Diagnostics and Treatments

Procedure indicated for patients with primary muscular spasticity or secondary to spastic paralysis, cerebral ictus, demyelinating lesions, spinal cord injuries, etc.

The purpose of this technique is to administer botulinum toxin (type A or type B) in order to improve muscle spasticity, correcting forced postures and their long-term consequences (painful contractures, bone deformities, etc.).

Treatment description:

• An initial assessment of the affected muscles and their functionality is performed.
• In the same consultation, botulinum toxin is injected through a needle/electrode with electromyographic guidance to ensure precise localization of the infiltration in the target muscles of the extremities. Precision is very important to avoid side effects due to the involvement of nearby muscles that are not involved.
• Botulinum toxin treatment relaxes spastic muscles and therefore corrects forced and non-functional postures (e.g. adduction of lower limbs, claw hand, equinus foot, etc.). It is safe, self-limiting and with few side effects.
• The duration of each treatment is 3-6 months.

• Issuance of a personalized report and, if required, communication with the referring physician.
• Follow-up after discharge by telephone consultation.

At all times, the Neurology Department secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.

Pre-surgical evaluation

• Procedure indicated for patients in whom seizures persist despite one year of treatment or after attempting to control seizures with three drugs (drug-resistant epilepsy)
  During this study a series of tests are performed to determine the location of the epileptogenic area and will require admission for video-EEG monitoring in a room with specialized intensive surveillance. Generally, a controlled withdrawal of medication is performed, being necessary a close supervision by the Epilepsy Program team. With this procedure, a record of the seizures is made with monitoring and the patient is prevented from suffering inappropriate risks.
• It is also necessary to complement the tests and admission with an extensive neuropsychological study, psychiatric interview and cranial MRI with special epilepsy protocol (high definition machine required). Some patients require additional studies with PET, SPECT and intracranial electrodes.
• Treatment description:
  Admission to video-EEG monitoring room for 2 to 5 days.
• In order for the pre-surgical evaluation to be carried out properly , the following is available:
  Nursing team specialized in epilepsy and EEG in constant presence (supervision similar to an ICU) and with interaction during seizures.
  Neurological evaluation prior to admission by a member of the Epilepsy Program. The patient will also be evaluated daily.
  Review of tests and history, treatments used throughout your medical history and the results obtained.
  Continuous neurological care, in presence and localized.
  Daily information to the patient and family members.
  Specific neuropsychological study.
  Psychiatric interview, if indicated.
  Skull MRI with epilepsy protocol (high definition).
  Presentation of the case in a joint session with specialists from different areas (neurologists, neuroradiologists, neuropsychologists, psychologists, neurorehabilitators, etc.).
  Management of antiepileptic medication before and during admission.
  Daily review of video-EEG records to establish immediate medical attitude (add electrodes, reduce medication, administer drugs, etc).
• Issuance of a personalized report and, if required, communication with the referring physician.
• At all times, the Neurology Department secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.

Diagnostic procedure indicated for patients who need a diagnosis or follow-up of their crises.

• The purpose of the study is to obtain a differential diagnosis of paroxysmal episodes of daily frequency and/or to perform a quantification of the seizures.
• Indicated for patients with epilepsy in whom it is suspected that there may be subclinical seizures that go unnoticed or patients with a doubtful diagnosis in whom an extensive EEG study may demonstrate epileptiform discharges or seizures during sleep).

Treatment description:

Admission to video-EEG monitoring room for approximately one day.

In order for the study to be carried out properly, the following are available:

• Epilepsy and EEG nursing team in constant presence (ICU-like supervision). Neurological evaluation during admission by a member of the Epilepsy Program.
  Continuous neurological care, in presence and localized.
  Management of antiepileptic medication before and during admission.
• Issuance of a personalized report and, if required, communication with the referring physician.

Procedure indicated for the diagnosis and quantification of disorders and movements associated with sleep. Study of secondary insomnia. Analysis of sleep architecture.

In this procedure, the physiological parameters of brain electrical activity (EEG), body muscular activity (EMG), cardiac activity (ECG), eye movements (EOG), respiratory movements, nasal and mouth airflow, as well as snoring and body position are recorded simultaneously during one night. In this way the quality of sleep is analyzed, its efficiency and determines the existence of respiratory, motor, cardiac or sleep structure alterations.

• Description of the procedure:

For this test, the patient must spend one night in the hospital, being admitted to a room adapted for this type of study.

• In order for the study to be carried out properly, the following are available:

Neurological evaluation prior to admission to determine which type of study is the most appropriate (the set-up may vary).
Continuous medical attention in the presence and localized, if any incident arises.
A technician specialized in sleep and PSG, located in an adjoining room, will constantly follow the study to verify that the recording is running normally.

Issuance of a personalized report and, if required, communication with the referring physician.

At all times, the Neurology Department secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.

• A lumbar puncture (LP) is a technique that consists of introducing a needle between two vertebrae, in the lumbar region, reaching the subarachnoid space, which contains cerebrospinal fluid (CSF).
• This test is performed by our neurologists in the Cure Room. Before the test is performed, you will be given a detailed explanation of all the procedures and possible post-puncture effects (such as headache, localized pain in the area, etc.).
• Once the tip of the needle is placed in the right place, the pressure at which the fluid comes out is measured, a sample of fluid is withdrawn for analysis and/or drugs or contrasts are introduced.
• Issuance of a personalized report and, if required, communication with the referring physician.

At all times, the Neurology Department secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.

Procedure indicated for patients with complicated Parkinson’s disease with motor fluctuations refractory to other therapeutic measures.

The purpose of this test is to identify the dose of apomorphine (a potent dopamine agonist that acts on D1 and D2 receptors and is administered subcutaneously) needed to produce a significant clinical improvement in a patient with complicated Parkinson’s disease with profound offs and refractory to oral therapy.

Treatment description:

• The patient will be admitted to the day hospital, and depending on the severity of the disease, the stay will be 2-5 hours.
• For the procedure to be successful:
  • A pre-treatment is performed, prior to admission, with Domperodone (60 mg), for 3 days.
  • Aniparkinsonian medication is suppressed for 12 hours.
  • A subcutaneous injection of 2mg of Apomorphine is administered.
  • The motor response is observed and quantified, using scales. The clinical response to the different doses is evaluated by the movement disorders specialist.
  • If the response received is insufficient, the dose is increased at 1-hour intervals until the adequate dose is found.
  • During the test, the patient and/or family members and/or caregivers are taught how to handle the apomorphine dosing pen for subcutaneous application.
• Issuance of a personalized report and, if required, communication with the referring physician.
• Follow-up after discharge by telephone consultation.

At all times, the Neurology Department secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.

Procedure that replaces surgical treatment in some patients with epilepsy associated with small epileptogenic lesions.

Treatment with stereotactic radiosurgery, using an Elekta Leksell Gamma Knife gamma ray system.

Treatment description:

• In order for radiosurgery treatment to be carried out properly, the following are available:

• • Optimization of medical treatment prior to surgery.
  • Neurological evaluation before and after radiosurgery by the Epilepsy Program. The patient will also be evaluated daily.
  • Continuous neurological care, in presence and localized, for the management of crises and possible side effects of medication.
  • Issuance of a personalized report and, if required, communication with the referring physician.
  • Follow-up after discharge by telephone consultation.

At all times, the Neurology Department secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.

Treatment indicated for patients suffering from drug-resistant epilepsy that does not respond to treatment with various antiepileptic drugs.

In some patients with drug-resistant epilepsy, greater seizure control can be achieved by the formation of ketone bodies in the blood. This is possible by modifying the diet to increase ketone bodies.

Treatment description:

• To perform the treatment the patient must be admitted, a complete fasting is maintained and the family is instructed in the procedure.
• Gradually, with close neurologist-nutritionist collaboration, the diet is introduced.
• In order for radiosurgery treatment to be carried out properly, the following are available:

• • Optimization of medical treatment before starting the diet.
  • Neurological evaluation before and after admission by the Epilepsy Program. The patient will also be assessed daily (evaluation and education of patient and family).
  • Management of antiepileptic medication during admission. Early identification of side effects.
  • Continuous neurological care, in presence and localized, for the management of crises and possible side effects of medication.
  • Issuance of a personalized report and, if required, communication with the referring physician.
  • Follow-up after discharge by telephone consultation.

At all times, the Neurology Service secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.

Treatment indicated for patients who have undergone a pre-surgical evaluation and who have shown that surgery is an adequate alternative.

Once the pre-surgical evaluation has been carried out, the most appropriate surgical technique is performed in each case by means of focal resections (temporal lobectomy, extratemporal lobectomy, hemispherectomy), callosotomy, vagus nerve stimulator implantation, etc.

Treatment description:

Preparation of treatment prior to surgery.

In order for the surgical treatment to be carried out properly, the following are available:

Presence of the Epilepsy Team during the intervention to assist the neurosurgeon in determining the extent of the resection.
Neurological evaluation before and after surgery by the Epilepsy Program. The patient will also be assessed daily.
Continuous neurological care, in presence and localized, including the stay in ICU in the post-surgical period.
Daily information to the patient and family members.
Specific neuropsychological study.
Management of antiepileptic medication before and during admission, with special attention to the possible appearance of crises related to the intervention (acute post-surgical crises).
Issuance of a personalized report and, if required, communication with the referring physician.
Follow-up after discharge by means of telephone consultation.

At all times, the Neurology Department secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.

Surgical treatment of dystonia (intraoperative microregistration and stimulation, programming of stimulation parameters).

Treatment indicated for patients suffering from disabling generalized or segmental dystonia refractory to pharmacological treatment and botulinum toxin injections. Currently, the technique generally used is deep brain stimulation of the bilateral internal globus pallidus.

Treatment description:

• The patient is admitted to a room so that the procedure can be performed.
• Initial and daily neurological evaluation during admission by the Movement Disorders Program.

For a correct intervention it is necessary:

• Existence of a multidisciplinary team: neurosurgeon, neurologist, neuroradiologist and anesthesiologist.
• Neuroimaging techniques are used to plan the surgical target.

In the operating room, the target is specified:

• By means of intraoperative microregistration techniques, an exact localization is achieved and neuronal discharge patterns are recorded, allowing the identification of the different anatomical structures.
• Guided by the microregistration, definitive macroelectrodes are implanted and the patient is examined, awake and in the operating room, in order to confirm that there are no adverse effects.

In a second phase,

• 7-14 days later, the pulse generators connected to the electrodes are implanted, usually in the infraclavicular region.
• In the following weeks, the parameters of the deep brain stimulation are programmed and adjusted.
• During the following 9-12 months, close follow-up is required to make periodic therapeutic adjustments (electrical and oral medication) in order to obtain the maximum benefit from the surgery.

Issuance of a personalized report and, if required, communication with the referring physician.

At all times, the Neurology Department secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.

Treatment indicated for patients suffering from Parkinson’s disease complicated with motor fluctuations and disabling dyskinesias and/or tremor refractory to medical treatment.

The treatment is aimed at patients who suffer from Parkinson’s disease and who, given the stage and intensity, find it disabling. At present, the technique generally used is deep brain stimulation of the subthalamic nucleus or globus pallidus, unilateral or bilateral. This technique is performed under minimal sedation.

Treatment description:

• The patient is admitted to a room for a period of 3 to 7 days.
• Initial and daily neurological evaluation during admission by the Movement Disorders Program.

For a correct intervention it is necessary:

• Existence of a multidisciplinary team: neurosurgeon, neurologist, neuroradiologist and anesthesiologist.
• Neuroimaging techniques are used to plan the surgical target.

In the operating room, the target is specified:

• By means of intraoperative microregistration techniques, accurate localization is achieved, neuronal discharge patterns are recorded and sensory/motor tremor cells are identified, allowing the identification of different anatomical structures.
• Guided by the microregistration, definitive macroelectrodes are implanted and the patient is examined, awake and in the operating room, in order to confirm improvement of parkinsonian symptoms and possible adverse effects.

In a second phase,

• 7-14 days later, the pulse generator connected to the electrode is implanted, usually in the infraclavicular region.
• In the following weeks, the deep brain stimulation parameters are programmed and adjusted and the patient’s medication is started to be modified.
• During the following 6-12 months, close follow-up is required to make periodic therapeutic adjustments (electrical and oral medication) in order to obtain the maximum benefit from the surgery.

A personalized report is issued and, if required, a communication with the referring physician will be made.

At all times, the Neurology Department secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.

Treatment indicated for patients with disabling tremor refractory to pharmacological treatment.

Currently, the technique generally employed is deep brain stimulation of the ventral intermediate nucleus (VIM) of the thalamus.

Treatment description:

• The patient is admitted to a room so that the procedure can be performed.
• Initial and daily neurological evaluation during admission by the Movement Disorders Program.

For a correct intervention it is necessary:

• Existence of a multidisciplinary team: neurosurgeon, neurologist, neuroradiologist and anesthesiologist.
• Neuroimaging techniques are used to plan the surgical target.

In the operating room, the target is specified:

• By means of intraoperative microregistration techniques, through a microelectrode, an exact localization is achieved, neural discharge patterns are recorded that allow the identification of the different anatomical structures.
• Guided by the microregistration, definitive macroelectrodes are implanted and the patient is examined to confirm that there are no adverse effects.

In a second phase :

• 7-14 days later, the pulse generators connected to the electrodes are implanted, usually in the infraclavicular region.
• In the following weeks, the parameters of the deep brain stimulation are programmed and adjusted.
• During the following 9-12 months, close follow-up is required for periodic therapeutic adjustments (electrical and oral medication) in order to obtain the maximum benefit from the surgery.

Issuance of a personalized report and, if required, communication with the referring physician.

At all times, the Neurology Department secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.

Treatment indicated for patients with disabling tremor refractory to pharmacological treatment, it is an alternative to surgical treatment.

Treatment with stereotactic radiosurgery, using an Elekta Leksell Gamma Knife gamma ray system.

Treatment description:

• Initial and daily neurological evaluation during admission by the Movement Disorders Program.
• Prior to admission, medical treatment is optimized.
• Continuous neurological care, in presence and localized, for the management of tremor after surgery.

Issuance of a personalized report and, if required, communication with the referring physician.

Follow-up after discharge by telephone consultation.

At all times, the Neurology Service secretary, by telephone or in person, will schedule and coordinate anynecessary complementary testsor other appointments.