Neuromodulation : journal of the International Neuromodulation Society
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We examined the efficacy of peripheral nerve stimulation (PNS) in treating neuropathic and causalgic pain, with a stimulation system specifically designated for PNS itself. ⋯ Our study results confirm that PNS is an effective modality in managing severe neuropathic and intractable pain following multiple joint surgeries that are complicated by causalgic pain.
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Appropriate stimulation of the dorsal column is required in order to achieve optimal control over pain by way of spinal cord stimulation (SCS). In this study, we objectively evaluated changes in somatosensory evoked potentials (SEPs) during a collision test in order to investigate whether paresthetic sensation or amount of pain reduction was correlated with the degree of dorsal column stimulation. ⋯ We show that SEP collision is useful for evaluating the degree of dorsal column stimulation needed as well as in considering factors related to differences between responders and nonresponders to SCS therapy.
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Case Reports
Bilateral globus pallidus interna deep-brain stimulation in a patient with myoclonus-dystonia: a case report.
Myoclonus-dystonia is a movement disorder characterized by childhood onset of myoclonus and dystonia. We report a case of the epsilon-sarcoglycan mutation-negative myoclonus-dystonia patient who underwent bilateral globus pallidus interna deep-brain stimulation with subsequent improvement of both myoclonus and dystonia. ⋯ This report suggests that patients with myoclonus-dystonia may significantly benefit from bilateral globus pallidus interna deep-brain stimulation. Larger studies of this patient population are needed to confirm the optimal target.
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The objective of this study is to present a novel surgical technique for safe placement of paddle-type spinal cord stimulation (SCS) electrode in the presence of epidural scar tissue. ⋯ SCS is a widely accepted treatment modality for chronic neuropathic pain. Placement of paddle electrode can be challenging, usually because of the presence of epidural scar tissue. There have been reported cases of spinal cord injury related to paddle electrode placement. We present a novel technique that allows for safe placement of a paddle-type SCS electrode in more challenging surgical circumstances, including the presence of epidural scar tissue.
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Spinal cord stimulation can be effectively used in the treatment of low back pain and extremity pain in failed back surgery syndrome. Ideal targets for stimulation corresponding to paresthesia overlap in the low back versus the extremities may differ in cranial-caudal location. ⋯ Dual paddle placement through a single laminotomy may be a reasonable option for select patients where coverage of anatomically-separated pain regions is necessary. This technique can be performed in most patients without significantly increased morbidity.