Neuromodulation : journal of the International Neuromodulation Society
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Review
Surgical neuroanatomy and programming in deep brain stimulation for obsessive compulsive disorder.
Deep brain stimulation (DBS) has been established as a safe, effective therapy for movement disorders (Parkinson's disease, essential tremor, etc.), and its application is expanding to the treatment of other intractable neuropsychiatric disorders including depression and obsessive-compulsive disorder (OCD). Several published studies have supported the efficacy of DBS for severely debilitating OCD. However, questions remain regarding the optimal anatomic target and the lack of a bedside programming paradigm for OCD DBS. Management of OCD DBS can be highly variable and is typically guided by each center's individual expertise. In this paper, we review the various approaches to targeting and programming for OCD DBS. We also review the clinical experience for each proposed target and discuss the relevant neuroanatomy. ⋯ DBS remains an experimental treatment for medication refractory OCD. Target selection and programming paradigms are not yet standardized, though an improved understanding of the relationship between the DBS lead and the surrounding neuroanatomic structures will aid in the selection of targets and the approach to programming. We propose to form a registry to track OCD DBS cases for future clinical study design.
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The objective of this narrative review is to discuss the clinical implications of position-related changes in spinal cord stimulation and technological improvements to better meet patient needs. ⋯ A new type of spinal cord stimulation system that incorporates accelerometer technology to automatically adjust stimulation amplitude based on patient position may better meet patient analgesic needs and is in early clinical application.
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Multicenter Study
The Italian experience with octopolar perc-paddle leads.
The aim of this study is to evaluate the efficacy of spinal cord stimulation using octopolar perc-paddle leads (S-Series, St. Jude Medical, St. Paul, MN, USA) introduced percutaneously with St. Jude Medical's Epiducer Lead Delivery System in patients suffering from low back and leg pain. ⋯ The possibility of using a percutaneous paddle lead, reducing the surgical aggressiveness but taking advantage of a different electric field and a better recruitment of the fibers of the lumbar region, has allowed pain therapists to be more effective in the treatment of these patients. The use of this device system suggests that the percutaneous paddle placement is safe and effective.
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This study aims to review some of the basic principles of extracellular electrical stimulation used in spinal cord stimulation therapy for intractable pain. ⋯ A better understanding of the interaction between electric fields and the targeted neural elements may guide the selection of stimulation parameters in contemporary neurostimulators and lead to continuing advances in engineering solutions for therapeutic spinal cord stimulation.
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This study aims to review the current state of spinal cord stimulation for the treatment of chronic pain associated with failed back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS) and to describe intraspinal targets and stimulation parameters, patient selection, therapy cost-effectiveness, and strategies to improve outcomes. ⋯ Innovation in spinal cord stimulation therapy has intensified with numerous new technical capabilities, safety advances, and novel stimulation targets. This progress holds hope for the many sufferers of chronic pain.