Neuromodulation : journal of the International Neuromodulation Society
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Direct testing of deep brain stimulation (DBS) mechanisms in humans is needed to assess therapy and to understand stimulation effects. ⋯ IPG replacement occurs when the DBS/brain interface is stable and patients demonstrate symptom reduction with known stimulation parameters. Conducting research at this time point avoids DBS implant issues, including temporary microlesion effects, fluctuating electrode impedances, and technical limitations of contemporary IPGs, providing advantageous conditions to conduct translational DBS research with minimal additional risk to research subjects.
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The application of transcranial static magnetic field stimulation (tSMS) in humans reduces the excitability of the motor cortex for a few minutes after the end of stimulation. However, when tSMS is applied in humans, the cortex is at least 2 cm away, so most of the strength of the magnetic field will not reach the target. The main objective of the study was to measure the strength and reproducibility of static magnetic fields produced by commercial neodymium magnets. ⋯ These measurements offer a quantitative empirical reference for developing devices useful for tSMS protocols in both humans and animals.
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Spinal cord stimulators (SCS) are increasingly placed in the United States in both the inpatient and outpatient setting. Although these interventions appear to be safe, the characteristics of the patients selected for ambulatory procedures have not been investigated. ⋯ Access to ambulatory SCS placement appears to be more common for Caucasians, male patients, with private insurance, and fewer comorbidities, in the setting of higher volume hospitals. Further investigation is needed in the direction of mapping these disparities for appropriate resource utilization.
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In spinal cord stimulation, anodes tend to have a strong effect over the area of dorsal column (DC) activation, when configured as both longitudinal guarded cathodes (LGCs) and transverse tripoles (TTs). Inclusion of a small spacing step (LGC+) in the center-center (C-C) spacing of the LGC can be an efficient method to study the local effects around the electrode. The primary aim of this computer modeling study is to investigate if enhanced DC recruitment is achieved when anodal currents in TT and LGC combinations (both LGC and LGC+) are increased up to 30% with respect to the cathodal current. Secondly, the merits of anodal intensification (AI) are evaluated by comparing the DC recruitment areas (S(RA)) and energy consumption (EDT ) of LGC+ with AI, against stimulation using an LGC without AI. ⋯ AI of TTS is not advantageous. LGC and LGC+ with AI allow additional DC stimulation, which may increase the likelihood of activating fibers inaccessible with conventional programming. LGC+ with AI can be more efficient than LGCs without AI, as a larger SRA and UR is achieved at lower EDT .
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Rechargeable (RC) implantable pulse generators (IPGs) for deep brain stimulation (DBS) in movement disorders have recently become available. No guidelines exist for parameter adjustment after conversion of non-RC to RC IPGs, or reports of patient satisfaction with RC IPGs when used as initial DBS device or after conversion from non-RC IPGs. ⋯ RC IPGs in DBS for movement disorders are well received by patients as initial therapy and after conversion. Mild reduction in stimulation parameters might be allowed after conversion to RC IPG.