Papers by Bengt Linderoth
[A course in USA put traces on professional life]
Läkartidningen
“The failed back surgery syndrome”: Definition and therapeutic algorithms - An update
European Journal of Pain Supplements, 2010
... View Within Article. Chronic low back pain with irradiation into the leg is thus a complex an... more ... View Within Article. Chronic low back pain with irradiation into the leg is thus a complex and mixed pain syndrome where both neuropathic and nociceptive pain components are represented (Baron and Binder, 2004). Nerve ...
Paroxysmal facial pain in disseminated sclerosis treated by retrogasserian glycerol injection
Acta Neurologica Scandinavica, 1989
In the material of patients with trigeminal neuralgia treated by retrogasserian glycerol injectio... more In the material of patients with trigeminal neuralgia treated by retrogasserian glycerol injection at the Karolinska Hospital, 23 cases (8%) were also diagnosed as suffering from disseminated sclerosis. These patients were often on carbamazepine treatment before the procedure, a regimen known to cause severe side effects and increase pre-existing symptoms in patients with multiple sclerosis. Following glycerol injection, more than 90% became pain-free within the first 2 months and 82% could discontinue drug therapy. This initial outcome corresponds well to the results in our larger series, but the long-term results in the group with multiple sclerosis is less satisfactory, with 61% recurrence at follow-up 8-79 months following treatment. In total 48% were pain-free at follow-up, following reinjections in 8 cases. In spite of less satisfactory long-term results, more than three-fourths of the patients wanted another glycerol injection after only low-dose trial with carbamazepine in case of recurrence.
Causes of the post-concussional syndrome
PubMed, 1974
1. Acta Neurol Scand Suppl. 1974;56:3-144. Causes of the post-concussional syndrome. Lidvall HF, ... more 1. Acta Neurol Scand Suppl. 1974;56:3-144. Causes of the post-concussional syndrome. Lidvall HF, Linderoth B, Norlin B. PMID: 4152047 [PubMed - indexed for MEDLINE]. MeSH Terms. Accidents; Adolescent; Adult; Aged; Amnesia ...
Spinal Cord Stimulation for Raynaud's Syndrome: Long-Term Alleviation of Bilateral Pain With a Single Cervical Lead COMMENTS
Neuromodulation, 2011
Spinal cord stimulation (SCS) has been described in a variety of neuropathic and vasospastic pa... more Spinal cord stimulation (SCS) has been described in a variety of neuropathic and vasospastic pain conditions including Raynaud's syndrome. We report here the outcome of single lead SCS in the case of a 49-year-old woman with severe Raynaud's syndrome, which had failed to respond to medical therapy. With a single quadripolar cervical lead in midline position at the C2/C3 level sustained pain relief of the bilateral pain was accomplished. Pain scores sank from 7/10 to 2-3/10 on the nominal analog scale and remained stable more than nearly four years by now. Treatment of bilateral pain in Raynaud's syndrome with SCS in a single technique is feasible. Advantages and disadvantages as compared with stimulation with bilateral leads are discussed.
[Peripheral and central nervous system stimulation in chronic therapy-resistant pain. Background, hypothetical mechanisms and clinical experiences]
PubMed, Nov 21, 2001
Severe neurogenic pain still constitutes a major problem since it is often resistant to conventio... more Severe neurogenic pain still constitutes a major problem since it is often resistant to conventional therapy. During the last 30 years electric activation of pain inhibitory mechanisms through stimulation both of peripheral nerves and of central nervous circuits has been used to great advantage. The simplest method of stimulation, transcutaneous electric nerve stimulation (TENS), is extensively used by physiotherapists as well as in pain clinics. The patient should always get his own stimulator for use at home. TENS originally served as a screening method to identify patients suitable for spinal cord stimulation therapy (SCS). The main indication is severe neuropathic pain of peripheral origin, but SCS has also been found valuable in extremity ischemia as well as in refractory angina pectoris. The most severe cases of neuropathic pain may benefit from intracranial stimulation via electrodes placed stereotactically in the posteromedial thalamus or epidurally over the motor cortex.
Molecular Pain, 2018
Spinal cord stimulation has become an important modality in pain treatment especially for neuropa... more Spinal cord stimulation has become an important modality in pain treatment especially for neuropathic pain conditions refractory to pharmacotherapy. However, the molecular control of inhibitory and excitatory mechanisms observed after spinal cord stimulation are poorly understood. Here, we used RNA-seq to identify differences in the expression of genes and gene networks in spinal cord tissue from nerve-injured rats with and without repetitive conventional spinal cord stimulation treatment. Five weeks after chronic constrictive injury to the left sciatic nerve, male and female rats were randomized to receive repetitive spinal cord stimulation or no treatment. Rats receiving spinal cord stimulation underwent epidural placement of a miniature stimulating electrode and received seven sessions of spinal cord stimulation (50 Hz, 80% motor threshold, 0.2 ms, constant current bipolar stimulation, 120 min/session) over four consecutive days. Within 2 h after the last spinal cord stimulation treatment, the L4-L6 spinal segments ipsilateral to the side of nerve injury were harvested and used to generate libraries for RNA-seq. Our RNA-seq data suggest further increases of many existing upregulated immune responses in chronic constrictive injury rats after repetitive spinal cord stimulation, including transcription of cell surface receptors and activation of non-neuronal cells. We also demonstrate that repetitive spinal cord stimulation represses transcription of several key synaptic signaling genes that encode scaffold proteins in the post-synaptic density. Our transcriptional studies suggest a potential relationship between specific genes and the therapeutic effects observed in patients undergoing conventional spinal cord stimulation after nerve injury. Furthermore, our results may help identify new therapeutic targets for improving the efficacy of conventional spinal cord stimulation and other chronic pain treatments.
Springer eBooks, 2007
The understanding of the mode of action of spinal cord stimulation (SCS) as treatment of neuropat... more The understanding of the mode of action of spinal cord stimulation (SCS) as treatment of neuropathic pain is still fragmentary. SCS evolved from the gate-control theory postulating a spinal modulation of noxious inflow, but there is little evidence that SCS influences nociceptive pain; pain relief in peripheral vascular disease and angina pectoris is presumably secondary to other SCS effects. In man, SCS may effectively abolish both continuous and evoked pain (tactile/thermal allodynia) whereas induced, acute nociceptive pain is unaffected. Recent SCS studies performed on rat models of mononeuropathy have demonstrated a preferential effect on A/3 fiber mediated functions, and the hyperexcitability of wide-dynamic-range dorsal horn neurons was attenuated. These effects were coupled to increased release of CABA and reduced glutamate and aspartate release in the dorsal horn. Intrathecal administration of CABA, baclofen and adenosine enhanced the SCS effect on tactile allodynia even in previously non-responsive rats. Preliminary results indicate that gabapentin may have a similar effect. CABAergic and adenosine-related mechanisms conceivably represent only examples of a number of putative receptor systems involved in SCS. Clinical trials have been initiated exploring the possibility to improve the efficacy of SCS by concomitant pharmacotherapy.
Spinal Cord Stimulation
Elsevier eBooks, 2009
Publisher Summary This chapter describes the surgical technique of implanting electrodes for spin... more Publisher Summary This chapter describes the surgical technique of implanting electrodes for spinal cord stimulation and outline the advantages and disadvantages of the types of anesthesia that can be utilized. The placement of surgical leads via laminotomy is a safe and effective procedure and is gaining popularity amongst implanters of SCS. There is approximately only 1.5 V difference when comparing the intraoperative and postoperative testing. The choice of anesthesia is largely driven by the surgeon's experience, his or her comfort level, and patient choice. Spinal anesthesia allows proper placement with the guidance of stimulation-induced paresthesia and eliminates the need for somatosensory evoked potentials. Spinal anesthesia does not block all sensory transmission in the superficial layers of the spinal dorsal columns, thus permitting intraoperative testing and proper lead positioning. The subarachnoid anesthetic agents act mostly on spinal rootlets and perhaps the ganglia, and the spinal afferent pathways remain unaffected. It is technically easy on the patient and the surgeon when compared with local anesthesia.
Neuromodulation, Feb 1, 2019
Objectives: Clinical high-frequency spinal cord stimulation (hfSCS) (>250 Hz) applied at subperce... more Objectives: Clinical high-frequency spinal cord stimulation (hfSCS) (>250 Hz) applied at subperception amplitudes reduces leg and low back pain. This study investigates, via labeling for c-fos-a marker of neural activation, whether 500 Hz hfSCS applied at amplitudes above and below the dorsal column (DC) compound action potential (CAP) threshold excites dorsal horn neurons. Materials and Methods: DC CAP thresholds in rats were determined by applying single biphasic pulses of SCS to T 12 -T 13 segments using pulse widths of 40 or 200 μsec via a ball electrode placed over the left DC and increasing amplitude until a short latency CAP was observed on the L 5 DC and sciatic nerve. The result of this comparison allowed us to substitute sciatic nerve CAP for DC CAP. SCS at T 12 -T 13 was applied continuously for two hours using: sham or hfSCS at 500 Hz SCS, 40 μsec pulse width, and 50, 70, 90, or 140% CAP threshold. Spinal cord slices from T 11 -L 1 were immunolabeled for c-fos, and the number of c-fos-positive cells was quantified. Results: 500 Hz hfSCS applied at 90 and 140% CAP threshold produced substantial (≥6 c-fos + neurons on average per slice per segment) c-fos expression in more segments between T 11 and L 1 than did sham stimulation (p < 0.025, 90% CAP; p < 0.001, 140% CAP, Fisher's Exact Tests) and resulted in more c-fos-positive neurons on average per slice per segment ipsilateral to than contralateral to the SCS electrode at 70, 90, and 140% CAP threshold (p < 0.01, Wilcoxon Signed Rank Tests). The finding of enhanced c-fos expression in the ipsilateral superficial dorsal horn provides evidence for activation/modulation of neuronal circuitry associated with subperception hfSCS.
European Journal of Pain, Nov 28, 2016
Background: Spinal cord stimulation (SCS) has been shown to provide pain relief in painful diabet... more Background: Spinal cord stimulation (SCS) has been shown to provide pain relief in painful diabetic polyneuropathy (PDPN). As the vasculature system plays a great role in the pathophysiology of PDPN, a potential beneficial side-effect of SCS is peripheral vasodilation, with high frequency (HF) SCS in particular. We hypothesize that HF-SCS (500 Hz), compared with conventional (CON) or low frequency (LF)-SCS will result in increased alleviation of mechanical hypersensitivity in chronic experimental PDPN. Methods: Diabetes was induced in 8-week-old female Sprague-Dawley rats with an intraperitoneal injection of 65 mg/kg of streptozotocin (n = 44). Rats with a significant decrease in mechanical withdrawal response to von Frey filaments over a period of 20 weeks were implanted with SCS electrodes (n = 18). Rats were assigned to a crossover design with a random order of LF-, CON-, HF-and sham SCS and mechanical withdrawal thresholds were assessed with von Frey testing. Results: Compared with sham treatment, the average 50% WT score for 5 Hz was 4.88 g higher during stimulation (p = 0.156), and 1.77 g higher post-stimulation (p = 0.008). CON-SCS resulted in 50% WT scores 5.7 g, and 2.51 g higher during (p = 0.064) and after stimulation (p < 0.004), respectively. HF-SCS started out with an average difference in 50% WT score compared with sham of 1.87 g during stimulation (p = 0.279), and subsequently the steepest rise to a difference of 5.47 g post-stimulation (p < 0.001). Conclusions: We demonstrated a delayed effect of HF-SCS on mechanical hypersensitivity in chronic PDPN animals compared with LF-, or CON-SCS. Significance: This study evaluates the effect of SCS frequency (5-500 Hz) on mechanical hypersensitivity in the chronic phase of experimental PDPN. High frequency (500 Hz) -SCS resulted in a delayed effect-on pain-related behavioural outcome in chronic PDPN.
Why Cardiologists are not using Devices to directly modulate the Nervous System
Internal Medicine Review, 2017
Neurosurgery, Nov 1, 1991
6 History of Stereotactic Neurosurgery in the Nordic
In the sixth volume of the classical and comprehensive textbook of neurosurgery by Olivecrona and... more In the sixth volume of the classical and comprehensive textbook of neurosurgery by Olivecrona and Tonnis (1957), Lars Leksell contributed a chapter on ‘‘Targeted Brain Operations’’ (Gezielte Hirnoperationen). In the introduction he refers to the development of his stereotactic instrument – he always preferred to describe his stereotactic frame as a surgical instrument – that followed the pioneering work by Spiegel and Wycis in 1947–1948. The first presentation of Leksell’s sterotactic apparatus dates from 1949 and already in the early 1950s he had gained experience in targeted lesional surgery using electrical current and different types of X-ray beams – radiosurgery. There is no doubt that this makes Leksell, together with a few others, one of the founders of stereotactic surgery. It should also be noted that the principal mode of function and general features of his original instrument have survived in the modern version that is still one of the most commonly used stereotactic systems in the world. That is why the advancement of stereotactic neurosurgery in the Nordic countries is so intimately associated with the name of Lars Leksell and his contributions. Lars Leksell (1907–1986) started his neurosurgical training with Herbert Olivecrona in 1935 at the Serafimer Hospital, one of the oldest hospitals in Sweden founded in 1752. The Olivecrona neurosurgical service enjoyed a solid international reputation and attracted a large number of trainees from all over the world. For a short period Leksell served as a volunteer
Elsevier eBooks, 2009
The understanding of the mode of action of spinal cord stimulation (SCS) as treatment of neuropat... more The understanding of the mode of action of spinal cord stimulation (SCS) as treatment of neuropathic pain is still fragmentary. SCS evolved from the gate-control theory postulating a spinal modulation of noxious inflow, but there is little evidence that SCS influences nociceptive pain; pain relief in peripheral vascular disease and angina pectoris is presumably secondary to other SCS effects. In man, SCS may effectively abolish both continuous and evoked pain (tactile/thermal allodynia) whereas induced, acute nociceptive pain is unaffected. Recent SCS studies performed on rat models of mononeuropathy have demonstrated a preferential effect on A/3 fiber mediated functions, and the hyperexcitability of wide-dynamic-range dorsal horn neurons was attenuated. These effects were coupled to increased release of CABA and reduced glutamate and aspartate release in the dorsal horn. Intrathecal administration of CABA, baclofen and adenosine enhanced the SCS effect on tactile allodynia even in previously non-responsive rats. Preliminary results indicate that gabapentin may have a similar effect. CABAergic and adenosine-related mechanisms conceivably represent only examples of a number of putative receptor systems involved in SCS. Clinical trials have been initiated exploring the possibility to improve the efficacy of SCS by concomitant pharmacotherapy.
Neuromodulation, Feb 1, 2020
Objectives: Painful diabetic peripheral neuropathy (PDPN) is a long-term complication of diabetes... more Objectives: Painful diabetic peripheral neuropathy (PDPN) is a long-term complication of diabetes mellitus (DM). Dorsal Root Ganglion Stimulation (DRGS) has recently emerged as a neuromodulation modality in the treatment of chronic neuropathic pain. The objective of this study was to compare the effect of burst DRGS (Burst-DRGS) and conventional DRGS (Con-DRGS) in an experimental model of PDPN. Materials and Methods: DM was induced in female Sprague-Dawley rats by intraperitoneal injection of streptozotocin (STZ, n = 48). Animals were tested for mechanical hypersensitivity (50% hind paw withdrawal threshold on Von Frey test) before, and 4 weeks after STZ injection. PDPN rats were then implanted with a unilateral bipolar lead at the L5 DRG (n = 22) and were stimulated for 30 min at days 2 and 3 postimplantation. Animals received Con-DRGS and Burst-DRGS in a randomized crossover design (n = 10), or received Sham-DRGS (n = 7) for 30 min, and were tested for mechanical hypersensitivity at baseline, 15 and 30 min during DRGS, and 15 and 30 min following DRGS. Five animals were withdrawn from the study due to electrode-related technical problems. Results: Con-DRGS and Burst-DRGS normalized STZ-induced mechanical hypersensitivity at 15 and 30 min during stimulation. A significant difference in terms of mechanical hypersensitivity was observed between both of the stimulated groups and the Sham-DRGS group at 15 and 30 min during stimulation. Interestingly, Burst-DRGS showed signs of a residual effect at 15 min after cessation of stimulation, while this was not the case for Con-DRGS. Conclusions: Under the conditions tested, Con-DRGS and Burst-DRGS are equally effective in attenuating STZ-induced mechanical hypersensitivity in an animal model of PDPN. Burst-DRGS showed signs of a residual effect at 15 min after cessation of stimulation, which requires further investigation.
Proceedings of the 12th Meeting of the European Society for Stereotactic and Functional Neurosurgery. Milan, 1996
PubMed, 1997
Effects of Spinal Cord Stimulation with different frequencies on blood flow in the rat hind paw
The FASEB Journal, Mar 1, 2008
Elsevier eBooks, 2012
Spinal cord stimulation (SCS) is one of the most effective modalities for management of refractor... more Spinal cord stimulation (SCS) is one of the most effective modalities for management of refractory neuropathic pain unresponsive to conservative therapies. The SCS has been successful in providing analgesia, improving function, and enhancing quality of life for patients suffering from chronic pain conditions such as failed back surgery syndrome, complex regional pain syndrome, ischaemic and phantom limb pain, and coronary artery disease. This technique has proven to be cost effective in the long term despite its high initial cost. In this review article, we discuss the history of SCS development, mechanism of action, and indications for SCS.
Neurosurgical treatment of short-lasting, unilateral, neuralgiform hemicrania with conjunctival injection and tearing
Headache, Apr 1, 2003
Trigeminal neuralgia solely involving the upper trigeminal nerve branch is rare. The SUNCT syndro... more Trigeminal neuralgia solely involving the upper trigeminal nerve branch is rare. The SUNCT syndrome (short-lasting, unilateral, neuralgiform hemicrania with conjunctival injection and tearing) in which the periorbital pain lasts for 60-120 s, and is accompanied by conjunctival injection and tearing is even less common. Unlike trigeminal neuralgia, SUNCT is usually not relieved by medication. Three patients with SUNCT were treated with retrogasserian glycerol rhizolysis, two of them twice. All five treatments provided complete pain relief and the duration of the effects was 2 to more than 4 years. One of these three patients also had a third treatment with compression of retroganglionic fibres with a Fogarthy balloon, according to Mullan, of the upper trigeminal nerve with excellent results.
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Papers by Bengt Linderoth