Neuromodulation : journal of the International Neuromodulation Society
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Study Design. A retrospective design comparing three matched groups was used to evaluate the application of a multidimensional approach to outcomes analysis using a variety of disease-specific and generic outcome measures to assess three treatments for failed back surgery syndrome. Objective. The objective of this study was to explore the use of a multidimensional analysis of outcomes to compare and contrast the effects of three different treatments: 1) intrathecal therapy using an implantable drug administration system (DAS), 2) standard medical therapy emphasizing the use of oral opioids (OO), and 3) residential pain and rehabilitation program (RPRP) for the treatment of chronic low back pain. Summary of Background Data. The incidence of low back pain in patients with prior back surgery remains significant. ⋯ No one treatment emerged as the most effective across all of the disease-specific and generic measures. However, patients in the DAS group tended to report greater improvement. Overall, although generally "satisfied" with treatment, they were generally "satisfied" with treatment despite continuing to report significant levels of pain, disability, and impaired QoL.
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Objective. To use a meta-analysis on all reported cases of deep brain stimulation (DBS) for dystonia to determine which factors significantly influence outcome. The Burke-Fahn-Marsden (BFM) movement scale, the most reported measure, was chosen as the primary outcome measure for this analysis. Methods. A MEDLINE search identified 137 patients who underwent DBS for dystonia in 24 studies that had individual BFM scores. ⋯ Longer duration of dystonia symptoms correlated negatively with surgical outcome. A regression model using the three variables-stimulation site, etiology of dystonia, and duration of dystonia symptoms-explained 51% of the variance in outcomes. Conclusion. Deep brain stimulation of the GPi provides significant improvement in BFM scores in a variety of dystonic conditions.
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The administration of intrathecal drugs has been shown to be efficacious in the treatment of both cancer pain and noncancer pain in patients who do not respond well to conventional treatment, in those who are unable to tolerate side-effects of opioids, and in those who constantly require significant increases in drug dosing. Although morphine represents the "drug of choice" for intrathecal administration, the use of alternative drugs (e.g., bupivacaine, clonidine, and hydromorphone) appears promising for intrathecal therapy of pain in patients who are unresponsive to morphine, those who cannot tolerate its side-effects, and those patients with neuropathic pain. This study analyzes results of studies published from 1990 to 2005 in order to evaluate the efficacy of intraspinal therapy.
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Objective. To assess the orthotic effect of a functional electrical stimulation device (Akita Heel Sensor System; AHSS) in the treatment of hemiplegic gait with foot drop. Materials and Methods. In the AHSS, a heel sensor is attached to a small plastic heel brace, and the peroneal nerve is stimulated via percutaneous intramuscular electrodes. During the swing phase of the hemiplegic gait, the common peroneal nerve is stimulated by the AHSS. ⋯ Mean step cadence was 31 ± 7 steps/10 m without stimulation and 27 ± 7 steps/10 m with stimulation. By correcting foot drop, the AHSS significantly increased walking speed and decreased cadence (p < 0.05). Conclusion. The AHSS can significantly improve walking in hemiplegic patients with foot drop.