Neuromodulation : journal of the International Neuromodulation Society
-
Brain-gut axis represents a complex reflex circuit that integrates the communication between cortex and the digestive system. Disturbances of the neuromodulatory processes in the brain-gut axis generate functional digestive disorders mainly centered on the pain symptoms and motility disorders. ⋯ The efficacy of the methods using electrostimulation is dependent on the parameters of the physical system used: amplitude, frequency, burst time of the electrical current and also the positioning of the electrodes. While pharmacological interventions are largely used at the moment, neuromodulatory interventions involving electrical stimulation showed clinical efficacy in research trials and have promise.
-
Introduction. Spinal cord stimulation is a widely used treatment modality for chronic pain, especially failed back surgery syndrome. However, migration of the lead or leads, coverage of axial pain, and the selection of an optimal system configuration continue to be subjects for serious debate. Materials and Methods. A retrospective study of the use of the method of "midline anchoring" of a single Octrode® lead, in 54 patients with low back and/or lower extremity pain, was done to assess the efficacy of this technique. ⋯ A "guarded cathode" array was used in the vast majority of the cases, with a relatively low position of the lead. Conclusions. "Midline anchoring" of the spinal cord stimulation lead is an effective implantation technique, allowing the use of a single, percutaneous, Octrode® lead, while preventing lead migration and allowing capture of axial and lower extremity pain, unilateral as well as bilateral. This study revives the idea of a single lead as a possible optimal configuration.
-
Background. Survival rates after acute brain injury have improved, but persistent coma continues to be a major clinical problem. Objective. We analyzed changes in cerebral perfusion after treatment with right median nerve stimulation (MNS) or MNS with hyperbaric oxygen (MNS + HBO), two noninvasive therapies that have shown promise in this patient population. Methods. During the period this series of patients was treated, decision-makers were offered the option of MNS for six weeks (continued for maximum of three months if patient responded) or MNS + HBO (HBO given during the first six weeks of MNS). ⋯ Multivariate analysis indicated that MNS + HBO was significantly related to increased cerebral perfusion compared with MNS alone (odds ratio = 8.44, 95% confidence intervals: 1.34-52.97). Conclusion. The combination of MNS + HBO is more likely to result in improved cerebral perfusion than MNS alone. Randomized prospective trials evaluating MNS, especially with adjunct HBO, are needed to clarify clinical indications and most effective treatment schemes.
-
Intrathecal drug delivery device infection with Mycobacterium fortuitum has not been reported previously. We report a case of an implanted baclofen pump infection and associated mycobacterium meningitis due to Mycobacterium fortuitum. The entire pump system was removed and the patient was treated successfully with a prolonged regimen of antibiotics.
-
Objectives. The probability of success with spinal cord stimulation (SCS) depends largely on appropriate patient selection. Here, we have assessed the predictive value of pain etiology as it relates to pain relief with SCS as part of a prospective multicenter clinical trial. Methods. Sixty-five subjects with chronic and intractable pain tested an epidural SCS system. ⋯ No predictive value of pain etiology was observed. Conclusions. Spinal cord stimulation is an effective therapy for neuropathic pain arising from a variety of causes. Failed back surgery syndrome, complex regional pain syndrome, and pain of other etiologies responded equally well to SCS.