Neuromodulation : journal of the International Neuromodulation Society
-
We began this study to determine the efficacy and safety of intrathecal baclofen (ITB) delivered by a programmable pump for the treatment of severe spasticity of spinal cord origin. One hundred fifty two patients with severe spasticity of spinal origin, refractory to oral baclofen, or who experienced intolerable side-effects were given a test dose of ITB. Only those who had a satisfactory response were considered to be appropriate for pump implantation. ⋯ Superficial pump pocket infection, pocket erosion, cerebrospinal fluid (CSF) leak, post-spinal puncture headache, and meningitis were some of the procedure-related complications. Two pumps flipped and another pump valve was stuck. We conclude that long-term intrathecal baclofen by an implanted programmable pump is a safe and effective method of treating severe intractable spinal spasticity.
-
The objective of this study was to investigate and test a real time system implemented for Functional Electrical Stimulation (FES) assisted foot drop correction, deriving control timing from signals recorded from a peripheral sensory nerve. A hemiplegic participant was attached with a cuff electrode on the sural nerve connected to a telemetry controlled implanted neural amplifier, and a stimulation cuff electrode on the peroneal nerve connected to an implanted stimulator. ⋯ The detection system's ability to detect heel strike and foot lift without errors and to detect the difference between walking and standing proved to be stable for the duration of the study. We conclude that using ALNs and natural sensors provide a stable and accurate control signal for FES foot drop correction.
-
The purpose of this paper is to discuss which nerve fibers in the various quadrants of the spinal cord are immediately activated under normal conditions of spinal cord stimulation, ie, at voltages within the therapeutic range. The conclusions are based on both empirical and computer modeling data. The recruitment of dorsal column (DC) fibers is most likely restricted to Aβ fibers with a diameter ≥ 10.7 μm in a 0.20-0.25 mm layer under the pia mater and fibers of 9.4-10.7 μm in an even smaller outer layer when a conventional SCS lead is used. ⋯ The latter are presumably of proprioceptive origin and responsible for segmental reflexes and uncomfortable sensations. Furthermore, it is shown to be unlikely that, apart from dorsal roots and a thin outer layer of the DCs, any other spinal structures are recruited when stimulation is applied in the dorsal epidural space. Finally, anodal excitation and anodal propagation block are unlikely to occur with SCS.