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Epidural stimulation

Ruyi Huang, Serapio M Baca, Jason W Worrell, Xingquan Liu, Yeji Seo, James C Leiter, Daniel C Lu
Respiration is produced and controlled by well-characterized brainstem nuclei, but the contributions of spinal circuits to respiratory control and modulation remain under investigation. Many respiratory studies are conducted in in vitro preparations (e.g., brainstem slice) obtained from neonatal rodents. While informative, these studies do not fully recapitulate the complex afferent and efferent neural circuits that are likely to be involved in eupnea (i.e., quiet breathing). To begin to investigate spinal contributions to respiration, we electrically stimulated the cervical spinal cord during unassisted respiration in anesthetized, intact mice...
October 7, 2016: Journal of Applied Physiology
Marie-Pascale Côté, Marion Murray, Michel A Lemay
Body-weight supported locomotor training (BWST) promotes recovery of load-bearing stepping in lower mammals, but its efficacy in individuals with a spinal cord injury (SCI) is limited and highly dependent on injury severity. While animal models with complete spinal transections recover stepping with step-training, motor complete SCI individuals do not, despite similarly intensive training. In this review, we examine the significant differences between humans and animal models that may explain this discrepancy in the results obtained with BWST...
October 20, 2016: Journal of Neurotrauma
Saul Wilson, Kingsley O Abode-Iyamah, John W Miller, Chandan G Reddy, Sina Safayi, Douglas C Fredericks, Nicholas D Jeffery, Nicole A DeVries-Watson, Sara K Shivapour, Stephanus Viljoen, Brian D Dalm, Katherine N Gibson-Corley, Michael D Johnson, George T Gillies, Matthew A Howard
OBJECTIVE: To develop a large animal model of spinal cord injury (SCI), for use in translational studies of spinal cord stimulation (SCS) in the treatment of spasticity. We seek to establish thresholds for the SCS parameters associated with reduction of post-SCI spasticity in the pelvic limbs, with implications for patients. STUDY DESIGN: The weight-drop method was used to create a moderate SCI in adult sheep, leading to mild spasticity in the pelvic limbs. Electrodes for electromyography (EMG) and an epidural spinal cord stimulator were then implanted...
October 19, 2016: Journal of Spinal Cord Medicine
Jin-Gyu Choi, Sang-Woo Ha, Byung-Chul Son
OBJECTIVES: The authors investigated the difference in clinical outcome and the position of paddle lead spinal cord stimulation (SCS) between three-column and five-column paddle lead SCS in patients with FBSS. MATERIALS AND METHODS: In 21 patients who underwent paddle lead SCS at T9 (three-column, n = 9; five-column, n =12) for FBSS, a 12-month follow-up numerical rating scale, percent pain relief, and CT assessment of contact angle and percent reduction of T9 canal area were investigated...
October 12, 2016: World Neurosurgery
Tess Torregrosa, Ryan A Koppes
Recovery of motor control is paramount for patients living with paralysis following spinal cord injury (SCI). While a cure or regenerative intervention remains on the horizon for the treatment of SCI, a number of neuroprosthetic devices have been employed to treat and mitigate the symptoms of paralysis associated with injuries to the spinal column and associated comorbidities. The recent success of epidural stimulation to restore voluntary motor function in the lower limbs of a small cohort of patients has breathed new life into the promise of electric-based medicine...
2016: Cells, Tissues, Organs
Jeffrey Huang, Huan Gao
STUDY OBJECTIVE: Neuraxial anesthesia has been widely used in China. Recently, Chinese anesthesiologists have applied nerve stimulator and ultrasound guidance for peripheral nerve blocks. Nationwide surveys about regional anesthesia practices in China are lacking. We surveyed Chinese anesthesiologists about regional anesthesia techniques, preference, drug selections, complications, and treatments. DESIGN: A survey was sent to all anesthesiologist members by WeChat...
November 2016: Journal of Clinical Anesthesia
David Pang
INTRODUCTION: Chronic pain in children has been an under-recognized problem compared to adult pain. The aim of management is to help children and their families cope with the symptoms rather than a cure. Current medical treatments to reduce pain intensity are often short lived, poorly tolerated or ineffective. RESULTS: The use of electrical stimulation to treat pain is the current basis of modern Neuromodulation at the spinal cord and has been well established as spinal cord stimulation in adult practice...
August 9, 2016: European Journal of Paediatric Neurology: EJPN
Carolien S E Bulte, Christa Boer, Koen J Hartemink, Otto Kamp, Martijn W Heymans, Stephen A Loer, Stefano F de Marchi, Rolf Vogel, R Arthur Bouwman
OBJECTIVE: To evaluate the effect of acute cardiac sympathectomy by thoracic epidural anesthesia on myocardial blood flow and microvascular function. DESIGN: A prospective observational study. SETTING: The study was conducted in a tertiary teaching hospital. PARTICIPANTS: Ten patients with a mean age of 48 years (range 22-63 years) scheduled for thoracic surgery. INTERVENTIONS: Myocardial contrast echocardiography was used to study myocardial blood flow and microvascular responsiveness at rest, during adenosine-induced hyperemia, and after sympathetic stimulation by the cold pressor test...
May 25, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Fei Yang, Qian Xu, Bin Shu, Vinod Tiwari, Shao-Qiu He, Louis P Vera-Portocarrero, Xinzhong Dong, Bengt Linderoth, Srinivasa N Raja, Yun Wang, Yun Guan
Activation of Aβ-fibers is an intrinsic feature of spinal cord stimulation (SCS) pain therapy. Cannabinoid receptor type 1 (CB1) is important to neuronal plasticity and pain modulation, but its role in SCS-induced pain inhibition remains unclear. In this study, we showed that CB1 receptors are expressed in both excitatory and inhibitory interneurons in substantia gelatinosa (SG). Patch-clamp recording of the evoked excitatory postsynaptic currents (eEPSCs) in mice after spinal nerve ligation (SNL) showed that electrical stimulation of Aβ-fibers (Aβ-ES) using clinical SCS-like parameters (50 Hz, 0...
November 2016: Pain
Daniel San-Juan, Manuel Escanio Cortés, Martha Tena-Suck, Adolfo Josué Orozco Garduño, Jesús Alejandro López Pizano, Jonathan Villanueva Domínguez, Maricarmen Fernández Gónzalez-Aragón, Juan Luis Gómez-Amador
This paper reports the case of a patient with optic nerve schwannoma and the first use of neurophysiological intraoperative monitoring of visual evoked potentials during the removal of such tumor with no postoperative visual damage. Schwannomas are benign neoplasms of the peripheral nervous system arising from the neural crest-derived Schwann cells, these tumors are rarely located in the optic nerve and the treatment consists on surgical removal leading to high risk of damage to the visual pathway. Case report of a thirty-year-old woman with an optic nerve schwannoma...
September 1, 2016: Journal of Clinical Monitoring and Computing
Enrico Rejc, Claudia A Angeli, Nicole Bryant, Susan J Harkema
Individuals affected by motor complete spinal cord injury are unable to stand, walk, or move their lower limbs voluntarily; this diagnosis normally implies severe limitations for functional recovery. We have recently shown that the appropriate selection of epidural stimulation parameters was critical to promoting full-body, weight-bearing standing with independent knee extension in four individuals with chronic clinically complete paralysis. In the current study, we examined the effects of stand training and subsequent step training with epidural stimulation on motor function for standing in the same four individuals...
October 5, 2016: Journal of Neurotrauma
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
Dirk Rasche, Volker M Tronnier
BACKGROUND: Invasive neuromodulation of the cortical surface for various chronic pain syndromes has been performed for >20 years. The significance of motor cortex stimulation (MCS) in chronic trigeminal neuropathic pain (TNP) syndromes remains unclear. Different techniques are performed worldwide in regard to operative procedure, stimulation parameters, test trials, and implanted materials. OBJECTIVE: To present the clinical experiences of a single center with MCS, surgical approach, complications, and follow-up as a prospective, noncontrolled clinical trial...
July 25, 2016: Neurosurgery
Pedro Hidalgo-Lopezosa, María Hidalgo-Maestre, María Aurora Rodríguez-Borrego
OBJECTIVE: to evaluate the effects of labor stimulation with oxytocin on maternal and neonatal outcomes. METHOD: descriptive and analytical study with 338 women who gave birth at a tertiary hospital. Obstetric and neonatal variables were measured and compared in women submitted and non-submitted to stimulation with oxytocin. Statistics were performed using Chi-square test, Fisher exact test, Student t-test; and crude Odds Ratio with 95% confidence interval were calculated...
2016: Revista Latino-americana de Enfermagem
EungDon Kim, MiSun Roh, SooHyang Kim, DaeHyun Jo
The sympathetic block is widely used for treating neuropathic pain such as complex regional pain syndrome (CRPS). However, single sympathetic block often provides only short-term effect. Moreover, frequent procedures for sympathetic block may increase the risk of complications. The use of epidural route may be limited by concern of infection in case of previous implantation of the spinal cord stimulation (SCS). In contrast, a continuous sympathetic block can be administered without such concerns. The continuous thoracic sympathetic block (TSGB) has been used to treat the ischemic disease and other neuropathic conditions such as postherpetic neuralgia...
2016: Pain Research & Management: the Journal of the Canadian Pain Society
Nolan R Williams, E Baron Short, Thomas Hopkins, Brandon S Bentzley, Greg L Sahlem, Jaspreet Pannu, Matt Schmidt, Jeff J Borckardt, Jeffrey E Korte, Mark S George, Istvan Takacs, Ziad Nahas
BACKGROUND: Epidural prefrontal cortical stimulation (EpCS) represents a novel therapeutic approach with many unique benefits that can be used for treatment-resistant depression (TRD). OBJECTIVE: To examine the long-term safety and efficacy of EpCS of the frontopolar cortex (FPC) and dorsolateral prefrontal cortex (DLPFC) for treatment of TRD. METHODS: Adults (N = 5) who were 21-80 years old with severe TRD [failure to respond to adequate courses of at least 4 antidepressant medications, psychotherapy and ≥20 on the Hamilton Rating Scale for Depression (HRSD24)] were recruited...
June 28, 2016: Brain Stimulation
Ivano Dones, Luca Zanin, Ines Marongiu, Vincenzo Levi, Luisa Chiapparini, Michele Rizzi
BACKGROUND: The efficacy of epidural spinal cord stimulation on chronic neuropathic pain due to failed back surgery syndrome or nerve root lesions is well reported. There is even literature reporting the effects of spinal cord stimulation in controlling peripheral vascular lesions as in peripheral arteriopathies or diabetic neuropathies and in complex regional pain syndrome type II. This is probably due to an effect of epidural spinal cord stimulation, mainly on the parasympathetic nervous system...
September 2016: World Neurosurgery
Ian Thomas Walling, Lucy Gee, Paul Neubauer, Lance Frith, Emery Williams, Clif Burdette, Julie G Pilitsis
INTRODUCTION: Chronic migraines (CM) afflict approximately 16.6% of adults and negatively impact quality of life. Furthermore, although some CM can be treated with steroids, occipital nerve block, radiofrequency therapy, or medical therapy, approximately 15% of patients remain refractory to treatment. We explore focused high-intensity ultrasound (HIU) as a therapy allowing for ablation or pulse modulation of the occipital nerve in a validated rodent model of CM. METHODS: Male Sprague-Dawley rats received inflammatory media via an epidural cannula over 3 weeks to induce a CM state...
August 2016: Neurosurgery
Parag N Gad, Roland R Roy, Hui Zhong, Yury P Gerasimenko, Giuliano Taccola, V Reggie Edgerton
The inability to control timely bladder emptying is one of the most serious challenges among the many functional deficits that occur after a spinal cord injury. We previously demonstrated that electrodes placed epidurally on the dorsum of the spinal cord can be used in animals and humans to recover postural and locomotor function after complete paralysis and can be used to enable voiding in spinal rats. In the present study, we examined the neuromodulation of lower urinary tract function associated with acute epidural spinal cord stimulation, locomotion, and peripheral nerve stimulation in adult rats...
July 2, 2016: Experimental Neurology
Valentina Brusati, Gloria Brembilla, Federico Cirillo, Luciana Mastricci, Samantha Rossi, Andrea Michele Paganelli, Enrico Ferrazzi
OBJECTIVE: To evaluate the effectiveness and safety of 25 mcg sublingual misoprostol for induction of Labor at term according to parity and membrane integrity. METHODS: We conducted a prospective observational study on singleton pregnancies undergoing induction of Labor at term. Twenty-five mcg of misoprostol were administered sublingually every 4 h. Main outcomes were vaginal deliveries within 24 h, time-to-vaginal-delivery, hyper-stimulation syndrome, cesarean section rate, arterial pH< 7...
June 20, 2016: Journal of Maternal-fetal & Neonatal Medicine
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