Functional & Pain Neurosurgery

Parkinson's disease is a chronic, neurodegenerative movement disorder caused by the progressive loss of dopamine-producing nerve cells in the substantia nigra of the brain. Its classic features are resting tremor, muscle rigidity and slowness of movement (bradykinesia). In advanced stages where medication becomes insufficient, deep brain stimulation (DBS) is an important surgical option.

Trigeminal neuralgia (tic douloureux) is a cranial neuralgia characterized by sudden, severe attacks of electric-shock-like or stabbing pain on one side of the face. In most cases it is caused by a blood vessel compressing the fifth cranial (trigeminal) nerve where it exits the brainstem. Treatment begins with medication; in resistant cases surgical options such as microvascular decompression (MVD) are used.

Essential tremor is the most common movement disorder, characterized by a bilateral tremor that mainly affects the hands and arms and appears with posture (postural) and movement (kinetic). It often runs in families. Mild cases may not require treatment; medication is used when there is functional impairment, and surgical options such as deep brain stimulation (DBS) are used in resistant cases.

Hemifacial spasm is a movement disorder characterized by involuntary, recurrent contractions of the muscles supplied by the seventh cranial (facial) nerve on one side of the face. It usually starts around the eyelid and spreads over time to the lower face. In most cases it is caused by a blood vessel compressing the facial nerve. Botulinum toxin injection and microvascular decompression (MVD) are the main treatment options.

Dystonia is a movement disorder characterised by abnormal, repetitive movements and postures caused by involuntary, sustained or intermittent muscle contractions. It is the most common movement disorder after Parkinson's disease. Treatment depends on aetiology and distribution; botulinum toxin is first-line for focal dystonias, while deep brain stimulation of the globus pallidus interna (GPi-DBS) is a key option for generalised dystonia.

Torticollis (cervical dystonia) is the most common focal dystonia, characterised by an abnormal head posture (turned, tilted, flexed or extended) caused by involuntary, sustained or intermittent contractions of the neck muscles. Botulinum toxin injections are the mainstay of treatment; in refractory cases, deep brain stimulation of the globus pallidus interna (GPi-DBS) may be used.

Glossopharyngeal neuralgia is a rare cranial neuralgia characterised by severe, unilateral, electric shock-like, paroxysmal pain in the throat, base of the tongue and ear, in the distribution of the ninth cranial nerve (glossopharyngeal nerve). First-line treatment is with anticonvulsants; in refractory cases, microvascular decompression is the main surgical option.

Occipital neuralgia is a headache syndrome characterised by recurrent, severe, electric shock-like neuropathic pain in the nape, back of the head and vertex, caused by irritation, inflammation or compression of the greater and/or lesser occipital nerves. Treatment is stepwise: medication, nerve blocks, physiotherapy, and in refractory cases decompression surgery or occipital nerve stimulation.