Neuromodulation : journal of the International Neuromodulation Society
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Randomized Controlled Trial
Predictors of implantable pulse generator placement after sacral neuromodulation: who does better?
Numerous studies have documented a relationship between provider variables, including surgeon volume and specialty, and outcomes for surgical procedures. In this study we analyzed claims data from a Medicare database to analyze outcomes of sacral neuromodulation (SNM) with respect to both provider and patient factors. ⋯ The rate of IPG implantation after SNM was greater among high-volume providers. Women had better outcomes than men. Further research may better define the relationship between outcomes of sacral neuromodulation and specific etiology of voiding dysfunction.
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Motor cortex stimulation has been reported as an effective treatment for medically resistant neuropathic pain. The goal of this study is to review the efficacy of this treatment in a series of 14 patients. ⋯ In our cohort of 14 patients with neuropathic pain, motor cortex stimulation failed to produce acceptable long-term benefit. Possible reasons for this failure are discussed in the context of a small retrospective study.
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To provide a general control system framework for neuromodulation, its practical challenges, and historical underpinnings in cardiac rhythm devices, and to illustrate the potential of closed-loop techniques in neuromodulation with a case study using an adaptive neural stimulation system that integrates sensing, actuation, and state estimation for the treatment of chronic pain through spinal cord stimulation. ⋯ Technological advances in neuromodulation using such a control framework have the potential to improve neurologic therapies. Future opportunities for extending the role of these systems are briefly discussed.
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The purpose of this study was to examine how scar formation may affect electrical current distribution in the spinal cord when using paddle leads placed in the epidural space during treatment with spinal cord stimulation. ⋯ This study is one of the first to examine the effects of scar tissue on dorsal column stimulation and the only one using a detailed computational approach toward that end. It appears that different thickness and location of scar between electrode contacts and the dura may likely lead to a significant number and location of complex changes in the activated fibers. It is likely that a more complete assessment of scarring and its effect on the electrical environment of any given paddle lead would allow more accurate and predictable reprogramming of patients with commercially available systems in place.