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Spinal neurostimulation

David M Schultz, Aaron K Calodney, Alon Y Mogilner, Todd W Weaver, Michelle D Wells, E Katherine Stromberg, Mollie P Roediger, Peter E Konrad, John T Sasaki
OBJECTIVES: The Implantable Systems Performance Registry (ISPR) was created to monitor the product performance of Medtronic Spinal Cord Stimulation (SCS) and implanted intrathecal drug infusion systems available in the United States. MATERIALS AND METHODS: Data were collected on 2605 patients from 44 centers from various geographic regions across the United States implanting and following patients with SCS systems between June 25, 2004 and January 31, 2014. Actuarial life table methods are used to estimate device performance over time...
October 12, 2016: Neuromodulation: Journal of the International Neuromodulation Society
Miguel Pais-Vieira, Amol P Yadav, Derek Moreira, David Guggenmos, Amílcar Santos, Mikhail Lebedev, Miguel A L Nicolelis
Although electrical neurostimulation has been proposed as an alternative treatment for drug-resistant cases of epilepsy, current procedures such as deep brain stimulation, vagus, and trigeminal nerve stimulation are effective only in a fraction of the patients. Here we demonstrate a closed loop brain-machine interface that delivers electrical stimulation to the dorsal column (DCS) of the spinal cord to suppress epileptic seizures. Rats were implanted with cortical recording microelectrodes and spinal cord stimulating electrodes, and then injected with pentylenetetrazole to induce seizures...
September 8, 2016: Scientific Reports
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
Lance A Roy, Rathnayaka Mudiyanselage Kalpanee D Gunasingha, Richard Rauck
PURPOSE OF REVIEW: Neurostimulation is a well tolerated, cost-efficient, and effective method to treat chronic pain. Although spinal cord stimulation (SCS) has been shown to help patients, newer modalities such as burst, kilohertz-frequency, and dorsal root ganglion stimulation may provide greater pain relief, fewer paresthesias, and better outcomes. RECENT FINDINGS: Burst stimulation, programed as five-impulse burst at a frequency of 500 Hz, delivers more charge per second than conventional stimulation...
October 2016: Current Opinion in Anaesthesiology
Kliment Gatzinsky, Roald Baardsen, Hendrik P Buschman
OBJECTIVE: To evaluate the effectiveness and safety of percutaneous octapolar (8-contact) leads in spinal cord stimulation (SCS) treatment of failed back surgery syndrome (FBSS) patients who have not reached their therapy goals with other treatment interventions. METHODS: Our prospective, multicenter, open-label, nonrandomized study included 93 patients ≥ 18 years of age suffering from chronic (≥ 6 months), intractable pain predominantly in the legs. Patients implanted with octapolar lead(s) and a neurostimulator after a successful test trial were followed for 12 months...
July 20, 2016: Pain Practice: the Official Journal of World Institute of Pain
Jonathan P Miller, Sam Eldabe, Eric Buchser, Lisa M Johanek, Yun Guan, Bengt Linderoth
OBJECTIVE: All spinal cord stimulation (SCS) parameters (amplitude, pulse width, frequency) influence the interaction of stimulation with the nervous system and impact the delivery of charge. Regardless of the stimulation pattern, there are certain crucial elements related to dose, and a basic fundamental knowledge of the parameters used to administer the therapy is fundamentally important. METHODS: This paper reviews basic concepts of energy delivery in neurostimulation (amplitude, pulse width, and frequency) and introduces the concept of the duty cycle and charge per sec as another way to characterize stimulation patterns...
June 2016: Neuromodulation: Journal of the International Neuromodulation Society
Richard L Weiner, Anthony Yeung, Carlos Montes Garcia, Laura Tyler Perryman, Benjamin Speck
OBJECTIVES: Test a miniaturized neurostimulator transforaminally placed at the dorsal root ganglion (DRG) and evaluate the device's safety and efficacy in treating failed back surgery syndrome (FBSS) low back pain. DESIGN: Pilot, two-phase study. SUBJECTS: Eleven subjects with chronic intractable neuropathic trunk and/or lower limbs pain were included. METHODS: The system consisted of an implantable, miniaturized stimulator, provided by Stimwave Technologies (Freedom-4) and an external transmitter...
April 28, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Luiz Fabio Dimov, Adriano Cardozo Franciosi, Ana Carolina Pinheiro Campos, André Russowsky Brunoni, Rosana Lima Pagano
Transcranial direct current stimulation (tDCS) is an emerging, noninvasive technique of neurostimulation for treating pain. However, the mechanisms and pathways involved in its analgesic effects are poorly understood. Therefore, we investigated the effects of direct current stimulation (DCS) on thermal and mechanical nociceptive thresholds and on the activation of the midbrain periaqueductal gray (PAG) and the dorsal horn of the spinal cord (DHSC) in rats; these central nervous system areas are associated with pain processing...
2016: PloS One
Rajivan Maniam, Alan David Kaye, Nalini Vadivelu, Richard D Urman
Craniofacial pain, including trigeminal neuralgia, trigeminal neuropathic pain, and persistent idiopathic facial pain, is difficult to treat and can have severe implications for suffering in patients afflicted with these conditions. In recent years, clinicians have moved beyond treating solely with pharmacological therapies, which are generally not very effective, and focused on new interventional pain procedures. These procedures have evolved as technology has advanced, and thus far, early results have demonstrated efficacy in small patient cohorts with a variety of craniofacial pain states...
April 2016: Current Pain and Headache Reports
David Abejón, Pablo Rueda, Ricardo Vallejo
INTRODUCTION: Pulse frequency (Fc) is one of the most important parameters in neurostimulation, with Pulse Amplitude (Pw) and Amplitude (I). Up to certain Fc, increasing the number of pulses will generate action potentials in neighboring neural structures and may facilitate deeper penetration of the electromagnetic fields. In addition, changes in frequency modify the patient's sensation with stimulation. MATERIALS/METHODS: Fifty patients previously implanted with rechargeable current control spinal cord stimulation...
April 2016: Neuromodulation: Journal of the International Neuromodulation Society
Jianhang Jiao, Cristian Sevcencu, Winnie Jensen, Xiaoyu Yang, Kristian R Harreby
OBJECTIVES: Fast ripple (FR) activity has received increasing attention as a potential epileptic marker. The current knowledge on how neurostimulation affects FRs is, however, very limited. In this study, we assess the influence of the vagus nerve stimulation (VNS) and spinal cord stimulation (SCS) frequency on ictal FRs associated with spike-and-wave (SW) seizures. METHODS: SW discharges were induced and maintained by an infusion of pentylenetetrazol in rat. During ongoing SW seizures, SCS was conducted at 30, 80, 130, and 180 Hz and VNS at 10, 30, 80, 130, and 180 Hz...
April 2016: Neuromodulation: Journal of the International Neuromodulation Society
Sam Eldabe, Eric Buchser, Rui V Duarte
OBJECTIVE: Spinal cord and peripheral neurostimulation techniques have been practiced since 1967 for the relief of pain, and some techniques are also used for improvement in organ function. Neuromodulation has recognized complications, although very rarely do these cause long-term morbidity. The aim of this article is to present a review of complications observed in patients treated with neurostimulation techniques. METHODS: A review of the major recent publications in the literature on the subjects of spinal cord, occipital, sacral, and peripheral nerve field stimulation was conducted...
February 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Jean-Pascal Lefaucheur
The treatment of neuropathic pain by neuromodulation is an objective for more than 40 years in modern clinical practice. With respect to spinal cord and deep brain structures, the cerebral cortex is the most recently evaluated target of invasive neuromodulation therapy for pain. In the early 90s, the first successes of invasive epidural motor cortex stimulation (EMCS) were published. A few years later was developed repetitive transcranial magnetic stimulation (rTMS), a noninvasive stimulation technique. Then, electrical transcranial stimulation returned valid and is currently in full development, with transcranial direct current stimulation (tDCS)...
February 2016: Pain
Lisa K Mouzi, Olivia Adams, Germaine Cuff, Elaan Lukasiewicz, Elise Champeil, Arthur Atchabahian
OBJECTIVE: Our aim was to establish a plasma concentration curve for ropivacaine following femoral nerve blockade and to ascertain whether the resulting plasma concentrations differ significantly depending on whether neurostimulation (NS) or ultrasound (US) guidance was used. METHODS: Sixteen male and female subjects aged 18 to 80 who were scheduled to undergo unilateral total knee replacement or anterior cruciate ligament reconstruction under general or spinal anaesthesia, and for whom a femoral nerve block was indicated for postoperative analgesia, were enrolled in this prospective, randomised study...
February 2016: Anaesthesia, Critical Care & Pain Medicine
W Michael Hooten, Steven P Cohen
Low back pain (LBP) is a leading cause of disability worldwide. In the absence of a classification system for pain syndromes, classification of LBP on the basis of the distribution of pain as axial (pain generally localized to the low back) or radicular neuropathic (pain radiating to the lower extremities) is relevant to clinical practice because the distribution of pain is often a corollary of frequently occurring disease processes involving the lumbar spine. Common sources of axial LBP include the intervertebral disc, facet joint, sacroiliac joint, and paraspinal musculature, whereas common sources of radicular pain include a herniated intervertebral disc and spinal stenosis...
December 2015: Mayo Clinic Proceedings
Heather Smith, Youngwon Youn, Ryan C Guay, Andras Laufer, Julie G Pilitsis
Invasive analgesic therapies provide an alternative to medical management of chronic pain. With the increasing incidence of chronic pain not only in the United States but worldwide, more therapies have evolved to address the growing need for pain relief options. These therapies include spinal injections, nerve blocks, radiofrequency ablation, neurostimulation, and intrathecal drug delivery.
January 2016: Medical Clinics of North America
Jason E Pope, David Provenzano, Porter McRoberts, Timothy Deer
Upper extremity neuropathic pain states greatly impact patient functionality and quality of life, despite appropriate surgical intervention. This article focuses on the advanced therapies that may improve pain care, including advanced treatment strategies that are available. The article also surveys therapies on the immediate horizon, such as spinal cord stimulation, peripheral nerve stimulation, and dorsal root ganglion spinal cord stimulation. As these therapies evolve, so too will their placement within the pain care algorithm grounded by a foundation of evidence to improve patient safety and management of patients with difficult neuropathic pain...
February 2016: Hand Clinics
Manuel J Rodriguez, Mariano Fernandez-Baena, Alex Barroso, Jose A Yanez
BACKGROUND: Complex regional pain syndrome (CRPS) is a multifactorial condition with complex pathogenesis characterized by spontaneous or stimulus-induced pain that is disproportionate to the inciting event. It is also commonly accompanied by a myriad of autonomic and motor disturbances in highly variable combinations. This condition has been underreported in children until recently. Consequently, the management of CRPS in the pediatric population presents an even greater challenge than in adults, partly because there is a lack of clinical data concerning the efficacy of the diverse treatment methods available, and partly because successful treatment of CRPS involves a multidisciplinary approach...
November 2015: Pain Physician
D Feierabend, S Frank, R Kalff, R Reichart
BACKGROUND: Spinal cord stimulation (SCS) is an established procedure for treatment of chronic neuropathic pain of peripheral origin. The efficacy of SCS in case of central poststroke pain (CPSP), especially thalamic pain, has not been adequately proven. OBJECTIVES: The efficacy of SCS as an extracranial neurostimulation method for the management of central pain syndrome was investigated. MATERIALS AND METHODS: In this study, relevant pharmacological and nonpharmacological measures for central pain management were reviewed...
April 2016: Der Schmerz
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
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