Neuromodulation : journal of the International Neuromodulation Society
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The objective of this study is to investigate the association between intrathecal drug, flow rate, drug concentration, and drug dose with the formation of intrathecal inflammatory masses. ⋯ This is the first detailed study showing an association of diamorphine with granulomas. This study supports the previous finding of intrathecal opioid dose being a risk factor for intrathecal granulomas and clonidine being protective. In addition we have found that the yearly increase in opioid dose is a risk factor for granulomas and could serve as an indicator for closer surveillance.
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Spinal cord stimulation with percutaneous leads after loss of coverage with implanted surgical lead.
This case report presents an application of percutaneous spinal cord stimulation to a patient with complex regional pain syndrome type 1 involving the bilateral lower extremities with loss of coverage with surgical lead. ⋯ Percutaneous spinal cord stimulation offers an alternative treatment option for the patient with loss of coverage with surgical lead.
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The aim of this study was to investigate and compare effective parameters for gastric electrical stimulation (GES) to modulate gastric muscle functions in different species. ⋯ There is no significant difference in stimulation parameters when GES is applied to alter gastric slow waves in different animal models. Furthermore, the effective parameters for GES to alter slow waves are similar between the humans and various animal models. These findings suggest that stimulation parameters obtained from animal studies are applicable in humans.
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Occipital nerve stimulation (ONS) is a peripheral nerve stimulation (PNS) technique that has been used with success in the management of intractable chronic daily headaches (CDHs) and occipital neuralgia (ON). The technique involves the placement of a stimulating surgical or percutaneous electrode over the occipital nerves within the subcutaneous tissues at the skull base. Until recently, procedures involving the occipital nerves were based on identifying bony or arterial landmarks with direct palpation or fluoroscopy. Although universally accepted as an imaging technique, fluoroscopy does not provide real-time imaging of the occipital nerves or vessels. Furthermore, therapeutic efficacy of ONS is directly related to the ability of the stimulating electrode to produce peripheral nerve dermatomal paresthesia, emphasizing the need for precision placement. ⋯ Ultrasound imaging has been used increasingly for peripheral nerve blockade in surgical anesthesia and in chronic pain management as it allows real-time localization of both nervous and vascular structures (color flow Doppler) and, thus, a method for increasing blockade precision and safety. As an adjunct to ONS, the position of the introducer needles and electrodes can be visualized in relation to the occipital nerves and vasculature. This reproducible positioning allows accurate depth of placement (assuring production of the prerequisite PNS dermatomal paresthesia required for ONS efficacy) and limits the risk of injury to the occipital artery or nerve(s). In this case series, ultrasonography provided real-time, safe, and reliable placement of ONS electrodes. It also allowed identification of nervous and vascular structures unable to be seen with fluoroscopy, The portable nature of modern ultrasound machines, together with an ever improving pixelation of the Doppler color flow images/real-time measurements, and a lack of radiation exposure make this technology an attractive emerging modality in the field of Neuromodulation.
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Subthalamic nucleus deep brain stimulation has become a useful tool in effectively treating severe Parkinson's disease. ⋯ He had excellent recovery of HZ lesions and related pain after specific antiviral therapy. The importance of a correct diagnosis of this unusual complication is outlined in order to minimize the risk of debilitating chronic HZ-associated pain.