes, 14% due to alcohol, and 2% due to substances. The secondary transfer rate was 49%. For severe injuries, the time intervals from incident to hospital and subsequently to neurosurgical unit were 35 minutes and 4 hours, respectively. In 65% and 72% of cases, there was no record of preresuscitation hypoxia or hypotension, respectively, whereas suspected or definite episodes of hypoxia and hypotension were 27% and 13%, respectively. Most cases were mild trauma (63%), the remaining were severe (26%) and moderate (11%) injuries. Severe systemic trauma coexisted in 18%. Cranial surgery rate was 19% and it increased to 39% in severe trauma. The 6-month overall good outcome was 71%, with lower rates in moderate (58%) and severe (24%) injuries. The organization of Greece's first head injury registry offered an important preliminary core data concerning brain trauma etiology, management, and long-term outcome.
    No preview · Article · Nov 2008 · The Journal of trauma
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    ABSTRACT: A comparison of outcomes between different modes of head-injury treatment in the elderly has important bearing on questions of cost-effectiveness and medical ethics. Here, we have examined rates of mortality in elderly head-trauma victims to determine whether it is valid to differentiate an "edge" age group of younger elderly patients, 65-74 years of age, from older elderly patients, considering possible benefit from intensive treatment and surgical intervention. We collected data from 1926 cases of head trauma and separated them into three age groups: 14-64 years, 65-74 years, and 75 years or older. We then compared these groups with respect to cause of injury, severity of injury, and whether or not treatment included either admission to an Intensive Care Unit (ICU) or surgical intervention. We found that road traffic accidents were the major cause of head injury in the younger age group, whereas in the elderly falls predominated. Mortality was higher in the elderly in all the head injury severity subgroups. Young subjects with a Glasgow Coma Scale (GCS) score of less than or equal to 8 tended to benefit from ICU treatment whereas patients 75 and over did not, regardless of their severity of injury. For these patients who were in the 65-74 age group, the data suggested that some benefit was likely. Patients 75 and older were significantly less likely to survive surgical intervention than younger patients. We conclude that it is valid to treat patients in the age group 65-74 years as a separate group from those patients 75 and older. Patients in this younger subset of the elderly may benefit from ICU treatment or surgical intervention. However, the patients in our older subset of elderly patients clearly did not, and they had a significantly higher risk of surgical mortality.
    No preview · Article · Sep 2007 · Journal of Neurotrauma
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    ABSTRACT: We present a 30-year-old man with progressive spastic paraparesis. Spinal imaging revealed extensive calcification of the thoracic cord and cauda equina arachnoid, an intradural extramedullary cyst and evidence of rapidly progressing syringomyelia. Radiological diagnosis was arachnoiditis ossificans and an attempt at surgical decompression was made because of progressive neurologic deterioration. Due to tenacious adhesion of the calcified plaques to the cord and roots, only cyst drainage was achieved; the patient had no clinical improvement. A literature review revealed only two other cases reported in the literature with co-existence of arachnoiditis ossificans and syringomyelia. In none of the previous cases was there an intradural extramedullary arachnoid cyst, nor did the syrinx progress in such a rapid fashion. An attempt is made to explain possible pathophysiological mechanisms leading to this unusual pathology.
    No preview · Article · Jul 2007 · Journal of Clinical Neuroscience
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    ABSTRACT: Despite the major progress in neurophysiological monitoring, there are still difficulties in the early identification and quantification of cerebral damage after a stroke. In this prospective study we examined the associations between serum S-100B protein, a serum marker of brain injury, and initial neurological-neuroimaging severity, secondary deterioration, external ventricular drainage (EVD: therapeutic intervention) and outcome in patients with subarachnoid haemorrhage (SAH). We recorded all pertinent clinical data of 52 patients with SAH and measured S-100B serum levels on admission and every 24 h for a maximum of 9 consecutive days. Mann-Whitney U-test and Kruskal Wallis analysis were employed to assess the association of S-100B levels with all variables of interest. Log-rank test was used to evaluate survival and Cox's proportional hazard regression analysis to define the significant predictors of survival rate. Admission S-100B was statistically significantly associated with initial neurological status, neuroimaging severity, and one-year outcome (p = 0.0002, 0.001, and 0.017, Kruskal Wallis analysis). Admission S-100B above 0.3 microg/L predicted unfavourable outcome (p < 0.0001, log rank test) and constituted an independent predictor of short-term survival (p = 0.035 Cox's proportional hazard regression analysis) with a hazard ratio of 2.2 (95% C.I.: 1.06-4.6) indicating a more than doubling of death probability. Secondary neurological deterioration associated with S-100B increase (p < 0.0001) and external ventricular drainage (EVD) with S-100B reduction (p = 0.003, Wilcoxon signed rank test). Serum S-100B protein seems to be a useful biochemical indicator of neurological - neuroimaging severity, secondary deterioration, EVD (therapeutic intervention), and outcome in patients with SAH.
    No preview · Article · Apr 2007 · Acta Neurochirurgica
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    ABSTRACT: S-100B protein is a promising marker of injury severity and outcome after head injury. We examined the relationship between serum S-100B concentrations and injury severity, clinical course, survival, and treatment efficacy after severe traumatic brain injury (TBI). Prospective observational study in a neurosurgical intensive care unit. 102 adult patients with severe TBI, admitted between June 2001 and November 2003 (30 months). Serum S-100B levels were measured by immunoluminometric technique on admission and every 24 h thereafter for a maximum of 7 days. Initial S-100B levels were significantly related to pupillary status, computed tomography severity 1, and 1-month survival. Cox's proportional hazard regression analysis showed that initial S-100B was an independent predictor of 1-month survival, in the presence of dilated pupils, and with increased age. Subjects with initial levels above 1 microg/l had a nearly threefold increased probability of death within 1 month. Serum S-100B alteration indicated neurological improvement or deterioration. Finally, surgical treatment reduced S-100B levels. Serum S-100B protein reflects injury severity and improves prediction of outcome after severe TBI. S-100B may also have a role in assessing the efficacy of treatment after severe TBI.
    No preview · Article · Mar 2007 · Intensive Care Medicine
  • C L Nicholson · Stefanos Korfias · A Jenkins
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    ABSTRACT: Chronic pain is a complex condition that requires a multi-disciplinary approach to management. Spinal cord stimulation (SCS) has evolved into a relatively easily implemented, reversible technique with low morbidity for the management of chronic, intractable pain in selected patients. Percutaneous placement of electrode arrays, under local anaesthesia, supported by programmable, implanted electronics has been a major technical advance. Multicenter prospective studies were conducted and demonstrated that SCS, as a neuromodulation procedure, is indeed a superior method for treatment of chronic pain if the patients are selected with caution and a proper strategy. Future development of innovative electrodes and pulse generation systems will continue to improve this therapy.
    No preview · Article · Feb 2007 · Acta neurochirurgica. Supplement
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    ABSTRACT: Vagus nerve stimulation (VNS) is the most widely used non-pharmacological treatment for medically intractable epilepsy and has been in clinical use for over a decade. It is indicated in patients who are refractory to medical treatment or who experience intolerable side effects, and who are not candidates for resective surgery. VNS used in the acute setting can both abort seizures and have an acute prophylactic effect. This effect increases over time in chronic treatment to a maximum at around 18 months. The evidence base supporting the efficacy of VNS is strong, but its exact mechanism of action remains unknown. A vagus nerve stimulator consists of two electrodes embedded in a silastic helix that is wrapped around the cervical vagus nerve. The stimulator is always implanted on the left vagus nerve in order to reduce the likelihood of adverse cardiac effects. The electrodes are connected to an implantable pulse generator (IPG) which is positioned subcutaneously either below the clavicle or in the axilla. The IPG is programmed by computer via a wand placed on the skin over it. In addition, extra pulses of stimulation triggered by a hand-held magnet may help to prevent or abort seizures. VNS is essentially a palliative treatment and the number of patients who become seizure free is very small. A significant reduction in the frequency and severity of seizures can be expected in about one third of patients and efficacy tends to improve with time. Vagus nerve stimulation is well tolerated and has few significant side effects. We describe our experience on the use of VNS on drug-resistant epilepsy in 90 patients treated in two departments (in Athens, Greece and Newcastle, England).
    No preview · Article · Feb 2007 · Acta neurochirurgica. Supplement

Publication Stats

803 Citations
102.08 Total Impact Points

Institutions

  • 2014
    • University of Piraeus
      Le Pirée, Attica, Greece
  • 2002-2014
    • Evangelismos Hospital
      • Intensive Care Unit
      Athínai, Attica, Greece
  • 2012
    • Athens Medical Center
      Athínai, Attica, Greece
  • 2004
    • National and Kapodistrian University of Athens
      • Division of Neurosurgery
      Athínai, Attica, Greece