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Introduction to Functional Neurosurgery and Pain Disorders

Functional neurosurgery and surgery of pain disorders are two neurosurgical subspecialties studying the pathological processes that trigger some neurological diseases. Neuromodulation*, which is the main tool of this subspecialty, uses minimally invasive surgical techniques to reverse the abnormal functioning of the central or peripheral nervous system and, therefore, restore the balance that health entails.

Some of the most commonly treated disorders in functional neurosurgery are:

Movement disorders

Among movement disorders is Parkinson's disease or the essential tremor. These diseases must be evaluated by a team of specialists, after which, in those cases in which the symptoms are resistant to multiple drugs, the surgical option can be considered. Neuromodulation in these cases takes the form of electrodos implantados en el cerebro mediante un seguro y preciso sistema de coordenadas, con la intención de revertir la función patológica de ciertos circuitos cerebrales relacionados con la enfermedad y así mitigar de forma muy importante los síntomas del/la paciente.

 This is an internationally approved approach, which has been shown to be very effective, and for which there is more than 30 years of experience and more than 100,000 patients operated world-wide. 

Primary headaches

Some primary headaches, such as cluster headache, and neuralgias, such as trigeminal neuralgia, are included in this group such as cluster headache (trigeminal neuralgia) They present as an excruciating pain on the retro-ocular area, the face, the mouth or in the head. When these disorders become resistant to medication, neuromodulation may have a role.

Failed back syndrome and neuropathic pain

Probably the most frequent group. 

This section includes patients who have undergone the following procedures multiple surgeries The pain is a consequence of the process of repeated injury (both from the underlying disease and from surgeries) and scarring.  Then, an intense pain appears in one of the extremities (usually a leg) that becomes refractory to the use of multiple drugs.

This is a very difficult condition to treat and has to be evaluated very carefully. It is known that many of these patients will return for spinal surgery with unsatisfactory results.

In many cases, the pain described meets the criteria for “neuropathic pain"this means that it is the nerve (or nerve root) itself that generates the sensation of pain, without external compression or injury. Evaluation by a specialist may help some of these patients, who will be candidates for neuromodulation therapies.

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Què és la Neuromodulació?

La neuromodulació és un camp de recerca clínico-quirúrgica que té com a objectiu restablir la funció normal de determinats circuits patològics (majoritàriament circuits del moviment o circuits relacionats amb el dolor). Aquest objectiu es pot aconseguir mitjançant l’ús de teràpies poc invasives que actuen directament sobre el nucli o nervi afectat i que en un percentatge no menyspreable dels casos poden ser molt efectives. Algunes d’aquestes teràpies inclouen fàrmacs neuromoduladors, tècniques de radiofreqüència o l’implant d’elèctrodes d’estimulació cerebral, medul·lar o radicular.

La valoració per un equip multidisciplinar és important per poder escalonar els tractaments, des dels menys invasius (fàrmacs) fins als més invasius (cirurgies), passant per teràpies intermèdies.

És important reconèixer que no tots els tipus de dolors són tributaris de teràpies de neuromodulació, i la correcta selecció del pacient és la millor garantia per obtenir un resultat clínic satisfactori.

What is Neuromodulation?

Neuromodulation is a clinical-surgical research field whose objective is to restore the normal function of pathological circuits (mostly movement circuits or pain-related circuits). This objective can be achieved using minimally invasive therapies applied to the affected nucleus or nerve, which in a non-negligible percentage of cases will be very effective. Some of these therapies include neuromodulatory medication, radiofrequency techniques or the implantation of electrodes for stimulation of the brain, spinal cord, or nerve roots.

The assessment by a multidisciplinary team is important so that the treatment can be “staggered” from the least invasive (medication) to the most invasive (surgery), passing through intermediate therapies. 

It is important to know that not all kind of pains are tributaries of neuromodulation therapies, being the correct selection the best guarantee to obtain a satisfactory result.

¿Qué es la Neuromodulación?

La neuromodulación es un campo de investigación clínico-quirúrgica cuyo objetivo es restablecer la función normal de determinados circuitos patológicos (mayoritariamente circuitos del movimiento o circuitos relacionados con el dolor). Este objetivo puede ser logrado mediante el uso de terapias poco invasivas que actúan directamente sobre el núcleo o nervio afectado y que en un porcentaje no despreciable de los casos pueden ser muy efectivas. Algunas de estas terapias incluyen fármacos neuromoduladores, técnicas de radiofrecuencia o el implante de electrodos de estimulación cerebral, medular o radicular.

La valoración por un equipo multidisciplinar es importante para poder escalonar los tratamientos, desde los menos invasivos (fármacos) hasta los más invasivos (cirugías), pasando por terapias intermedias.

Es importante conocer que no todos los tipos de dolores son tributarios de terapias de neuromodulación, siendo la correcta selección del paciente la mejor garantía para obtener un resultado clínico satisfactorio.