Stimulation

This became practical with the miniaturization of electronic components and development of safe silicone polymers. Cooper applied stimulation to the surface of the cerebellum on the basis of work on cerebellar physiology, but a blinded trial showed this treatment to be ineffective and it fell into disuse. Theories relating to centren-cephalic epilepsy and a thalamo-cortical relay had suggested that chronic thalamic stimulation might lead to better control of the epilepsy. Fisher has written a good review of these techniques [23].

Similar physiological considerations lead to intermittent retrograde stimulation of the left vagus nerve. Through a transverse or oblique cervical incision, the left vagus nerve is exposed in the neck. The stimulator consists of three elements - two stimulating electrodes and an anchoring wire - that have to be wrapped around the nerve. The lead is then tunnelled to the generator, which is placed in a subcutaneous pocket, just inferior to the clavicle.

The results of a number of trials have been published and the effects on seizure frequency have been mixed. There are inevitable minor side effects associated with this stimulation, including hoarseness and a sensation in the throat, and there is also the risk of electrode movement, cable fracture and receiver or generator failure. Deaths occur in patients with functioning VNSs in place, but the incidence of SUDEP is no greater than would occur in a group of severe epileptics. There have been reports of asystole during testing under general

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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