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Epidural stimulation

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https://www.readbyqxmd.com/read/28535546/cost-utility-analysis-of-lumbar-interlaminar-epidural-injections-in-the-treatment-of-lumbar-disc-herniation-central-spinal-stenosis-and-axial-or-discogenic-low-back-pain
#1
Laxmaiah Manchikanti, Vidyasagar Pampati, Ramsin M Benyamin, Joshua A Hirsch
BACKGROUND: Cost utility or cost effective analysis continues to take center stage in the United States for defining and measuring the value of treatments in interventional pain management. Appropriate cost utility analysis has been performed for caudal epidural injections, percutaneous adhesiolysis, and spinal cord stimulation. However, the literature pertaining to lumbar interlaminar epidural injections is lacking, specifically in reference to cost utility analysis derived from randomized controlled trials (RCTs) with a pragmatic approach in a practical setting...
May 2017: Pain Physician
https://www.readbyqxmd.com/read/28515284/long-lasting-increase-in-axonal-excitability-following-epidurally-applied-dc
#2
Elzbieta Jankowska, Dominik Kaczmarek, Francesco Bolzoni, Ingela Hammar
Effects of direct current (DC) on nerve fibres have primarily been investigated during or just after DC application. However, locally applied cathodal DC was recently demonstrated to increase the excitability of intraspinal preterminal axonal branches for more than one hour. The aim of this study was, therefore, to investigate whether DC evokes a similarly long-lasting increase in the excitability of myelinated axons within the dorsal columns. The excitability of dorsal column fibres stimulated epidurally was monitored by recording compound action potentials in peripheral nerves in acute experiments in deeply anaesthetized rats...
May 17, 2017: Journal of Neurophysiology
https://www.readbyqxmd.com/read/28489550/a-fully-integrated-wireless-soc-for-motor-function-recovery-after-spinal-cord-injury
#3
Yi-Kai Lo, Yen-Cheng Kuan, Stanislav Culaclii, Brian Kim, Po-Min Wang, Chih-Wei Chang, Jonathan A Massachi, Minji Zhu, Kuanfu Chen, Parag Gad, V Reggie Edgerton, Wentai Liu
This paper presents a wirelessly powered, fully integrated system-on-a-chip (SoC) supporting 160-channel stimulation, 16-channel recording, and 48-channel bio-impedance characterization to enable partial motor function recovery through epidural spinal cord electrical stimulation. A wireless transceiver is designed to support quasi full-duplex data telemetry at a data rate of 2 Mb/s. Furthermore, a unique in situ bio-impedance characterization scheme based on time-domain analysis is implemented to derive the Randles cell electrode model of the electrode-electrolyte interface...
May 5, 2017: IEEE Transactions on Biomedical Circuits and Systems
https://www.readbyqxmd.com/read/28487834/effect-of-treadmill-training-protocols-on-locomotion-recovery-in-spinalized-rats
#4
Hamid R Kobravi, Ali Moghimi, Zahra Khodadadi
Both treadmill training and epidural stimulation can help to reactivate the central pattern generator (CPG) in the spinal cord after a spinal cord injury. However, designing an appropriate training approach and a stimulation profile is still a controversial issue. Since the spinal afferent signals are the input signals of CPG in the spinal cord, it can be concluded that the number of input afferent signals can affect the quality of movement recovery, such a phenomenon is in accordance with Hebbian theory. Therefore, at first in this paper, through some simulation studies on a model of CPGs, the effective influence of increasing the afferent input weight on activating CPG model was certified...
January 2017: Journal of Medical Signals and Sensors
https://www.readbyqxmd.com/read/28474539/induced-neural-activity-promotes-an-oligodendroglia-regenerative-response-in-the-injured-spinal-cord-and-improves-motor-function-after-spinal-cord-injury
#5
Qun Li, Thierry Houdayer, Su Liu, Visar Belegu
Myelination in central nervous system (CNS) is a dynamic process that includes birth of oligodendrocyte progenitor cells (OPCs), their differentiation into oligodendrocytes, and ensheathment of axons. Regulation of myelination by neuronal activity has emerged as a new mechanism of CNS plasticity. Indeed, activity-dependent myelination has been shown to regulate sensory, motor and cognitive functions. In this work, we aimed to employ this mechanism of CNS plasticity by utilizing induced neuronal activity to promote remyelination and functional recovery in a subchronic model of SCI...
May 5, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28425137/three-dimensional-printing-an-aid-to-epidural-access-for-neuromodulation
#6
Murray G Taverner, John P Monagle
OBJECTIVE: The case report details to use of three-dimensional (3D) printing as an aid to neuromodulation. METHODS: A patient is described in whom previous attempts at spinal neuromodulation had failed due to lack of epidural or intrathecal access, and the use of a 3D printed model allowed for improved planning and ultimately, success. RESULTS: Successful spinal cord stimulation was achieved with the plan developed by access to a 3D model of the patient's spine...
April 20, 2017: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/28422349/effects-of-extrinsic-cardiac-nerve-stimulation-on-atrial-fibrillation-inducibility-the-regulatory-role-of-the-spinal-cord
#7
Zixuan Dai, Congxin Huang, Qingyan Zhao, Shujuan Zhang, Hongyi Zhao, Youjing Zhang, Yongsheng Qian, Yanhong Tang
OBJECTIVE: To investigate the effect of the mutual regulation of the extrinsic cardiac nerves on atrial electrophysiology and atrial fibrillation (AF) vulnerability. METHODS AND RESULTS: Fourteen dogs were randomly divided into 2 groups: spinal cord stimulation (SCS) group (n = 7) and spinal cord block (SCB) group (n = 7). SCS was performed with 90% of the threshold voltage stimulating the T1 -T2 spinal level, while SCB was performed by injecting 2% lidocaine into the epidural space at the T2-3 level...
April 19, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28403104/effect-of-bipolar-pulsed-radiofrequency-on-refractory-chronic-cervical-radicular-pain-a-report-of-two-cases
#8
Min Cheol Chang
RATIONALE: Despite undergoing transforaminal epidural steroid injection (TFESI), many patients complain of persisting cervical radicular pain. For the management of chronic cervical radicular pain, clinicians are widely applying pulsed radiofrequency (PRF) stimulation to dorsal root ganglions (DRGs). To enhance the effect of PRF stimulation, we conducted bipolar PRF stimulation in 2 patients with chronic cervical radicular pain that was refractory to monopolar PRF and repeated TFESIs...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28402559/occipital-nerve-stimulation-attenuates-neuronal-firing-response-to-mechanical-stimuli-in-the-ventral-posteromedial-thalamus-of-a-rodent-model-of-chronic-migraine
#9
Ian Walling, Heather Smith, Lucy E Gee, Brian Kaszuba, Arun Chockalingam, Andrei Barborica, Cristian Donos, Damian S Shin, Julie G Pilitsis
BACKGROUND: Chronic migraine (CM) is a highly debilitating disease, and many patients remain refractory to medicinal therapy. Given the convergent nature of neuronal networks in the ventral posteromedial nucleus (VPM) and the evidence of sensitization of pain circuitry in this disease, we hypothesize CM rats will have increased VPM neuronal firing, which can be attenuated using occipital nerve stimulation (ONS). OBJECTIVE: To determine whether VPM firing frequency differs between CM and sham rats, and whether ONS significantly alters firing rates during the application of mechanical stimuli...
April 10, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28400726/review-of-epidural-spinal-cord-stimulation-for-augmenting-cough-after-spinal-cord-injury
#10
REVIEW
Jan T Hachmann, Jonathan S Calvert, Peter J Grahn, Dina I Drubach, Kendall H Lee, Igor A Lavrov
Spinal cord injury (SCI) remains a debilitating condition for which there is no cure. In addition to loss of somatic sensorimotor functions, SCI is also commonly associated with impairment of autonomic function. Importantly, cough dysfunction due to paralysis of expiratory muscles in combination with respiratory insufficiency can render affected individuals vulnerable to respiratory morbidity. Failure to clear sputum can aggravate both risk for and severity of respiratory infections, accounting for frequent hospitalizations and even mortality...
2017: Frontiers in Human Neuroscience
https://www.readbyqxmd.com/read/28400498/effect-of-thoracic-epidural-anesthesia-on-heart-rate-variability-in-a-porcine-model
#11
Arjun Mahajan, Tatsuo Takamiya, Peyman Benharash, Wei Zhou
Heart rate variability (HRV) is increasingly recognized as a means of evaluating autonomic tone. Thoracic epidural anesthesia (TEA) has been previously demonstrated to suppress the electrical storms in patients. However, the effect of TEA on HRV during sympathoexcitation remains unknown. In this study, we aimed to determine the effects of TEA on HRV response to left stellate ganglion stimulation (LSS) in a porcine model. In 12 anesthetized pigs after insertion of an epidural catheter to T1 level, a median sternotomy was performed to expose the heart and the left stellate ganglion...
April 2017: Physiological Reports
https://www.readbyqxmd.com/read/28385196/enabling-task-specific-volitional-motor-functions-via-spinal-cord-neuromodulation-in-a-human-with-paraplegia
#12
Peter J Grahn, Igor A Lavrov, Dimitry G Sayenko, Meegan G Van Straaten, Megan L Gill, Jeffrey A Strommen, Jonathan S Calvert, Dina I Drubach, Lisa A Beck, Margaux B Linde, Andrew R Thoreson, Cesar Lopez, Aldo A Mendez, Parag N Gad, Yury P Gerasimenko, V Reggie Edgerton, Kristin D Zhao, Kendall H Lee
We report a case of chronic traumatic paraplegia in which epidural electrical stimulation (EES) of the lumbosacral spinal cord enabled (1) volitional control of task-specific muscle activity, (2) volitional control of rhythmic muscle activity to produce steplike movements while side-lying, (3) independent standing, and (4) while in a vertical position with body weight partially supported, voluntary control of steplike movements and rhythmic muscle activity. This is the first time that the application of EES enabled all of these tasks in the same patient within the first 2 weeks (8 stimulation sessions total) of EES therapy...
April 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28364968/-sphenopalatine-ganglion-block-for-postdural-puncture-headache-in-ambulatory-setting
#13
José Miguel Cardoso, Miguel Sá, Rita Graça, Hugo Reis, Liliana Almeida, Célia Pinheiro, Duarte Machado
BACKGROUND AND OBJECTIVES: Postdural puncture headache (PDPH) is a common complication following subarachnoid blockade and its incidence varies with the size of the needle used and the needle design. Supportive therapy is the usual initial approach. Epidural blood patch (EBP) is the gold-standard when supportive therapy fails but has significant risks associated. Sphenopalatine ganglion block (SPGB) may be a safer alternative. CASE REPORT: We observed a 41 year-old female patient presenting with PDPH after a subarachnoid blockade a week before...
March 30, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28358748/effect-of-thoracic-epidural-anesthesia-on-ventricular-excitability-in-a-porcine-model
#14
Kimberly Howard-Quijano, Tatsuo Takamiya, Erica A Dale, Kentaro Yamakawa, Wei Zhou, Una Buckley, Aman Mahajan
BACKGROUND: Imbalances in the autonomic nervous system, namely, excessive sympathoexcitation, contribute to ventricular tachyarrhythmias. While thoracic epidural anesthesia clinically suppresses ventricular tachyarrhythmias, its effects on global and regional ventricular electrophysiology and electrical wave stability have not been fully characterized. The authors hypothesized that thoracic epidural anesthesia attenuates myocardial excitability and the proarrhythmic effects of sympathetic hyperactivity...
March 30, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28345483/spinal-epidural-stimulation-strategies
#15
Prithvi K Shah, Igor Lavrov
Significant advancements in spinal epidural stimulation (ES) strategies to enable volitional motor control in persons with a complete spinal cord injury (SCI) have generated much excitement in the field of neurorehabilitation. Still, an obvious gap lies in the ability of ES to effectively generate a robust locomotor stepping response after a complete SCI in rodents, but not in humans. In order to reveal potential discrepancies between rodent and human studies that account for this void, in this review, we summarize the findings of studies that have utilized ES strategies to enable successful hindlimb stepping in spinal rats...
March 1, 2017: Neuroscientist: a Review Journal Bringing Neurobiology, Neurology and Psychiatry
https://www.readbyqxmd.com/read/28319551/a-contemporary-medicolegal-analysis-of-implanted-devices-for-chronic-pain-management
#16
Christopher R Abrecht, Penny Greenberg, Ellen Song, Richard D Urman, James P Rathmell
BACKGROUND: Analysis of closed malpractice claims allows the study of rare but serious complications and likely results in improved patient safety by raising awareness of such complications. Clinical studies and closed claims analyses have previously reported on the common complications associated with intrathecal drug delivery systems (IDDS) and spinal cord stimulators (SCS). This study provides a contemporary analysis of claims from within the past 10 years. METHODS: We performed a closed claims analysis for a period January 1, 2009 to December 31, 2013 for cases with pain medicine as the primary service...
April 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28286722/acute-neuropathic-orchalgia-and-scrotalgia-after-percutaneous-spinal-cord-stimulator-lead-placement-two-cases-with-an-unusual-complication
#17
Meng Huang, Virendra R Desai, David Ho, Richard K Simpson
Spinal cord stimulation is an effective adjunct to the treatment of a variety of chronic pain syndromes. Complications are relatively low in morbidity and are most often secondary to hardware malfunction/malposition. Infection and undesired dysesthesias represent only a minority of complications. Neuropathic orchalgia and scrotalgia after placement of epidural spinal cord stimulator is a previously unreported morbidity. While alarming, this condition is physiologically benign, causing no neurological or urological dysfunction...
January 30, 2017: Curēus
https://www.readbyqxmd.com/read/28274815/electroacupuncture-improves-gait-locomotion-h-reflex-and-ventral-root-potentials-of-spinal-compression-injured-rats
#18
Carlos Escobar-Corona, Sergio Torres-Castillo, Erika Elizabeth Rodríguez-Torres, Bertha Segura-Alegría, Ismael Jiménez-Estrada, Salvador Quiroz-González
This study explored the effect of electroacupuncture stimulation (EA) on alterations in the Hoffman reflex (H-reflex) response and gait locomotion provoked by spinal cord injury (SCI) in the rat. A compression lesion of the spinal cord was evoked by insufflating a Fogarty balloon located in the epidural space at the T8-9 spinal level of adult Wistar male rats (200-250 gr; n=60). In different groups of SCI rats, EA (frequencies: 2, 50 and 100Hz) was applied simultaneously to Huantiao (GB30), Yinmen (BL37), Jizhong (GV6) and Zhiyang (GV9) acupoints from the third post-injury day until the experimental session...
March 6, 2017: Brain Research Bulletin
https://www.readbyqxmd.com/read/28268678/novel-fractal-planar-electrode-design-for-efficient-neural-stimulation
#19
Xuefeng Wei, Mehdi Benmassaoud, Miriam Meller, Sindhuja Kuchibhatla
Planar electrodes are used in epidural spinal cord stimulation and cortical stimulation. Stimulation efficiency of an electrode is characterized by its ability to activate a volume of neural tissue with lower voltage and power requirements. As current density tends to increase towards the sharp edges of an electrode, we hypothesize that electrode designs involving a greater amount of sharp edges will have higher variations of current density, and therefore increase stimulation efficiency, compared to electrodes with flat or rounded edges...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28248888/comparison-between-bipolar-pulsed-radiofrequency-and-monopolar-pulsed-radiofrequency-in-chronic-lumbosacral-radicular-pain-a-randomized-controlled-trial
#20
RANDOMIZED CONTROLLED TRIAL
Min Cheol Chang, Yun Woo Cho, Sang Ho Ahn
BACKGROUND: Chronic lumbosacral radicular pain is a challenging medical problem with respect to therapeutic management. Many patients with lumbosacral radicular pain complain of persistent leg pain after transforaminal epidural steroid injection. Nowadays, pulsed radiofrequency (PRF) stimulation on the dorsal root ganglion (DRG) is widely used for controlling lumbosacral radicular pain. METHODS: We evaluated the effect of bipolar PRF on the DRG for the management of lumbosacral radicular pain...
March 2017: Medicine (Baltimore)
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