Neuromodulation : journal of the International Neuromodulation Society
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The aim of this study was to determine the efficacy and safety of intrathecal baclofen (ITB) delivered by a programmable pump for the chronic treatment of severe spasticity due to traumatic brain injury (TBI). Eight patients with severe spasticity following TBI, refractory to oral baclofen or who experienced intolerable side effects, were screened. The first five patients were enrolled in a research protocol that was approved by the Institutional Review Board for Human Research at Boston University Medical Center. ⋯ Reduction of spasticity resulted in improved levels of physical activity and locomotion and ease of care. Complications consisted of muscular hypotonia, areflexic bladder and urinary retention, erythema, and breakdown of the skin over the pump. Our results suggest that long-term intrathecal baclofen by an implanted programmable pump is a safe and effective method of treating severe intractable spasticity arising from traumatic brain injury.
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This paper reports on 80 patients using dual electrode, spinal cord stimulation (SCS) over a four-year period Implant status, stimulation mode, anode-cathode configuration (array), cathode position, paresthesia overlap, explantation rates, complications, Visual Analog Scores (VAS), and overall satisfaction were examined in patients implanted with dual 8 contact, staggered, percutaneous electrodes. All patients had undergone implantation for chronic axial and extremity pain [e.g., Failed Back Surgery Syndrome (FBSS), Complex Regional Pain Syndrome (CRPS)]. Outcomes were evaluated in view of our previous reports in this same group at 24 and 30 months (1,2). ⋯ Thirty-five percent of patients with thoracic implants achieved paresthesia in the low back at 48 months. Explantation rates and overall patient satisfaction were significantly affected by painful radio frequency (RF) antenna coupling. This data supports the efficacy of dual electrodes in optimizing long-term SCS paresthesia overlap and complex pain outcomes.
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The purpose of this case study was to evaluate a patient with diplegic cerebral palsy who underwent soft tissue lengthening augmented with intramuscular electrical stimulation. This is a prospective case study, pre- and post-test design. ⋯ All measured parameters, except knee extensor strength, improved during the postoperative period (baseline to 4-month follow-up) and continued to improve during the rehabilitative period (4-12 month follow-up), despite no formal therapy or home exercise program during this period. We conclude that surgical releases augmented with electrical stimulation resulted in a satisfactory clinic outcome, and may offer a new approach to the treatment of patients with cerebral palsy.
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We describe a technique for the safe and aesthetically pleasing implantation of the Synergy pulse generator in the posterior iliac region for spinal cord stimulation. The technique can be applied to both thin and obese patients.
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This paper reviews data supporting the existence of individual, predictable, and unpredictable fluctuations in the severity of chronic pain and spasticity. It also evaluates what is known on the use of implantable programmable drug delivery systems for the management of predictable fluctuations in pain and spasticity. In addition to fixed rate infusion pumps, programmable drug delivery systems have been developed over the past 20 years for the management of predictable pain or spasticity fluctuations. ⋯ Ideally, the patient should be able to treat unpredictable fluctuations in symptoms, and a combination of patient controlled analgesia (PCA) with programmable drug delivery systems is currently in development. The future management of unpredictable fluctuations in the intensity of chronic pain and spasticity was subjected to critical evaluation. There seems to be a general agreement on the clinical importance of these phenomena, but stronger evidence is needed for a widespread change in the current management of most chronic pain patients.