Glossary of Terms

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Baclofen pump

A baclofen pump is a surgically implanted device that is used as a drug delivery system. Just like diabetic patients benefit from insulin pumps, patients with severe muscle tightness or spasticity can benefit from a baclofen pump. The medicine (baclofen) is pumped into the spinal fluid. The pump is refilled at home by a nurse or in the doctor’s office every few months.

Botox injections

Intra-muscular injections of botulinum protein which temporarily relaxes spasticity in skeletal muscle. These injections can be used to treat tight muscles in children with cerebral palsy, and adults with spasticity from stroke, dystonia, brain or spine injury or multiple sclerosis.

Brachial plexus repair

Repair of a network of nerves in the neck and axilla, composed of the anterior branches of the lower four cervical and first two thoracic spinal nerves and supplying the chest, shoulder and arm. Brachial plexus injury can be a result of a difficult birth or due to a traction injury of the arm or shoulder.

Brain tumors

Unfortunately, brain tumors can develop in infants and children, as well as in adults. In adults, about half of all brain tumors are metastases, but in children most tumors are primary tumors (originated in the brain not from elsewhere). Primary tumors come from abnormal tissue or cells in the brain. Some common primary childhood brain tumors include medulloblastoma, primitive neuroectodermal tumor (PNET), astrocytoma or glioma, juvenile pilocytic astrocytoma (JPA), pilomyxoid astrocytoma (PMA), ependymoma, and ganglia tumors. Meningiomas are rare in children, and are more common in adults. For more information about brain tumors and their treatment, please call our office or see the websites below.

Cerebral Palsy (CP)

A disorder usually caused by brain damage at or before birth. CP may involve muscular impairment and spasticity. Often accompanied by poor coordination, it sometimes involves speech and learning difficulties. CP is occasionally associated with hydrocephalus. We have developed a special team for helping children with cerebral palsy. Movement disorders and orthopedic problems, common to children with CP, are our specialty.

Cerebrospinal fluid (CSF)

CSF is a fluid that circulates throughout the central nervous system. It delivers nutrients to the structures of the nervous system and also removes waste from the brain and spinal cord. This fluid also protects the brain and spinal cord from trauma due to a fall, hit, or other traumatic scenario. In the brain CSF is contained in the ventricles and is produced mainly by the choroid plexus in the lateral third and fourth ventricles. This fluid is absorbed in the superior sagittal sinus into the blood stream.

Chiari malformation and decompression

Chiari malformation is a disorder that involves the back of the brain and skull. There are several theories about how and why Chiari malformations develop. Some doctors believe that Chiari malformation develops in utero, while the fetus is developing. Other doctors believe that a Chiari malformation is acquired, or develops over time. Very often, after a head or neck injury, a Chiari malformation is diagnosed. While a CT scan can show some brain deformities, a MRI is best for ruling out or showing a Chiari malformation. A Chiari decompression is a surgical removal of the posterior and inferior occipital bone and overlying dura. This procedure is done to remove pressure on the underlying cerebellum, as found in patients with Chiari malformation. In some patients, just enlarging the foramen magnum (the big hole at the bottom of the skull) is all that is needed. In other patients, the covering of the brain, called the dura, is opened and a patch inserted. The patch is sewn in to allow for more room to grow. For more information about Chiari malformation, please call our office or look at one of the websites listed below.

Chromosomal and metabolic abnormalities –

Disorders affecting the chromosomes (genes) and the biochemical, metabolic processes within the body.

Computed tomography (CT)

A series of x-rays used to image or view internal bodily structures, including the brain and spine. A series of cross-sectional scans are made along a single axis of a bodily structure and then a computer generated, three-dimensional image of that structure is created. For questions about the amount of radiation exposure for each CT scan, please see the websites listed below.

Concussion and Traumatic Brain Injury

There are many kinds of traumatic brain injury. In its most simple form, children may suffer a concussion with no findings on their CT scan. Children who have persistent headaches or other problems are often sent for an MRI of the brain to rule out swelling of the brain or other problems. If there is a bruise in the brain, this is called a contusion. Contusions, just like all bruises, may be small or large, and often heal well without complication. Any child who suffered a TBI is at risk for post-traumatic seizures, even though the risk may be low. Skull fractures can occur if there is sufficient force on the skull to cause a break. Skull fractures can be displaced, where the bone is knocked out of position, or non-displaced. Sometimes, children suffer traumatic intracranial bleeding. Bleeding can occur over the surface of the dura (the covering of the brain) and this is called an EPIDURAL HEMATOMA. Blood clots can also occur under the dura, over the brain, and in this case are called SUBDURAL BLEEDS or SUBDURAL HEMATOMAS (1). If there is a large bleed in or over the brain, a neurosurgeon operates quickly to remove or evacuate the blood clot. The damage caused by the bleeding may be temporary or permanent. If the bleed occurs in a vital or important part of the brain, the patient may suffer permanent brain damage. Sometimes, even if the neurosurgeon removes the clot, the damage caused by the bleed can cause death or permanent disability. There are many organizations which educate and support families of those who have suffered a TBI.

Congenital malformations

Malformations that may occur during birth and development. Congenital malformations may be genetically related. Congenital malformations may be mild or severe and in some instances can be diagnosed in utero (during pregnancy).

Corpus callosotomy

Corpus callosotomy is a surgical procedure that significantly reduces the frequency and severity of a patient’s seizures, particularly atonic seizures (drop attacks). This surgery is an option for about 10% of epilepsy patients whose epilepsy cannot be controlled by anti-epileptic drugs. This procedure is performed by cutting a portion (partial callosotomy means cutting the front two-thirds) or the entire corpus callosum (complete). However, none of the corpus callosum, the large fiber bundle connecting the two sides of the brain, is removed.

When the two sides are disconnected, this prevents the spread of the seizure activity. This surgery is effective against atonic seizures (drop attacks), tonic seizures and tonic-clonic seizures. For patients who receive a partial callosotomy, seizure frequency is reduced by 70 to 80% and 80 to 90% after a complete callosotomy.

During the surgery, after the patient is under general anesthesia, an incision is made and a piece of the skull is removed. The space between the two halves of the brain is entered using microscopic tools and the front (anterior) corpus callosum is sectioned. The posterior one-third can also be sectioned during this procedure or in a second operation, if necessary. Afterwards, the dura (membrane covering the brain) is closed, the skull is replaced and the scalp is closed.

After the surgery, the child will be carefully monitored for about 5-7 days before being discharged and then followed up with over the next few months to monitor the effectiveness of the procedure.

Cranial nerve disorders

Disorders that occur in the cranial nerves (which may affect the face, nose, eyes, mouth, and tongue.)

Craniofacial deformities

Anomalies involving the cranium (head/ skull) and/ or the face. Children and adults with craniofacial abnormalities are usually seen at multi-disciplinary, craniofacial team centers. The Craniofacial Teams provide comprehensive care for children and support for their families. For scheduling an appointment with the Craniofacial Team, please call our office.

Craniofacial disorders

Congenital anomalies of the skull or face, usually due to congenital or genetic factors.

Craniosynostosis

Craniosynostosis describes the premature fusion of sutures on a baby’s head. An infant or young baby’s skull is made of several bony plates which fuse along the suture lines by the time a child is 2 or 3 years old. Premature closing of a suture can cause the child to have an abnormally shaped head.

In mild cases, the brain will develop and function normally. However, in more severe cases, the premature fusion of the sutures can cause swelling, blindness, seizures and other complications. Fortunately, surgery for craniosynostosis has been effective and successful in relieving pressure, ensuring there is room for the brain to grow and improving the appearance of the head.

In a traditional surgery, incisions are made in the infant’s scalp and cranial bones. Then the affected area of the skull is reshaped, sometimes with plates and screws which may be absorbable. Immediate results are observed. Less invasive surgery is possible when the infant is less than 6 months old. Two small incisions are made and the sutures are separated. This approach allows the growing brain to shape the head normally, on its own. However, infants will also need a custom-made helmet to help with the shape and healing of the skull.

Craniotomy

This a surgical procedure in which the cranium is opened. A piece of the skull, called a bone flap, is removed in order to allow the surgeon to access the brain. The bone flap is later returned to its original place. This differs from a craniectomy in that in a craniectomy the bone flap is not returned to its location at the end of the procedure.

Cyst

A closed sac-like structure which contains either liquid, gaseous, or semi-solid substances. In the brain cysts are usually filled with cerebrospinal fluid (CSF). There are multiple types of cysts that may occur in the brain including arachnoid, subarachnoid and pineal cysts.

Deep brain stimulation (DBS)

Surgically placed electrodes which enter the brain through a small hole in the skull and stimulate deep brain structures. DBS is done for patients with unilateral or bilateral movement disorders, such as tremor, spasticity and/ or dystonia. Patients with movement disorder are usually evaluated at a multi-disciplinary center. For questions about movement disorders, or for an appointment at the Movement Disorders Center for Adults or Children, please call our office.

Dorsal rhizotomy

A surgical treatment for spasticity where abnormal sensory nerve roots are partially cut. People develop spasticity, or muscle tightness, after brain or spinal cord injury. Spasticity can cause contractures, hip subluxation and scoliosis. Spasticity may be treated medically, but in some cases, does not respond to medical treatment. A selective dorsal rhizotomy (SDR) stops the spasticity in the legs or arms, without losing the motor-abilities of those extremities. SDR is usually recommended for young children with cerebral palsy and leg spasticity.

Dysraphism/ Spina Bifida

A congenital defect in which the spinal column is imperfectly closed so that part of the meninges or spinal cord may protrude, often resulting in neurological disorders. Some children are diagnosed in utero (pre-natally) while others may not be diagnosed until they are adults. There are many forms and different types of spina bifida, from MILD to severe. The Spina Bifida Association and the Spina Bifida Resource Network are excellent resources for children with spina bifida and their families. Most people who have spina bifida develop tethering of their spinal cord, that may be corrected at birth, or may be corrected later in life. Some patients with spina bifida also have hydrocephalus.

Electroencephalography (EEG)

A study of the electrical activity of the brain. EEG’s are performed by measuring electric potentials, using electrodes which are usually attached to the scalp. EEG’s are done for children and adults with epilepsy or those with seizures.

Electrophysiological monitoring

The monitoring of electrical signals which travel through the brain and spinal cord.

Encephalopathies

Any of the various diseases of the brain.

Endoscopic surgery

Surgery involving the placement of a thin-walled tube (endoscope) into an organ. Endoscopic surgery is usually referred to as ‘minimally invasive’. Surgery is performed with the assistance of a fiberoptic camera and small instruments which can be passed through the thin tube. In the brain, the camera and instruments can be moved around in the ventricles or in the spaces around the brain. Endoscopic surgery usually carries the same exact risks as open surgery, which is the more traditional form of surgery.

Endoscopic third ventriculostomy

This procedure is an alternative to shunt placement for the treatment of obstructive hydrocephalus. In this surgery a small hole is opened inside the brain to re-establish the proper flow of cerebrospinal fluid. The endoscopic nature of the surgery means it is less invasive and usually requires only a short recovery time.

Endovascular treatment

Non-surgical, non-invasive treatment of vascular diseases, including those of the nervous system (aneurysms, arteriovenous malformations, arterial stenosis). Endovascular treatment is usually done in an angiography suite with a specially-trained radiologist and your neurosurgeon.

Epilepsy

Any of the various neurological disorders characterized by sudden, recurring attacks of motor, sensory, or personality changes, with or without loss of consciousness, convulsions or seizures.

External ventricular drain (EVD)

External ventricular drains are placed in order to temporarily control intracranial pressure by draining cerebrospinal fluid outside of the brain.

Hydrocephalus

A condition in which there is an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain. This accumulation may cause enlargement of the skull and/ or compression of the brain. It may be treated with medication in some conditions, but is usually treated surgically by shunts or endoscopic third ventriculostomies. There are many different kinds of hydrocephalus, and almost all forms can be successfully treated. If you have questions about hydrocephalus, please see the following links, or call our office. The Hydrocephalus Association provides support and assistance to patients and their families.

ImPACT testing” (Immediate Post-Concussion Assessment and Cognitive Testing)

A computerized neurocognitive assessment used by medical doctors, psychologists, athletic trainers, and other licensed healthcare professionals to assist in determining an athlete’s ability to return to play after suffering a concussion. The results of an impact test after having a concussion are most helpful when they can be compared to a baseline impact test conducted prior to the concussion. This assessment can help to objectively evaluate the concussed individual’s post-injury condition and track recovery for safe return to normal activities, and as a result prevent the cumulative effects of concussion.

Intraoperative mapping

The mapping of function in the brain based on electrical potentials. Intraoperative mapping is usually done during brain surgery. When a neurosurgeon is removing a tumor or mass in the brain, often it is helpful to localize where some important brain functions lie. For example, intra-operative mapping can help define the motor areas of the brain. If possible, your neurosurgeon will specifically avoid operating in that area.

Intrathecal baclofen pumps

A surgically implanted pump and lumbar spinal catheter. The pump is filled with Baclofen (Lioresal) a medication to treat spasticity. The Baclofen is then slowly pumped into the cerebrospinal fluid of the spine. The pump can be re-filled and re-programmed through the skin, in the doctor’s office. Videos and information are available from our Neuromuscular Center. Please also refer to the Baclofen Pump entry on this page.

Intrathecal baclofen therapy (ITB)

Treatment of spasticity using an intrathecal baclofen pump (see above).

Magnetic Resonance Imaging (MRI)

An imaging study which does not involve x-rays. There is NO radiation exposure. A magnetic resonance spectrometer is used to produce electronic images of specific atoms and molecular structures within the body. MRIs are Commonly used to obtain fine-detailed pictures of the brain, white matter in the brain, spinal cord, and posterior fossa. Unfortunately, MRI studies take more time to perform compared to CT scans. This is why, for children, sedation or anesthesia, is often required. MRI shows better details of the anatomy, but does not show bone lesions well. FUNCTIONAL MRI can show neurosurgeons and neurologists where functional areas of the brain lie. However, a child usually has to be older than 6 or 7 years old, in order to be able to cooperate with functional imaging studies.

Multiple sclerosis

A chronic degenerative disease of the central nervous system in which gradual destruction of myelin occurs in patches throughout the brain or spinal cord or both, interfering with the nerve pathways and causing muscular weakness, loss of coordination, and speech and visual disturbances. It occurs chiefly in young adults and is thought to be caused by a defect in the immune system that may be of genetic of viral origin. Neurosurgeons can help patients with MS who have spasticity.

Myelomeningocele

A birth defect that causes incomplete closure of the neural tube. The nervous system starts out as a tube of nerve cells with a hollow center. The front (anterior) part of the tube closes and forms the head. The tail end of the tube, the dorsal part, closes about 26 days after conception, and forms the tail end of the spine. Sometimes, errors in closure of the tube occur. Babies may be born with a skin covered opening in the spine, or they may be born with the spinal cord exposed and uncovered. Neurosurgeons usually operate within 48 hours, to close the hole in the spine. Some children with this form of spina bifida also have a tethered spinal cord. Almost all babies with a myelomeningocele develop hydrocephalus. Chiari malformation occurs in most children with myelomeningocele, but this condition may be asymptomatic. If the Chiari malformation is not causing symptoms, most neurosurgeons do not do a Chiari decompression.

Neurocutaneous syndromes

Diseases involving the nervous system and skin. Also called PHAKOMOTOSES, there are many different types of neurocutaneous disorders. Almost all affect the skin and the nervous system. There are MILD to severe forms of neurocutaneous syndromes. Some patients with this disorder do require neurosurgery for tumors that develop in the nervous system. While many of these tumors are benign and resectable, some tumors are more malignant and unresectable (cannot be safely removed). Patients with neurocutaneous syndrome need to be followed regularly by their neurologist or neurosurgeon.

Neuronavigation

The identification of neuro-anatomy based on computer guidance and pre-operative MRI or CT images. Often, neurosurgeons will request a MRI or CT scan to use for mapping out a brain or spinal tumor during surgery. The ability to localize a tumor in the brain helps a neurosurgeon avoid important areas of the brain that are used for motor and speech. Sometimes, neuronavigation is also used to guide a spine surgery, when screws or other devices need to be safely placed in the bones of the spine.

Neuropsychology

This is a branch of clinical psychology, which studies the relation of behavior, emotion and cognition to brain function. There are an array of assessment methods employed to ascertain function and disfunction and applies the accumulated information to evaluate, treat and rehabilitate individuals with psychological or neurological problems.

Neurophysiological monitoring

Evaluation of the physiology and function of the nervous system (brain, brainstem, spinal cord and peripheral nerves). This kind of monitoring can be done before, during or after surgery.

Orthotic (brace) design

An orthopedic appliance designed to straighten or support a body part. An orthotic, such as a helmet may be worn by children with plagiocephaly or following an endoscopic craniosynostosis surgery.

Papilladema

A condition where the optic nerve is swollen as it enters the back of the eye due to elevated intracranial pressure.

Peripheral neuropathies

A disease of the peripheral nerves. Peripheral neuropathy can be congenital (something someone is born with) or acquired. Some peripheral nerve disorders develop over time. While some peripheral neuropathies are painful, some are painless. Usually peripheral neuropathies cause weakness or numbness in the affected part. People can have a single peripheral neuropathy or multiple peripheral neuropathies.

Plagiocephaly

An asymmetrical deformity of the skull due to premature closure of the sutures of the skull, or from positional molding. Plagiocephaly may be treated with physical therapy, molding helmets, and/ or surgery. Babies with plagiocephaly are sometimes referred by their pediatricians for a cranial molding helmet. It is usually advisable to see a pediatric neurosurgeon, or craniofacial plastic surgeon, to rule out craniosynostosis first. Craniosynostosis can occur in infants and does require surgery. Plagiocephaly is usually caused by positional molding or flattening of the thin, infant skull. Many babies are referred to our Craniofacial Team every month, to rule out craniosynostosis, and to get treated for plagiocephaly.

Positron emission tomography (PET)

Tomography in which a computer-generated image of local metabolic and physiological functions in tissues is produced through the detection of gamma rays that are emitted when introduced radionuclides decay and release positrons. Also used for imaging the functional status of the brain.

Psychometrics

The branch of psychology that deals with the design, administration, and interpretation of quantitative tests for the measurement of psychological variables such as intelligence, aptitude, and personality traits.

Seizure

The physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain. They are often associated with convulsions however not all seizures include convulsions.

Shunts

A surgically implanted tube which diverts spinal fluid from the brain or spinal canal, to the peritoneum (abdomen), pleura (lungs) or gallbladder. Shunts were developed in the later part of the 20th century. With early shunts, there were high complication rates. Newer shunts have better technology, and with better techniques, the risks of shunt implantation are substantially lower. Even so, shunt infection, blockage or breakage may occur. It is important to follow up regularly with your neurosurgeon if you have a shunt. They are commonly used to treat hydrocephalus.

Single photon emission computed tomography (SPECT)

An imaging study that uses tomography of metabolites to evaluate physiological functions in various organs, including the brain. The image is formed by a computer synthesis of data that is transmitted by single gamma photons emitted by radionuclides administered to the patient.

Spasticity

A movement disorder, usually seen in patients with cerebral palsy, stroke, multiple sclerosis. Increased tightness or spasticity in the muscles may lead to the development of contractures, hip subluxation or breakdown, scoliosis and/ or other problems. People with severe spasticity have limited range of motion and often cannot move the affected limb. Spasticity may be treated medically or surgically. Medications, such as baclofen and/ or valium, may help reduce the muscle cramping and tightness. Sometimes though, medications have unwanted or intolerable side effects, and surgery is recommended. There are many different treatment options, such as Botox injections, baclofen pump implantation and selective dorsal rhizotomy. Deep brain stimulation has also been tried for patients with severe spasticity. Because each person responds differently, there is not one recommended treatment for spasticity. Please also see the Baclofen Pump and Intrathecal Baclofen Pumps entries on this page.

Spina Bifida

A congenital defect in which the spinal column is imperfectly closed so that part of the meninges or spinal cord may protrude, often resulting in neurological disorders. There are many different types of spina bifida. Some children are diagnosed in utero (pre-natally) while others may not be diagnosed until they are adults. There are many forms of spina bifida, from mild to severe. The Spina Bifida Association and the Spina Bifida Resource Network are excellent resources for children with spina bifida and their families. Most people who have spina bifida develop tethering of their spinal cord, that may be corrected at birth, or may be corrected later in life. Some patients with spina bifida also have hydrocephalus.

Spinal Trauma

NJPNI Physicians and staff care for many children and young adults with simple and complex spinal trauma. From “whip-lash” type injuries and cervical sprains to severe, traumatic spinal fractures with spinal cord injuries, we manage children in the acute and sub-acute stages of injury. After discharge from the hospital, we help guide patients and their families with long-term rehabilitation and recovery. We follow these children into adulthood to ensure that they maintain spinal stability and acceptable, healthy spinal posture.

Figure 1

Spinal trauma x-ray

Figure 2

Spinal trauma x-ray

 

Spinal Tumor/ Spine Tumor

A tumor or neoplasm (growth) that occurs anywhere along the spinal column or within the spinal cord. Spine tumors may compress the spinal cord and cause neurological signs and symptoms. Movement, sensation, bowel and/ or bladder function may be affected. Most tumors can be completely or party removed.

Stereotactic guidance

Intraoperative, computer-based localization of brain anatomy and function based on pre-operative neuro-imaging. Stereotactic guidance is also called neuronavigation (see entry on this page). Often, neurosurgeons will request a MRI or CT scan to use for mapping out a brain or spinal tumor during surgery. The ability to localize a tumor in the brain helps a neurosurgeon avoid important areas of the brain that are used for motor and speech. Sometimes, neuronavigation is also used to guide a spine surgery, when screws or other devices need to be safely placed in the bones of the spine.

Syringomyelia

Cavity formation within the spinal cord, sometimes caused by other lesions. Syrinxes can form in any part of the spinal cord and can cause many different types of symptoms. Some syrinxes are asymptomatic, and can be conservatively followed on imaging studies. Syrinxes can be seen in neurologically normal children.

Tethered spinal cord

Sacral retention of the spinal cord by the terminal filum or scar tissue may cause bowel or bladder incontinence, progressive motor loss and/ or sensory impairment in the legs. Almost all patients with a tethered spinal cord have some form of spina bifida. Scar tissue (adhesions), cysts, lipomas (fatty masses or lumps), and other lesions can cause tethering (tying) of the spinal cord to the skin, or bony sacrum. Some children with a tethered spinal cord have a birthmark, stigmata, or dimple over the lower part of the spine. Diagnosis of tethered spinal cord is made upon completion of a Magnetic Resonance Imaging (MRI) of the spine (Figure 1). Most children with a tethered spinal cord require surgery to free up or release the spinal cord, in order to prevent spinal cord or nerve damage. Surgery may be done with a surgical microscope and intraoperative spinal cord monitoring (Figure 2). After surgery, patients are followed clinically and with a follow-up MRI. In some cases, re-tethering of the spinal cord may occur years later.

Figure 1

Tethered spinal cord x-ray

Figure 2

Tethered spinal cord image

 

Torticollis

Torticollis is a tilting or twisting of the head that may be congenital or acquired. Babies may have torticollis at birth from in utero positioning or from a bony malformation of the spine. Usually x-rays and other imaging studies are deferred. Babies with active torticollis, or active head turning, should have imaging studies done. Babies who tilt their heads at rest, without active twisting, are usually followed conservatively with physical therapy, stretching at home, respositioning and increased tummy time. Regardless of the cause of torticollis, babies with this disorder usually develop cranial or skull deformity. This skull asymmetry is called plagiocephaly (refer to entry on this page). Plagiocephaly can be mild to severe and is treated in many different ways, depending on its’ severity. Many infants are referred to our Craniofacial Center for evaluation of torticollis and plagiocephaly. For more information, or to request our brochure or appointment, please call our office.

Traumatic brain injury (TBI)

TBI is a form of acquired brain injury that occurs when a sudden trauma causes damage to the brain. There are various symptoms of traumatic brain injury and they can result from an array of situations, among them hitting the head or an object piercing the skull. Please refer also to the concussion and brain injury portion of this glossary.

Umbilical cord blood banking

Umbilical cord blood banking may be done after a child’s birth. There are many organizations that would be happy to provide more information about this process. The team at cordbloodbanking.com provides the latest up-to-date information and free resources for expecting parents. There have been over 35,000 cord blood transplants thanks to donors worldwide. With more awareness we can increase this number and further save the lives of children suffering from cancers, blood disorders and many other serious disorders and disabilities including cerebral palsy. For more information PLEASE go to cordbloodbanking.com

Vagal nerve stimulators (VNS)

A VNS is a surgically implanted stimulator that is used to treat various kinds of seizures, and other neurological disorders. The battery or generator is surgically placed near or under the armpit. The leads are thin, insulated wires, which wrap around the vagus nerve, in the neck. Electrical stimulation of this nerve has been shown to reduce seizure frequency in some populations of patients with epilepsy. Information is available from our office and from the websites below.