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Dorsal column stimulation

Nathan D Crosby, John J Janik, Warren M Grill
Kilohertz-frequency spinal cord stimulation (KHF-SCS) is a potential paresthesia-free treatment for chronic pain. However, the effects of KHF-SCS on spinal dorsal column (DC) axons and its mechanisms of action remain unknown. The objectives of this study were to quantify activation and conduction block of DC axons by KHF-SCS across a range of kHz frequencies (1, 5, 10, or 20 kHz) and waveforms (biphasic pulses or sinusoids). Custom platinum electrodes delivered SCS to the T10/T11 DCs of anesthetized male Sprague-Dawley rats...
October 19, 2016: Journal of Neurophysiology
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
Ruiqi Wu, Langting Su, Pai-Feng Yang, Li Min Chen
Reactivation of deafferented cortex plays a key role in mediating the recovery of lost functions, although the precise mechanism is not fully understood. This study simultaneously characterized the dynamic spatiotemporal features of tactile responses in areas 3b and 1 before and 6-8 weeks after partial dorsal column lesion (DCL), and examined how the reactivation relates to the recovery of simple hand use in squirrel monkeys. A combination of high spatiotemporal resolution functional intrinsic optical imaging, microelectrode mapping, behavioral assessment, and tracer histology methods were used...
September 2016: ENeuro
Laura M Muncie, Nathaniel R Ellens, Emeline Tolod-Kemp, Claudio A Feler, John S Winestone
OBJECTIVE This study is a retrospective case series involving C1-2 spinal cord stimulation in patients with complex regional pain syndrome (CRPS) under general endotracheal anesthesia. Currently, C1-2 paddle lead placement is an accepted practice, which provides effective cervical stimulation to ameliorate upper-extremity and sometimes lower-extremity symptoms experienced by patients with CRPS. However, this technique must be performed under general endotracheal anesthesia rather than in an awake or semiconscious state due to intraoperative safety concerns and patient comfort...
September 30, 2016: Journal of Neurosurgery. Spine
Chao Li, Michael A Galgano, David A Carter
The most frequently encountered complication of dorsal column stimulators is lead migration. The vast majority of these events are seen in the first few weeks to months. Late paddle lead migration is a very uncommon occurrence in this setting. We describe a case of a 51-year-old male with a history of reflex sympathetic dystrophy having undergone dorsal column stimulator insertion at the level of C1-C2. A good clinical benefit was appreciated in the postoperative period once the stimulator was turned on. Approximately six months postoperatively, the patient suddenly lost coverage...
2016: Curēus
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
Ricardo de Oliveira, Rithiele Cristina de Oliveira, Luiz Luciano Falconi-Sobrinho, Raimundo da Silva Soares, Norberto Cysne Coimbra
The electrical stimulation of the dorsolateral columns of the periaquedutal grey matter (dlPAG) or deep layers of the superior colliculus (dlSC) evokes defensive behaviours followed by an antinociceptive response. Monoaminergic brainstem reticular nuclei are suggested to comprise the endogenous pain modulatory system. The aim of the present work was to investigate the role played by 5-HT2 subfamily of serotonergic receptors of the nucleus raphe magnus (NRM) and the gigantocellularis/paragigantocellularis pars α reticular nuclei (Gi/PGiα) in the elaboration of instinctive fear-induced antinociception elicited by electrical stimulation of dlPAG or of dlSC...
January 1, 2017: Behavioural Brain Research
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...
2016: Scientific Reports
Melissa R Andrews, Sara Soleman, Menghon Cheah, David A Tumbarello, Matthew R J Mason, Elizabeth Moloney, Joost Verhaagen, Jean-Charles Bensadoun, Bernard Schneider, Patrick Aebischer, James W Fawcett
The regenerative ability of CNS axons decreases with age, however, this ability remains largely intact in PNS axons throughout adulthood. These differences are likely to correspond with age-related silencing of proteins necessary for axon growth and elongation. In previous studies, it has been shown that reintroduction of the α9 integrin subunit (tenascin-C receptor, α9) that is downregulated in adult CNS can improve neurite outgrowth and sensory axon regeneration after a dorsal rhizotomy or a dorsal column crush spinal cord lesion...
July 2016: ENeuro
Hui-Xin Qi, Feng Wang, Chia-Chi Liao, Robert M Friedman, Chaohui Tang, Jon H Kaas, Malcolm J Avison
After lesions of the somatosensory dorsal column (DC) pathway, the cortical hand representation can become unresponsive to tactile stimuli, but considerable responsiveness returns over weeks of post-lesion recovery. The reactivation suggests that preserved subthreshold sensory inputs become potentiated and axon sprouting occurs over time to mediate recovery. Here, we studied the recovery process in 3 squirrel monkeys, using high-resolution fMRI CBV-fMRI mapping of contralateral somatosensory cortex responsiveness to stimulation of distal finger pads with low and high level electrocutaneous stimulation (ES) before and 2, 4, and 6weeks after a high cervical level contralateral DC lesion...
August 11, 2016: NeuroImage
Ganesan Baranidharan, John Titterington
Traditional (40-50 Hz) spinal column stimulation is an efficacious and widely accepted treatment for chronic neuropathic pain conditions. However, there are major challenges including its ineffectiveness for axial back pain, the burden of paresthesia-related discomfort and difficulties producing indisputable research. Recently, there have been the major technological innovations of high-frequency and burst stimulation. Studies have shown these to provide improved analgesia even for axial pain without the problems associated with paresthesia...
November 2016: Pain Management
Alan D Legatt, Avra S Laarakker, Jonathan P Nakhla, Rani Nasser, David J Altschul
The authors report herein a case of anterior cervical discectomy and fusion (ACDF) surgery in which findings on somatosensory evoked potential (SSEP) monitoring led to the correction of carotid artery compression in a patient with a vascularly isolated hemisphere (no significant collateral blood vessels to the carotid artery territory). The amplitude of the cortical SSEP component to left ulnar nerve stimulation progressively decreased in multiple runs, but there were no changes in the cervicomedullary SSEP component to the same stimulus...
June 10, 2016: Journal of Neurosurgery. Spine
R Nardone, Y Höller, F Brigo, V N Frey, P Lochner, S Leis, S Golaszewski, E Trinka
STUDY DESIGN: Topical review of the literature. OBJECTIVE: The objective of this review article was to assess indications and usefulness of various neurophysiological techniques in diagnosis and management of cervical spondylogenic myelopathy (CSM). METHODS: The MEDLINE, accessed by Pubmed and EMBASE electronic databases, was searched using the medical subject headings: 'compressive myelopathy', 'cervical spondylotic myelopathy (CSM)', 'cervical spondylogenic myelopathy', 'motor evoked potentials (MEPs)', 'transcranial magnetic stimulation', 'somatosensory evoked potentials (SEPs)', 'electromyography (EMG)', 'nerve conduction studies (NCS)' and 'cutaneous silent period (CSP)'...
May 31, 2016: Spinal Cord
Mert Akbaş, Mehmet Arif Yeğin, İrem Özdemir, Ethem Göksu, Mahmut Akyüz
Spinal cord stimulation as treatment of chronic low back pain via neuromodulation has been frequently performed in recent years. The dorsal column is stimulated by an electrode placed at the epidural region. In the case presently described, subcutaneous lead was implanted in a patient with failed back syndrome after spinal cord stimulation was inadequate to treat back and gluteal pain. A 65-year-old male had undergone surgery to treat lumbar disc herniation, after which he received physical therapy and multiple steroid injections due to unrelieved pain...
January 2016: Aǧrı: Ağrı (Algoloji) Derneği'nin Yayın Organıdır, the Journal of the Turkish Society of Algology
Jeffrey E Arle, Longzhi Mei, Kristen W Carlson, Jay L Shils
OBJECTIVE: Spinal cord stimulation (SCS) treats neuropathic pain through retrograde stimulation of dorsal column axons and their inhibitory effects on wide dynamic range (WDR) neurons. Typical SCS uses frequencies from 50-100 Hz. Newer stimulation paradigms use high-frequency stimulation (HFS) up to 10 kHz and produce pain relief but without paresthesia. Our hypothesis is that HFS preferentially blocks larger diameter axons (12-15 µm) based on dynamics of ion channel gates and the electric potential gradient seen along the axon, resulting in inhibition of WDR cells without paresthesia...
June 2016: Neuromodulation: Journal of the International Neuromodulation Society
Edmund R Hollis, Nao Ishiko, Ting Yu, Chin-Chun Lu, Ariela Haimovich, Kristine Tolentino, Alisha Richman, Anna Tury, Shih-Hsiu Wang, Maysam Pessian, Euna Jo, Alex Kolodkin, Yimin Zou
Limited functional recovery can be achieved through rehabilitation after incomplete spinal cord injury. Eliminating the function of a repulsive Wnt receptor, Ryk, in mice and rats by either conditional knockout in the motor cortex or monoclonal antibody infusion resulted in increased corticospinal axon collateral branches with presynaptic puncta in the spinal cord and enhanced recovery of forelimb reaching and grasping function following a cervical dorsal column lesion. Using optical stimulation, we observed that motor cortical output maps underwent massive changes after injury and that hindlimb cortical areas were recruited to control the forelimb over time...
May 2016: Nature Neuroscience
Feline F J A Ter Bruggen, Ismail Eralp, Leo Leliveld, Chris Jansen, Dirk L Stronks, Frank J P M Huygen
OBJECTIVE: During implantation of a neuromodulative system, high patient satisfaction is closely associated with the equilibrium between an effective analgesia and sedation regimen, and the possibility for the patient to be awake and cooperative during procedure. This study assessed the efficacy of the sedative dexmedetomidine to achieve this balance, with patient satisfaction as the primary outcome. METHODS: Ten patients undergoing implantation of a dorsal column and dorsal root ganglion stimulator received dexmedetomidine (1 mcg/kg over 10 minutes, followed by 0...
February 23, 2016: Pain Practice: the Official Journal of World Institute of Pain
Paolo Barbaresi, Emanuela Mensà
Electrical stimulation of the dorsal columns (DCs; spinal cord stimulation; SCS) has been proposed to treat chronic neuropathic pain. SCS may activate a dual mechanism that would affect both the spinal cord and supraspinal levels. Stimulation of DCs or DC nuclei (DCN) in animals where neuropathic pain has been induced causes activation of brainstem centers including the periaqueductal gray (PAG), which is involved in the endogenous pain suppression system. Biotinylated dextran-amine (BDA) was iontophoretically injected into the DCN to analyze the ascending projection directed to the PAG...
August 2016: Neuroscience Research
Xiaoyi Min, Alexander R Kent
The effectiveness of spinal cord stimulation (SCS) for chronic pain treatment depends on selection of appropriate stimulation settings, which can be especially challenging following posture change or SCS lead migration. The objective of this work was to investigate the feasibility of using SCS lead impedance for determining the location of a SCS lead and for detecting lead migration, as well as the impact of axial movement and rotation of the St. Jude Medical PENTA™ paddle in the dorsal-ventral or medial-lateral directions on dorsal column (DC) stimulation thresholds and neural activation regions...
August 2015: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Pierre Sacré, Sridevi V Sarma, Yun Guan, William S Anderson
Chronic pain affects about 100 million adults in the US. Despite their great need, neuropharmacology and neurostimulation therapies for chronic pain have been associated with suboptimal efficacy and limited long-term success, as their mechanisms of action are unclear. Yet current computational models of pain transmission suffer from several limitations. In particular, dorsal column models do not include the fundamental underlying sensory activity traveling in these nerve fibers. We developed a (simple) simulation test bed of electrical neurostimulation of myelinated nerve fibers with underlying sensory activity...
2015: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
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