Neuromodulation : journal of the International Neuromodulation Society
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In this article we will discuss the treatment of Occipital Neuralgia (ON) and Transformed Migraine (TM) using a paddle style surgical stimulator lead. A paddle style electrode may have advantages to the cylindrical style in reducing migrations from cervical tension or anchor dislodgement. It should be considered in refractory "neuropathic" cervicocranial syndromes such as ON and TM before moving on to more aggressive surgical interventions.
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Drop foot stimulators today operate open loop with a trapezoidal stimulation profile. The traditionally applied profile originated as much from technological constraints as suitability for the physical pathology. It was proposed that by increasing the stimulation intensity during the loading response phase of gait, the ankle angle trajectory would become closer to that of normal gait and a more efficient heel rocker would be introduced. ⋯ Statistical analysis revealed that this was significant at p = 0.05 level. Increasing stimulation intensity during loading response prolongs the heel rocker. This is an essential mechanism for advancement over the stance limb and providing shock absorption during weight acceptance, thus, we conclude that this improves the gait pattern of the drop foot sufferer.
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The Prospective Italian Register of spinal cord stimulation (SCS) was designed to evaluate the clinical outcome of patients with severe peripheral arterial occlusive disease (PAOD) treated with SCS. Baseline data were collected for all patients with PAOD undergoing SCS treatment (September 1998 to February 2001) at 34 participating centers. If, after a 2- to 3-week trial, SCS demonstrated significant clinical benefits, a permanent implantable pulse generator was implanted. ⋯ All PAOD parameters improved significantly during follow-up. At 12 months postimplantation, 76.1% of patients were responsive to SCS therapy. The reduction in the use of analgesics and the number and duration of hospital stays offers clear economic advantages.
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Results from a clinical evaluation of Functional Electrical Therapy (FET) in chronic hemiplegic subjects are presented. FET is an intensive exercise that integrates voluntary maximized manipulation and augmented grasping by electrical stimulation of forearm and hand muscles. A total of 16 chronic hemiplegic subjects participated in a six-month long study. ⋯ The trends of UEFT and DT scores during the therapy (three weeks) were steeper when compared with the trend during follow-up (23 weeks). The changes of the trends during the study suggest that prolonged treatment could lead to bigger gains. We found standard deviations were increased towards the end of follow-up suggesting individual differences in response to either the treatment or the disablement process.
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Irritable Bowel Syndrome (IBS) is a functional gastrointestinal (GI) disorder, characterized by abdominal pain, altered bowel habit (diarrhea and/or constipation), and bloating in the absence of demonstrable organic pathology. It is the most common GI disorder seen in primary care and gastroenterology practices. Conservative therapies for IBS are directed at both pain and correction of altered GI motility. ⋯ Symptoms of IBS cannot be explained entirely by changes in motility alone and may also arise from complex feedback and feed-forward interactions between supraspinal circuits, the spinal cord, and the periphery, in effect, a neuropathic process, that might be amenable to neuromodulation, that is, spinal cord stimulation. We present here a single case report of a patient with IBS who responded positively to SCS after failing all conservative therapies to alleviate or manage her abdominal pain and diarrheal episodes. Our discussion is focused on the reasons why SCS might work in patients with IBS.