Functional neurosurgery is concerned with the treatment of conditions where central nervous system (brain and spinal cord) function is abnormal although the structure or anatomy is normal. Examples of conditions treated by functional neurosurgery are pain, movement disorders (Parkinson's disease and tremor), psychiatric conditions and pain. Johns Hopkins University has a long tradition in the development of techniques for studying the brain (neurophysiologic monitoring). It is just these techniques which are used during functional procedures to locate regions of abnormal function in the brain. There is no center in the world with greater expertise in neurophysiologic monitoring than the Center of Functional Neurosurgery at Johns Hopkins. Fred Lenz, MD, PHD, FRCS(C), Dr. Lenz is the Director of Functional Neurosurgery at Johns Hopkins and Professor of Neurosurgery at the Johns Hopkins University School of Medicine. Dr. Lenz is a Canadian who received his MD and PhD in neurophysiology from the University of Toronto. He is board certified in Neurosurgery by the Royal College of Surgeons of Canada and by the American Board of Neurosurgery. He has spoken nationally and internationally at surgical and scientific meetings and at universities. He works closely with other physicians in the Hopkins Neurology groups in epilepsy and movement disorders and in the Blaustein pain clinic. Epilepsy Epilepsy is a condition characterized by the occurrence of seizures, transient alterations in consciousness resulting from abnormal electrical activity in the brain. The Epilepsy Center at Hopkins consists of six neurologists, five nurses and four individuals involved in technical support (programmers etc). The Center has a significant presence on the national scene and has been involved in multiple research studies into the nature and treatment of epilepsy and in multiple trials of new drugs for the treatment of epilepsy. Additionally, it is a center for training in the neurology of epilepsy. The Epilepsy Center includes a four bed Epilepsy Monitoring Unit where monitoring of electrical signals from the brain and behavior during seizures is used to clarify the diagnosis and treatment of epilepsy. One hundred to one hundred and fifty patients are monitored in this unit each year. In patients who are unresponsive to or intolerant of medical therapy, surgery becomes an option. All patients are evaluated by a neurologist, often during an admission to the epilepsy monitoring unit, to determine that all medical options have been exhausted prior to surgery. Hopkins has a long history of surgical procedures for the treatment of epilepsy extending back to the fifties. Procedures include implantation of electrodes to identify epileptic parts of the brain, removal of epileptic parts of the brain, separation of the two sides of the brain, vagal nerve stimulation and thalamic stimulation. To the left is an example of electroencephalographic signals during onset of a seizure. Surgical excision of the area of seizure onset or electrical stimulation of that area can be used to relieve seizures. For more information about Epilepsy, visit the Epilepsy Foundation of America website. Movement Disorders Movement disorders are abnormalities of movement characterized by increased movement (e.g. Tremor or dystonia) or by the absence of movement (Parkinson's disease). The Johns Hopkins Center for Parkinson's Disease and Movement Disorders consists of six neurologists, a nurse, and social worker is a significant presence on the national scene. It is one of the first three National Institutes of Health Parkinson's Centers, the other two being MGH-Harvard University and Emory University. It sponsored by the American Parkinson's Disease Association, receives referrals from International Tremor Foundation, the Society for Progressive Supranuclear Palsy and sponsors a number of Parkinson's Support Groups in Maryland and a Dystonia Support Group (Dystonia Research Foundation). This center has been involved in a large number of drug trials and is a member of the Parkinson's Study Group for evaluation of new therapies for Parkinson's Disease. It is a center for use of Botox (Botulinum Toxin, including Botox B) for treatment of neurologic conditions, particularly torticollis. In patients who are unresponsive to or intolerant of medical therapy, surgery becomes an option. All patients are evaluated by a movement disorder neurologist to determine that all medical options have been exhausted prior to surgery. We have a decade's experience of over 350 procedures for the treatment of movement disorders. This is a larger experience than any center between New York and Atlanta. Procedures include pallidotomy and stimulators (thalamic, pallidal and subthalamic) for Parkinson's disease and dystonia, thalamotomy and thalamic stimulator for essential tremor, selective denervation (Bertrand procedure) for torticollis, and selective primary ramus section or baclofen pump for spasticity secondary to cerebral palsy, multiple sclerosis and spinal cord injury. This picture shows an example of the effect of surgery thalamotomy on essential tremor, the most common form of abnormal tremor. The patient has been asked to write the same text or draw a spiral before the surgery and again one year after the surgery. Chronic Pain Pain serves as an important signal that the body has been injured or is about to be injured. However, following some painful stimuli or injuries to the nervous system, pain persists in the absence of any ongoing tissue injury. There are many medical and physical therapy options for the treatment of this type of chronic pain. When these options are exhausted, patients may be candidates for surgical approaches to the treatment of their chronic pain. The Blaustein Pain Treatment Center at Johns Hopkins is an internationally recognized center for the treatment of pain. The center consists of multiple anesthesiologists, neurologists, neurosurgeons, radiologists and other medical specialists. It is also comprised of a facility for carrying out minor procedures to evaluate and treat pain, procedures such as blocking nerves with local anesthetics. Once conservative means have failed, surgery is an option for the treatment of these conditions. Psychiatric Disease There have been tremendous advances in the medical treatment of psychiatric disease so that surgery for psychiatric conditions (psychosurgery) is rarely performed. However, cingulotomy is still performed for treatment of some conditions such as obsessive compulsive disorder, a condition characterized by the compulsion to check things repeatedly or to carry out rituals repeatedly, such as hand washing. To be considered a candidate for these procedures the patient is evaluated by a committee consisting of two psychiatrists, a neurologist and a psychologist. The surgery itself is a simple two hour procedure carried out under local anesthetic.