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Spinal cord injury and neurostimulation

Bin Shu, Fei Yang, Yun Guan
Chronic pain after spinal cord injury (SCI) is a form of central neuropathic pain that is debilitating and often refractory to current pharmacological treatments. Neurostimulation pain therapies, such as epidural spinal cord stimulation, have only moderate success in reducing SCI pain. The pathogenesis of SCI pain may involve a state of central neuronal hyperexcitability, especially in the spinal cord dorsal horn, that develops after injury. We hypothesize that the neuronal structures near the spinal cord injury site may be an important pain generator, and intraspinal microstimulation (ISMS) may normalize dorsal horn neuronal hyperexcitability and hence alleviate SCI pain...
July 2017: Medical Hypotheses
Antonino Naro, Antonino Leo, Margherita Russo, Carmela Casella, Antonio Buda, Aurelio Crespantini, Bruno Porcari, Luigi Carioti, Luana Billeri, Alessia Bramanti, Placido Bramanti, Rocco Salvatore Calabrò
The present paper aims at providing an objective narrative review of the existing non-pharmacological treatments for spasticity. Whereas pharmacologic and conventional physiotherapy approaches result well effective in managing spasticity due to stroke, multiple sclerosis, traumatic brain injury, cerebral palsy and incomplete spinal cord injury, the real usefulness of the non-pharmacological ones is still debated. We performed a narrative literature review of the contribution of non-pharmacological treatments to spasticity management, focusing on the role of non-invasive neurostimulation protocols (NINM)...
May 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Aswin Chari, Ian D Hentall, Marios C Papadopoulos, Erlick A C Pereira
Traumatic spinal cord injury (SCI) is a devastating neurological condition characterized by a constellation of symptoms including paralysis, paraesthesia, pain, cardiovascular, bladder, bowel and sexual dysfunction. Current treatment for SCI involves acute resuscitation, aggressive rehabilitation and symptomatic treatment for complications. Despite the progress in scientific understanding, regenerative therapies are lacking. In this review, we outline the current state and future potential of invasive and non-invasive neuromodulation strategies including deep brain stimulation (DBS), spinal cord stimulation (SCS), motor cortex stimulation (MCS), transcutaneous direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) in the context of SCI...
February 10, 2017: Brain Sciences
Timothy R Deer, Tim J Lamer, Jason E Pope, Steven M Falowski, David A Provenzano, Konstantin Slavin, Stanley Golovac, Jeffrey Arle, Joshua M Rosenow, Kayode Williams, Porter McRoberts, Samer Narouze, Sam Eldabe, Shivanand P Lad, Jose A De Andrés, Eric Buchser, Philippe Rigoard, Robert M Levy, Brian Simpson, Nagy Mekhail
INTRODUCTION: Neurostimulation involves the implantation of devices to stimulate the brain, spinal cord, or peripheral or cranial nerves for the purpose of modulating the neural activity of the targeted structures to achieve specific therapeutic effects. Surgical placement of neurostimulation devices is associated with risks of neurologic injury, as well as possible sequelae from the local or systemic effects of the intervention. The goal of the Neurostimulation Appropriateness Consensus Committee (NACC) is to improve the safety of neurostimulation...
January 2017: Neuromodulation: Journal of the International Neuromodulation Society
G Cruccu, L Garcia-Larrea, P Hansson, M Keindl, J-P Lefaucheur, W Paulus, R Taylor, V Tronnier, A Truini, N Attal
BACKGROUND AND PURPOSE: Our aim was to update previous European Federation of Neurological Societies guidelines on neurostimulation for neuropathic pain, expanding the search to new techniques and to chronic pain conditions other than neuropathic pain, and assessing the evidence with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. METHODS: A systematic review and meta-analysis of trials published between 2006 and December 2014 was conducted...
October 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Gustavo P Braz, Michael F Russold, Ché Fornusek, Nur Azah Hamzaid, Richard M Smith, Glen M Davis
This is a case series study with the objective of comparing two motion sensor automated strategies to avert knee buckle during functional electrical stimulation (FES)-standing against a conventional hand-controlled (HC) FES approach. The research was conducted in a clinical exercise laboratory gymnasium at the University of Sydney, Australia. The automated strategies, Aut-A and Aut-B, applied fixed and variable changes of neurostimulation, respectively, in quadriceps amplitude to precisely control knee extension during standing...
October 2015: Artificial Organs
Matthew R Kaufman, Andrew I Elkwood, Farid Aboharb, John Cece, David Brown, Kameron Rezzadeh, Reza Jarrahy
BACKGROUND: Patients who are ventilator dependent as a result of combined cervical spinal cord injury and phrenic nerve lesions are generally considered to be unsuitable candidates for diaphragmatic pacing due to loss of phrenic nerve integrity and denervation of the diaphragm. There is limited data regarding efficacy of simultaneous nerve transfers and diaphragmatic pacemakers in the treatment of this patient population. METHODS: A retrospective review was conducted of 14 consecutive patients with combined lesions of the cervical spinal cord and phrenic nerves, and with complete ventilator dependence, who were treated with simultaneous microsurgical nerve transfer and implantation of diaphragmatic pacemakers...
June 2015: Journal of Reconstructive Microsurgery
Peter J Grahn, Kendall H Lee, Aimen Kasasbeh, Grant W Mallory, Jan T Hachmann, John R Dube, Christopher J Kimble, Darlene A Lobel, Allan Bieber, Ju Ho Jeong, Kevin E Bennet, J Luis Lujan
OBJECT: Despite a promising outlook, existing intraspinal microstimulation (ISMS) techniques for restoring functional motor control after spinal cord injury are not yet suitable for use outside a controlled laboratory environment. Thus, successful application of ISMS therapy in humans will require the use of versatile chronic neurostimulation systems. The objective of this study was to establish proof of principle for wireless control of ISMS to evoke controlled motor function in a rodent model of complete spinal cord injury...
July 2015: Journal of Neurosurgery
Hongyun Huang, Tiansheng Sun, Lin Chen, Gustavo Moviglia, Elena Chernykh, Klaus von Wild, Haluk Deda, Kyung-Sun Kang, Anand Kumar, Sang Ryong Jeon, Shaocheng Zhang, Giorgio Brunelli, Albert Bohbot, Maria Dolors Soler, Jianjun Li, Alexandre Fogaça Cristante, Haitao Xi, Gelu Onose, Helmut Kern, Ugo Carraro, Hooshang Saberi, Hari Shanker Sharma, Alok Sharma, Xijing He, Dafin Muresanu, Shiqing Feng, Ali Otom, Dajue Wang, Koichi Iwatsu, Jike Lu, Adeeb Al-Zoubi
Currently, there is a lack of effective therapeutic methods to restore neurological function for chronic complete spinal cord injury (SCI) by conventional treatment. Neurorestorative strategies with positive preclinical results have been translated to the clinic, and some patients have gotten benefits and their quality of life has improved. These strategies include cell therapy, neurostimulation or neuromodulation, neuroprosthesis, neurotization or nerve bridging, and neurorehabilitation. The aim of this consensus by 31 experts from 20 countries is to show the objective evidence of clinical neurorestoration for chronic complete SCI by the mentioned neurorestorative strategies...
2014: Cell Transplantation
Timothy R Deer, Nagy Mekhail, David Provenzano, Jason Pope, Elliot Krames, Simon Thomson, Lou Raso, Allen Burton, Jose DeAndres, Eric Buchser, Asokumar Buvanendran, Liong Liem, Krishna Kumar, Syed Rizvi, Claudio Feler, David Abejon, Jack Anderson, Sam Eldabe, Philip Kim, Michael Leong, Salim Hayek, Gladstone McDowell, Lawrence Poree, Elizabeth S Brooks, Tory McJunkin, Paul Lynch, Leo Kapural, Robert D Foreman, David Caraway, Ken Alo, Samer Narouze, Robert M Levy, Richard North
INTRODUCTION: The International Neuromodulation Society (INS) has determined that there is a need for guidance regarding safety and risk reduction for implantable neurostimulation devices. The INS convened an international committee of experts in the field to explore the evidence and clinical experience regarding safety, risks, and steps to risk reduction to improve outcomes. METHODS: The Neuromodulation Appropriateness Consensus Committee (NACC) reviewed the world literature in English by searching MEDLINE, PubMed, and Google Scholar to evaluate the evidence for ways to reduce risks of neurostimulation therapies...
August 2014: Neuromodulation: Journal of the International Neuromodulation Society
Timothy R Deer, Nagy Mekhail, Erika Petersen, Elliot Krames, Peter Staats, Jason Pope, Youssef Saweris, Shivanand P Lad, Sudhir Diwan, Steven Falowski, Claudio Feler, Konstantin Slavin, Samer Narouze, Lotfi Merabet, Asokumar Buvanendran, Felipe Fregni, Joshua Wellington, Robert M Levy
INTRODUCTION: The International Neuromodulation Society (INS) has identified a need for evaluation and analysis of the practice of neurostimulation of the brain and extracranial nerves of the head to treat chronic pain. METHODS: The INS board of directors chose an expert panel, the Neuromodulation Appropriateness Consensus Committee (NACC), to evaluate the peer-reviewed literature, current research, and clinical experience and to give guidance for the appropriate use of these methods...
August 2014: Neuromodulation: Journal of the International Neuromodulation Society
Timothy R Deer, Nagy Mekhail, David Provenzano, Jason Pope, Elliot Krames, Michael Leong, Robert M Levy, David Abejon, Eric Buchser, Allen Burton, Asokumar Buvanendran, Kenneth Candido, David Caraway, Michael Cousins, Michael DeJongste, Sudhir Diwan, Sam Eldabe, Kliment Gatzinsky, Robert D Foreman, Salim Hayek, Philip Kim, Thomas Kinfe, David Kloth, Krishna Kumar, Syed Rizvi, Shivanand P Lad, Liong Liem, Bengt Linderoth, Sean Mackey, Gladstone McDowell, Porter McRoberts, Lawrence Poree, Joshua Prager, Lou Raso, Richard Rauck, Marc Russo, Brian Simpson, Konstantin Slavin, Peter Staats, Michael Stanton-Hicks, Paul Verrills, Joshua Wellington, Kayode Williams, Richard North
INTRODUCTION: The Neuromodulation Appropriateness Consensus Committee (NACC) of the International Neuromodulation Society (INS) evaluated evidence regarding the safety and efficacy of neurostimulation to treat chronic pain, chronic critical limb ischemia, and refractory angina and recommended appropriate clinical applications. METHODS: The NACC used literature reviews, expert opinion, clinical experience, and individual research. Authors consulted the Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Neuropathic Pain (2006), systematic reviews (1984 to 2013), and prospective and randomized controlled trials (2005 to 2013) identified through PubMed, EMBASE, and Google Scholar...
August 2014: Neuromodulation: Journal of the International Neuromodulation Society
Elif Ç Seymour, David S Freedman, Mutlu Gökkavas, Ekmel Ozbay, Mesut Sahin, M Selim Unlü
Electrical neural stimulation with micro electrodes is a promising technique for restoring lost functions in the central nervous system as a result of injury or disease. One of the problems related to current neural stimulators is the tissue response due to the connecting wires and the presence of a rigid electrode inside soft neural tissue. We have developed a novel, optically activated, microscale photovoltaic neurostimulator based on a custom layered compound semiconductor heterostructure that is both wireless and has a comparatively small volume (<0...
2014: Frontiers in Neuroengineering
Leonardo Kapural
Spinal cord stimulation (SCS) is minimally invasive and reversible therapy for treatment of severe, otherwise nonresponsive chronic pain. Such approach is relatively safe, with very few side-effects, not addictive, and provides enduring therapeutic response. A number of clinical studies support the efficacy of spinal cord stimulation in treating failed back surgery syndrome and complex regional pain syndrome, as well as peripheral neuropathic pain, postamputation pain, postherpetic neuralgia, root and spinal cord injury pain...
April 2014: Current Pain and Headache Reports
Robert J Coffey, Ron Kalin, James M Olsen
BACKGROUND: Magnetic resonance imaging (MRI) is preferred for imaging the central nervous system (CNS). An important hazard for neurostimulation patients is heating at the electrode interface induced, for example, by 64-MHz radiofrequency (RF) magnetic fields of a 1.5T scanner. OBJECTIVE: We performed studies to define the thermal dose (time and temperature) that would not cause symptomatic neurological injury. METHODS: Approaches included animal studies where leads with temperature probes were implanted in the brain or spine of sheep and exposed to RF-induced temperatures of 37 °C to 49 °C for 30 minutes...
February 2014: Neurosurgery
Raffaele Nardone, Yvonne Höller, Stefan Leis, Peter Höller, Natasha Thon, Aljoscha Thomschewski, Stefan Golaszewski, Francesco Brigo, Eugen Trinka
CONTEXT: Past evidence has shown that invasive and non-invasive brain stimulation may be effective for relieving central pain. OBJECTIVE: To perform a topical review of the literature on brain neurostimulation techniques in patients with chronic neuropathic pain due to traumatic spinal cord injury (SCI) and to assess the current evidence for their therapeutic efficacy. METHODS: A MEDLINE search was performed using following terms: "Spinal cord injury", "Neuropathic pain", "Brain stimulation", "Deep brain stimulation" (DBS), "Motor cortex stimulation" (MCS), "Transcranial magnetic stimulation" (TMS), "Transcranial direct current stimulation" (tDCS), "Cranial electrotherapy stimulation" (CES)...
January 2014: Journal of Spinal Cord Medicine
D Krasmik, Jörg Krebs, Arndt van Ophoven, Jürgen Pannek
AIMS: To investigate the outcome and complications of sacral deafferentation (SDAF) and sacral anterior root stimulation (SARS) in patients with neurogenic lower urinary tract dysfunction (NLUTD) resulting from complete spinal cord injury (SCI). METHODS: Retrospective chart analysis of 137 patients who underwent SDAF/SARS at a single institution. Patients were categorized as being at risk of renal damage when the maximum detrusor pressure was >40 cmH2 O or detrusor compliance was <20 ml/cmH2 O...
November 2014: Neurourology and Urodynamics
Fayçal Mounaïm, Mohamad Sawan
In order to investigate new neurostimulation strategies for micturition recovery in spinal cord injured patients, custom implantable stimulators are required to carry-on chronic animal experiments. However, higher integration of the neurostimulator becomes increasingly necessary for miniaturization purposes, power consumption reduction, and for increasing the number of stimulation channels. As a first step towards total integration, we present in this paper the design of a highly-integrated neurostimulator that can be assembled on a 21-mm diameter printed circuit board...
August 2012: IEEE Transactions on Biomedical Circuits and Systems
J Worsøe, M Rasmussen, P Christensen, K Krogh
Background. Loss of normal bowel function caused by nerve injury, neurological disease or congenital defects of the nervous system is termed neurogenic bowel dysfunction (NBD). It usually includes combinations of fecal incontinence, constipation, abdominal pain and bloating. When standard treatment of NBD fails surgical procedures are often needed. Neurostimulation has also been investigated, but no consensus exists about efficacy or clinical use. Methods. A systematic literature search of NBD treated by sacral anterior root stimulation (SARS), sacral nerve stimulation (SNS), peripheral nerve stimulation, magnetic stimulation, and nerve re-routing was made in Pubmed, Embase, Scopus, and the Cochrane Library...
2013: Gastroenterology Research and Practice
Ion Dragomiri Steanu, Simona Elena Albu, Cristian Persu
In the last decades, functional Urology developed itself as a subspecialty, and, although is strongly linked to Urology, it has its own language, devices and dedicated people. The ice water test (IWT) was first described in 1957 and gained its place in the armamentarium of functional urologists for the coming years. Now, when urodynamic devices are more and more complex and sensitive, when neuromodulation and neurostimulation are gaining popularity and with the terminology changes of the last decade, one can wonder if a 50 years old test may still be of some use...
June 2012: Mædica
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