Neuromodulation : journal of the International Neuromodulation Society
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Subthalamic nucleus deep brain stimulation (STN DBS) is effective for treatment of levodopa-induced dyskinesias in patients with Parkinson's disease (PD). Medical or surgical procedures requiring electrocautery may require inactivation of the pulse generators to avoid damage to the lead or extension wire or possible reprogramming of the stimulators. This generally causes only mild and temporary disability. We report a patient with previously well-controlled dyskinesias who had severe and prolonged dyskinesias following reactivation of deep brain stimulation (DBS) following an orthopedic procedure. ⋯ Clinicians caring for PD patients treated with STN DBS should be aware of the possible reappearance of severe dyskinesias arising from routine inactivation and reactivation of pulse generators for medical or surgical procedures.
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Comparative Study
Peripheral nerve field stimulation in the treatment of postlaminectomy syndrome after multilevel spinal surgeries.
Chronic low back pain in patients with postlaminectomy syndrome (PLS) is challenging to treat, especially for patients who have undergone multilevel surgical procedures. Despite conservative therapy and available interventional pain procedures including spinal cord stimulation (SCS) and intrathecal therapies, patients may continue with intractable low back pain. Peripheral nerve field stimulation (PNFS) may represent an effective alternative treatment option for these patients when conventional treatments do not provide adequate relief of intractable low back pain. ⋯ PNFS may be more effective in treating intractable low back pain than SCS in patients with PLS after multilevel spinal surgeries.
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Case Reports Randomized Controlled Trial
Deep brain stimulation for early-stage Parkinson's disease: an illustrative case.
Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective intervention in advanced Parkinson's disease (PD), but its efficacy and safety in early PD are unknown. We are conducting a randomized pilot trial investigating DBS in early PD. This report describes one participant who received bilateral STN-DBS. ⋯ This report details the first successful application of bilateral STN-DBS for early-stage PD during a clinical trial.
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The use of occipital nerve stimulators for the treatment of migraines has recently been suggested. However, there have been reports of complications, including lead migration causing local muscle stimulation and spasm with local burning sensation and loss of successful neuromodulation. ⋯ Disruption of occipital nerve stimulator lead insulation may mimic lead migration with failure of neuromodulation, spasm, and local burning sensations. Prior to reimplanting, a lead should be thoroughly inspected to ensure there is no mechanical failure. Anchoring should be performed with gentle direct suturing or the use of a protective anchoring device.