Neuromodulation : journal of the International Neuromodulation Society
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Objective. The aim of the present study was to describe the surgical and clinical outcomes of the implantation and stimulation of the pedunculopontine tegmental nucleus in humans. Materials and Methods. Fourteen patients affected by movement disorders (12 Parkinson's disease and 2 progressive supranuclear palsy) underwent surgery for bilateral or monolateral implantation of stimulating electrodes in the pedunculopontine tegmental nucleus. The correct placement of electrodes was established and verified by combining angio-CT scans with magnetic resonance imaging. ⋯ The correct positioning of stimulating electrodes in pontine structures such as the pedunculopontine nucleus may be ascertained not only through neuroimaging techniques but also through clinical neurophysiology. The evolution of the surgical planning that we have developed emphasizes the limited value of single-unit recordings to identify the pedunculopontine tegmental nucleus and highlights the opportunities offered by functional evaluations of neurophysiologic parameters. As far as the clinical efficacy is concerned, our data suggest a promising outcome for simultaneous implantations of different basal ganglia nuclei in Parkinsonian and in progressive supranuclear palsy patients as well.
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Introduction. Peripheral nerve stimulation has become a useful tool in neuromodulation in the treatment of chronic and intractable pain syndromes. Method. While most of the reports in the literature describe the use of a subcutaneously placed small diameter cylindric lead, we present a case report of a 37-year-old man who did not have adequate axial back stimulation with such a lead. Conclusion. He had excellent stimulation and reduction of his pain after the device was replaced with an insulated subcutaneous paddle lead.
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Ultrasound-Guided Localization of Difficult-to-Access Refill Port of the Intrathecal Pump Reservoir.
Introduction. Ultrasound guidance is being increasingly utilized in many chronic pain interventions. This is a report of the use of ultrasound imaging for accessing an intrathecal pump. Case Report. A 56-year-old patient with a programmable implanted intrathecal drug delivery system for chronic non-malignant pain needed a pump refill of sufentanil. ⋯ As the patient continued to have a collection of fluid during his following visit, the collection was aspirated under ultrasound guidance. The specimen revealed a proteinaceous collection with minimal quantities of sufentanil. Conclusion. This is a successful demonstration of ultrasound guidance to facilitate access to a difficult-to-access refill port of a pump reservoir secondary to the formation of a seroma.
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Introduction. Spinal cord stimulation (SCS) is used clinically by many pain physicians and neurosurgeons alike without regard to their own outcome data. Methods. We reviewed our 20-year experience retrospectively of patients receiving SCS implants and analyzed our data by pain type and group. Results. We present 260 patients, 140 men and 120 women. ⋯ The therapy was not free of complications. The preponderance of our patients was patients with the diagnosis of PVD and our results in this group of patients were excellent. These excellent results of more than 90% improvement suggest to us that SCS be considered as a first-line approach to the clinical management of patients with pain and ulcer of PVD.
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Objectives. Post-herpetic neuralgia (PHN) is a painful complication of herpes zoster infection and a common cause of chronic severe pain in elderly and/or debilitated patients. Although a wide range of treatments have been tried, a substantial number of patients continue to experience pain which remains refractory to all therapies. Increasingly, studies have demonstrated that oral opioids can have a beneficial effect on neuropathic pain. ⋯ Patients most commonly reported improvement in the deep component of their pain, next allodynia, and less so superficial lancinating pain. Conclusions. In conclusion, while a complex therapy, long-term use of intrathecal opioids is well tolerated, doses are titratable, administration is safe, and may help relieve severe short- and long-term neuropathic pain in selected PHN patients. Whether the addition of newer investigational intrathecal agents could improve these results is yet to be determined.