Neuromodulation : journal of the International Neuromodulation Society
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Objectives. In spinal cord stimulation (SCS) therapy, limited pain relief during the temporary trial period is generally considered to be predictive of poor long-term benefit. To validate or refute this perception, the long-term outcomes of subjects who reported less than 50% pain relief during a temporary SCS trial were examined. Materials and Methods. Twelve subjects with intractable pain underwent implantation of trial SCS systems. ⋯ SCS appears to be a viable treatment option for patients who fail trials, raising some doubt as to the predictive sensitivity and specificity of the trial period. Thus, although outcome of a temporary trial period may be suggestive of later efficacy with SCS, it may not be the sole predictor of success. Alternatively, the arbitrary benchmark of 50% pain relief that is typically used to define the success of a temporary trial may be too stringent and unreliable.
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Objective. This study aims to assess long-term follow-up of efficacy and quality of life for 34 geriatric patients (10 men, 24 women, mean age 72.3 ± 11.6 years) with intrathecal (IT) drug delivery systems (IDDS), implanted between 1994 and 2002, for the treatment of severe noncancer chronic pain. Methods. Patients equal to or older than 64 years, who had no pain relief after administration of a placebo injection (subcutaneous saline), and who responded positively to an IT trial (morphine and bupivacaine at low doses) with pain relief greater 70% without intolerable adverse effects were included into our study. Clinical assessment forms and questionnaires assessing pain intensity, adverse events, complications, concommitent use of analgesics, and doses of IT drugs administered were filled out by our patients prior to and after IT drug delivery implantation. ⋯ Side-effects of therapy were reported by 50% of the patients, the most frequent being constipation (34.4%), drowsiness (21.9%), nausea (21.9%), and urinary retention (18.8%). No side-effects of therapy resulted in removal of the IDDS. Conclusion. The use of IT drug delivery through IDDS for the treatment of non-cancer- and cancer-related pain in geriatric patients is successful.
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Introduction. Subcutaneous, occipital nerve stimulation has emerged as a potentially effective treatment modality for patients with refractory headache disorders. The purpose of this study was to document occipital stimulation characteristics in 10 patients status post implantation of an occipital nerve stimulator. Methods. All possible electrode combinations were tested in each patient, and sensory threshold, discomfort threshold, and associated paresthesia maps were noted. ⋯ The associated paresthesia maps demonstrated that most patients felt stimulation as expected in the occipital regions; trigeminal distribution stimulation occurred but only in a minority of patients. Half of the patients experienced ≥ 50% reduction in headache frequency or severity. Conclusions. These results should aid in clinical decision-making and manufacturing requirements for this modality; larger, prospective studies will be needed to determine the safety and efficacy of stimulation techniques for headache disorders.
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Objectives. This study aims to explore the relationship among the levels of interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α) produced by cortical glial cells, and identify any correlation between neuromodulation and brain lateralization. Material and Methods. Cortical glial cells from Balb/c neonatal mice were cultured in vitro and the effects of treating or not treating these cells from both hemispheres with lipopolysaccharide (LPS) (10 µg/mL) for 24 hours were tested. The levels of IL-1β, IL-6, and TNF-α in left and right cortical glial cell cultures and the time course of any changes were compared. ⋯ Conclusion. Lipopolysaccharide increases cytokine production in both cerebral cortices, three cytokines have different expression time course within 72 hours, but only IL-1β in right cortex and IL-6 releasing is time-dependent, and more so on the right side than the left in 24 hours. We proposed the increased immunosuppressive activity of right cortex was due to the higher expression of IL-1β, TNF-α, and IL-6 in the right cortical glial cells, whereas there would be more immunoenhancement activity of the left cortex due to the lower levels of these three kinds of cytokines, this being a less pronounced effect than that on the right side. One of the reasons for the brain lateralization may be the different production of cytokines by the cortical glial cells on either side.
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Objectives. Sacral root stimulation (SRS) is a technique to restore the idiopathic overactive bladder (IOB). However, its mechanism of action is yet to be elucidated. Hence, we studied whether SRS restored IOB through the mechanism of spinal neuromodulation. ⋯ This spinal excitability decreased and bladder function improved after SRS, an effect that outlasted actual stimulation by at least 30 min. Conclusions. Our results showed that spinal excitability was increased in response to somatic nociceptive afferents in IOB patients. SRS restored bladder function, at least, in part, through spinal neuromodulation.