Neurology. Our Specialisations

Specialisation in pain

In Germany there are 8 million people with chronic pain syndrome. Back pain alone is the most frequent cause for sick certificates. The significance of pain in economic terms is huge, but above all it is the suffering of people affected by pain and the impairment to their quality of life, activities and participation in life, which is the most significant. The Department for Neurology at the Schön Klinik Vogtareuth offers modern pain diagnostics and treatment of pain for all types of pain. Inpatient and outpatient - all insurers.

 

What are the different types of pain?

We distinguish between acute and chronic pain, localised and diffuse pain, nerve pain and organ pain and the different consequences of pain. Virtually everyone is familiar with acute pain (headache, back pain) and often there is no need to resort to treatment because it mostly goes of its own accord after a short time. It is a different matter with pain which keeps recurring or never stops at all or with complicated pain (e.g. if there is multiple congenital or acquired disability, or spasticity in all four limbs, or the results of an accident): People with this type of pain need special help which we offer them at the Schön Klinik Vogtareuth.

 

Complex regional pain syndrome

Complex regional pain syndrome (CRPS), previously known as Sudeck´s disease or causalgia, is a pain disorder that can develop following a fracture, an operations, nerve damage or as a result of insignificant injuries to the arms or legs. The consequence is characterised by long-lasting, severe pain that cannot be explained by the injury, autonomic changes (swelling, shiny skin, changes in skin colour), signs of neurological deficits including sensitivity to stimuli (e.g. extreme sensitivity to touch) and muscle weakness that can result in the stiffening of joints. People affected by the feared and severely painful dysfunctions certainly need the individual and multidisciplinary help of an experienced and specialised team.

 

Back pain

Back pain is the most frequent acute and chronic pain syndrome. A distinction is made between acute back pain and a single bout of back pain, which as a rule disappears on its own like a cold without further treatment, and chronic back pain which recurs or never goes away at all. Lumbago is acute and causes transient painful restricted movement while diseases of the spine with curvatures, loss of bone (osteoporosis) or degenerative changes to the bone (osteochondrosis) cause chronic pain. Whether acute or chronic: a significant proportion of pain comes from muscle contractions and overburdening the body. And: the cause of 90% of back pain cannot be classified precisely in spite of all the diagnostics. But it can be treated.

 

How do we help pain?

Often the exact cause of pain is unclear even with an in-depth examination. With most people modern medicine detects signs of "wear and tear" and these physical changes are painful but not to the same degree in all people. Pain is as diverse as people themselves. There is no "recipe" for treating pain. We therefore look holistically at all the individual circumstances and findings when we provide help for pain, which is known from our knowledge of science and therapy to be important for long term treatment success. Therefore at the Schön Klinik Vogtareuth an interdisciplinary team offers people suffering from pain special multimodal pain therapy based on several approaches. All the necessary and special treatment procedures are available.

 

Alleviation of pain and quality of life through individual therapy

Pain is as diverse as people are. With our concept of multimodal pain therapy an interdisciplinary team therefore treats people with pain syndromes taking an holistic approach with consideration of individual circumstances and findings, which scientifically and therapeutically is known to be important for long-term relief and a better quality of life. Inpatient and outpatient - all insurers.

 

Multimodal pain therapy. The concept

The World Health Organisation WHO recommends an holistic approach in its „biopsychosocial disease model“ as the fundamental method of treatment. Holism is the key element in our treatment approach of multimodal pain therapy. Thereafter for treatment planning and in addition to the physical causes of pain, we take account of emotional and biographical factors, the patient's life circumstances, experiences of pain and how the patient deals with or fights pain. To achieve this approach, which is always individualised and multifaceted, there is an interdisciplinary specialised team of doctors from different faculties and therapists with various specialisations at the Department of Neurology at the Schön Klinik Vogtareuth to treat people affected. Therapy takes at least 7 treatment days. Treatment is indicated if at least three of the following criteria are fulfilled:

 

  • Manifest or threatened impairment to quality of life and/or incapacity to work
  • Failure of previous treatments
  • Existing misuse of painkilllers or dependency on painkillers
  • Concomitant mental disorder alongside pain
  • Serious physical concomitant disorder

 

Treatment is based on several approaches, hence the name „multimodal“ pain therapy. Besides the forms of physical therapy (physiotherapy, ergotherapy, massage etc.) special relaxation procedures oriented towards physical awareness are used, (e.g. Feldenkrais therapy), alongside differentiated, individualised treatment with medication and supported with psychotherapy, in order to produce an holistic strategy to overcome chronic pain syndrome.

 

Pain in psychosomatic medicine. Holistic approach

In our technologically advanced world which is geared to performance, many methods of treatment are performance-oriented and mechanistic. The affected person very often expects that an operation or individual therapy procedure will make pain disappear and immediately restore functioning abilities. Emotional, spiritual and personal factors, which in holistic terms of course are a component of individual pain syndrome, are often pushed into the background, overlooked or ignored. The medical specialism of psychosomatic medicine is specifically concerned with the connection between body and mind and with the disorders and crises which arise from chronic physical and mental pain. The team at the Department of Neurology at the Schön Klinik Vogtareuth therefore works closely with different teams at psychosomatic clinics to make sustainable the principle of holism and long-term treatment approaches, and through treatment meet the needs of people affected. We are not treating „the intervertebral disc“ or „the headache“, but the person suffering from pain.

 

Neuromodulation. The concept

In collaboration with the Clinic for Neurosurgery, we offer the modern neuromodulation therapy method for the treatment of chronic pain. The treatment principle is the change of pain transmission to the brain through electrical stimulation in the region of the spine (Spinal Cord Stimulation, SCS) or of an individual nerve (peripheral or subcutaneous nerve stimulation, PNS or SNS). We test whether the method is suitable for a patient and what treatment success we expect by a thorough examination (patient history, physical findings, imaging procedures). Doctors and patient decide on the intervention and under local anaesthesia a neurosurgeon places a thin electrode close to the spine or a nerve and a test stimulation is conducted to determine the correct position of the electrodes. After a controlled and successful test stimulation over several days (e.g. also in the home environment) we then implant the nerve stimulator under the skin in a second surgical intervention. Using an external programming device the electrical stimulation parameters can be changed at any time. The patients can use their own control device themselves to choose from a variety of stimulation programmes. Ideally pain decreases as a result of the stimulation and so savings can be made on analgesics. As part of the outpatient neurological and neurosurgical aftercare at the Schön Klinik Vogtareuth, we offer continuing and qualified long-term care for patients suffering from chronic pain.

 

Specialisation in Parkinson

Specialisation movement disorders

With a movement disorder the voluntary and involuntary capabilities of the brain are disturbed in their ability to control movements normally and at the same time suppress distracting movements. A common movement disorder is Parkinson's disease also called 'paralysis agitans', which as it progresses increasingly restricts the quality of life, activities and participation in everyday living of sufferers. Besides Parkinson's diseases, we also treat in particular what are known as the tremors (involuntary shaking) and dystonias (involuntary muscle contractions). The Department for Neurology of the Schön Klinik Vogtareuth offers comprehensive diagnostics and treatment for many movement disorders. Inpatient and outpatient - all insurers.

 

What are the different types of movement disorders?

The movement disorder Parkinson's (with around 400,000 sufferers in Germany) results from the degenerative loss of nerve cells, which are particularly important for the manufacture of the neurotransmitter dopamine. The main symptoms are slow movements (bradykinesia), rigidity (rigor), shaking (tremor) and the loss of stability when the body is in an upright position (postural instability). Other symptoms can go hand in hand with the disease besides these so-called motor symptoms, which vary from person to person but may include degenerative, non-motor symptoms (depression, sleep disorders or vegetative disorders).

The movement disorder tremor (involuntary shaking) can be a symptom of Parkinson's but also of other diseases and can occur in any region of the body in isolation (body, head extremities) but also in combination. Distinctive signs are involuntary, rhythmic and repeated contractions of antagonistic muscles. Differentiation is made for instance depending on frequency and the conditions under which they occur – at rest, when moving or stopping or during individual movements.

The movement disorder dystonia leads to abnormal, painful and inhibitory abnormal postures of the body, one example is wry neck (torticollis). Dystonia can occur as an independent clinical picture (idiopathic or primary dystonia) but also as a symptom of a different brain disease (symptomatic or secondary dystonia).

 

How do we help movement disorders?

We help movement disorders by using an individual and holistic approach. The therapy principle is "multimodal" and is based therefore on several approaches. Improvement of motor functions through physiotherapy, the compensation of insufficient supplies of neurotransmitters in the brain through medication and the alleviation of impairment and disabilities in everyday activities together with the reduction of risks caused by the illness are achieved by a multidisciplinary team with the latest scientific and therapeutic know-how at the Schön Klinik Vogtareuth depending on the particular needs of the person affected in order to achieve long-term treatment success.

The movement disorder 'tremor' (involuntary shaking) can be a symptom of Parkinson's but also of other diseases and can occur in every region of the body in isolation (body, head extremities) or also in combination. Distinctive signs are involuntary, rhythmic and repeated contractions of antagonistic muscles. Differentiation is made for instance depending on frequency and conditions under which they occur – at rest, or during movement, or at standstill or in individual movements.

The movement disorder dystonia leads to abnormal, painful and inhibitory malpositions of the body, one example is wry neck (torticollis). Dystonia can occur as an independent clinical picture (idiopathic or primary dystonia) but also as a symptom of a different brain disease (symptomatic or secondary dystonia).

 

Parkinson's Disease - Activities and everyday competence through individual therapy

Controlling symptoms at the start of a disease is not especially challenging. Restrictions on every day competence and activities of affected people and their relatives emerge once the disease progresses. With our concept of Parkinson's complex therapy an interdisciplinary and specially qualified team takes care of a sustainable improvement in quality of life and a self-determined participation in life. Inpatient and outpatient - all insurers.

 

The complex treatment of Parkinson's disease. The concept

At all stages of Parkinson´s disease people affected profit from intensive and stimulating therapy options. Besides medication and surgical treatment procedures these options are the most important types of treatment. We offer an individually designed therapy programme for patients suffering from symptoms which can no longer be adequately treated in the outpatient department, are in the advanced stage of the disease on an apomorphine pump or Duodopa pump or following deep brain stimulation. The therapy programme consists of the following components:

  • Physiotherapy
  • Physical Therapy
  • Ergotherapy
  • Speech/swallowing therapy
  • Psychological diagnostics and treatment.
  • Sport Therapy
  • Feldenkrais
 

Parkinson's: Apomorphine injector pen/apomorphine pump

Apomorphine, a derivative of morphine, is not a painkiller and you cannot become addicted to it. It belongs to the dopamine agonist group of drugs and is not available in tablet form. The drug acts very effectively and quickly (4-7 minutes) by injecting it underneath the skin (subcutaneous administration). When taken as needed, apomorphine is administered via an injector pen similar to the insulin injections that diabetics use. When used for continual therapy, the drug is administered via an external pump (the size of a mobile phone). The daily dosage is determined for each individual and fine calibration is possible using the basic bolus principle. This enables its concentration in the blood to remain stable and reduces fluctuations in its effectiveness. The medical team and nursing staff will give patients and relatives detailed explanations on how to use the devices.

 

Parkinson's: Duodopa pump

The duodopa pump also stimulates the nerve cells of the brain continually, reducing fluctuations in effectiveness over the course of the day. This is possible with the direct administration of the medication via a small tube into the upper part of the small intestine. A tube extending from the nose to the small intestine via the stomach is first used in the test phase to clinically evaluate its effectiveness. Patients are continually cared for by the team of doctors and nurses as well as nurses specialised in Parkinson´s disease and enables the dopamine dose to be adjusted quickly and several times daily, if necessary, based on the basic bolus principle. The external pump is larger than the apomorphine pump and is attached to a belt or a carrying strap. Once the test phase has been successfully completed, the permanent tube is put into place during a small operation that includes a gastrointestinal endoscopy. This is accompanied by the education of patients and relatives/carers.

 

Parkinson's: Deep brain stimulation (English): Deep Brain Stimulation, DBS)

We perform deep brain stimulation surgery for the treatment of Parkinson´s disease in conjunction with the Clinic for Neurosurgery and Epilepsy Surgery and the Clinic for Anaesthetics. This procedure was developed in 1988 and is currently used in more than 30 centres in Germany when indicated. Similar to a heart pacemaker, with a small computer, a so-called stimulator or „brain pacemaker“, is planted underneath the skin of the abdomen or chest. Thin cables, otherwise known as electrodes, run underneath the skin from this stimulator to the head and then via a neurosurgically drilled hole, through the skull to the brain. Their position in the brain is determined to the millimetre and corresponds to the part of the brain that is responsible for the movement disorder. Its position is determined before the operation using the most modern of imaging techniques. The individually programmed stimulator then initiates tiny electrical impulses in this part of the brain. There is a very high chance that the main symptoms of lack of movement, shaking and tense muscles will be reduced. It is expected that the amount of daily medication required previously will also be reduced. This therapy method is especially suitable for patients who react well to the Parkinson´s medication dopamine. To support this very specialised treatment, we offer a complete range of pre-operative diagnostics, intra-operative monitoring (to check the correct position of the electrodes) and inpatient and outpatient follow-up care, including the optimal programming of the stimulator.

 

Parkinson´s disease - individual follow-up care and outpatient treatment

Movement disorders are very complex diseases for which we offer individual therapy procedures to our patients. We are available for patients and their relatives after the acute inpatient treatment and the multimodal complex treatment have come to an end and also in terms of further outpatient care and aftercare if this cannot be provided by a practice-based neurologist or general practitioner. We are happy to answer any questions that treating colleagues may have regarding therapy and follow-up care at any time.

 

Specialisation epilepsy (in adults)

Epilepsy (cramps or seizures) is as common as diabetes or arthritis. Around 5% of all people have an epileptic attack once in their lives. Around 1% of all people suffer from epilepsy. At the Schön Klinik Vogtareuth a specialised team offers multimodal epilepsy diagnostics and treatment for adults with all types of epilepsy. Outpatient and inpatient. All insurers.

 

What are the different types of epilepsy?

The scientific classification of the types of epilepsy is in itself complicated. Epilepsy can be congenital or acquired. Often it is triggered by circumstances, e.g. in young children/infants because of a febrile seizure or because of traumatic brain injury, poisoning, uncontrolled diabetes or alcohol addiction. The term epilepsy is used when seizures recur without a particular cause. The various detrimental consequences of epilepsy depend on the type of seizures, their frequency, the patients' age, their profession and response to medication.

 

How do we help epilepsy?

The consequences and effects of this common illness are diverse and distinctly different from case to case. Individual diagnostics, sustainable treatment and a comprehensive consultation service are of utmost importance to the people affected. At the same time it is also crucial that the patient has access at the right time to the individual help of doctors and therapists who know the patient well. This is how we treat epilepsy in Vogtareuth.

 

Epilepsy - Symptom control and self-determination through individual therapy

Diagnostic testing and the selection of the most suitable form of therapy must be on an individual basis and be effective over a long period of time. Whether a small child, a young person or an adult – people grow and develop. Just as the lives of our patients are individual, so is the diagnosis of epilepsy. And only knowing your patients and their needs are you able to successfully treat them. Due to our collaboration with the Clinic for Neuropaediatrics, treating children and adolescents with epilepsy, the Clinic for Neurosurgery and Epilepsy Surgery, providing surgical measures to treat epilepsy in adults and children, and the Clinic for Neurology, as the first point of contact for adults, we are able to offer diagnostic testing and therapy for all types of epilepsy. At the same time we greatly value individual consultations and long-term care and support of the patient and their relatives - in every phase of life. Our comprehensive range of treatments and our expertise for our adult patients incorporates sophisticated diagnostics using long-term video EEG, choice of medication, adjustments to nutrition and the Atkins diet (ketogenic diet) as well as gentle minimally invasive interventions. With children the most care-free childhood possible is the most important thing, and with young people and adults it is the questions regarding education and the most suitable careers, leisure pursuits or family planning. So our treatment package does not end at the clinic door. With a multitude of outpatient packages such as reintegration procedures, residential care groups or the associated„epilepsy network and work“, we support our patients in their everyday lives.