Neuromodulation : journal of the International Neuromodulation Society
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Objectives. The study aims to assess the safety and efficacy of intrathecal (IT) ziconotide when delivered via an external infusion system. Materials and Methods. Patients with severe chronic pain were implanted with an external infusion system, and IT ziconotide was titrated over one to four weeks. Safety was evaluated via adverse event (AE) reports, and efficacy measures included the visual analog scale of pain intensity (VASPI), categorical pain relief scale (CPRS), and clinical global impression (CGI). ⋯ A significant (p ≤ 0.005) median percentage improvement in VASPI scores was seen at week 1 and maintained through week 4 (range: 11.0-32.6%); 53.6% of patients reported good to excellent pain control on the CGI and 52.2% of patients reported moderate to complete pain relief on the CPRS. Conclusions. The study results suggest that a short-term trial of IT ziconotide using an external infusion system may be sufficient to assess patient response. High rates of AEs were noted; however, ziconotide-related AEs were consistent with those reported in previous trials.
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Striatal hand is a deformity encountered in Parkinson's disease and other parkinsonisms. It is characterized by extension that occurs at all the interphalangeal joints, flexion at the metacarpophalangeal joints, and ulnar deviation. It can be differentiated from levodopa-induced dystonia and primary dystonia, since the deformity exists continuously even during sleep. ⋯ Although the precise mechanism remains unclear, rigidity is assumed to contribute to the limb deformities. Based on our experience, it seems possible therefore that the effect of STN-DBS on the hand deformity was a secondary effect on muscular rigidity. STN-DBS is assumed to represent a useful treatment option for striatal hand deformity.
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Objectives. This study aims to investigate the effect of functional electrical stimulation (FES) on gait in people with Parkinson's disease. Materials and Methods. Seven subjects with idiopathic Parkinson's disease received single-channel electrical stimulation for eight weeks to the common peroneal nerve to improve heel strike and provide sensory stimulus during the swing phase of gait. Stride length, time, and number of steps to complete a 20-m walk and distance completed in 3 min were assessed. ⋯ An immediate effect of FES was demonstrated over a 3-min walk but not over a 20-m walk. Improvements in gait largely persisted on reassessment four weeks after stopping use of FES although the frequency of falls returned to pretreatment levels. A larger study is required to support these findings, to understand the mechanisms of the effects of electrical stimulation on gait and to identify those most likely to benefit from it.
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Objectives. Over the past few years, there has been an increased reliance on the intrathecal delivery of drugs for patients suffering from intractable pain. We sought to demonstrate the effectiveness of the intrathecal pain pump by examining self-reported pre- and postimplantation pain levels. Methods. Eighty-four patients who had elected to implant a Medtronic SynchroMed 1 or 2 system in order to control their pain were asked to complete a survey. ⋯ Results. Perceived success rate for implantation is 68%, when measured by the ability to reduce reliance on oral medication. When measured by willingness to undergo the procedure again, the success rate is 86%. Conclusions. Overall, the implantation of an intrathecal pain pump is an effective way for most people to manage their intractable pain and reduce reliance on oral medications.
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Objective. This article aims to present a case of the use of an alternative form of neuromodulation for the treatment of axial back pain associated with postlaminectomy syndrome. Materials and Methods. An elderly patient with long-standing axial back pain in the setting of a prior decompressive laminectomy presented for evaluation and treatment. ⋯ The permanent system consisted of four Medtronic Quad Plus leads, two on each side of midline oriented horizontally over the L4-5 paraspinous muscles. Our patient was ultimately weaned off of all narcotic medications and, at one year follow-up, continues to report > 90% reduction of pain.