Neuromodulation : journal of the International Neuromodulation Society
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Background. Initially developed to excite peripheral nerves, magnetic stimulation was quickly recognized as a valuable tool to noninvasively activate the cerebral cortex. The subsequent discovery that repetitive transcranial magnetic stimulation (rTMS) could have long-lasting effects on cortical excitability spawned a broad interest in the use of this technique as a new therapeutic method in a variety of neuropsychiatric disorders. Although the current outcomes from initial trials include some conflicting results, initial evidence supports that rTMS might have a therapeutic value in different neurologic conditions. ⋯ Lastly, only two randomized, sham-controlled studies have been performed for epilepsy; although evidence indicates rTMS may reduce seizure frequency in patients with neocortical foci, more research is needed to confirm these initial findings. Conclusions. There is mounting evidence for the efficacy of rTMS in the short-term treatment of certain neurologic conditions. More long-term research is needed in order to properly evaluate the effects of this method in a clinical setting.
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Background. Patients with unstable angina pectoris may become refractory to conventional therapies. Electrical neurostimulation with transcutaneous electrical stimulation and/or spinal cord stimulation has been shown to be effective for patients with refractory unstable angina pectoris in hospital settings. Our aim was to investigate the effects of electrical neurostimulation on outcomes of unstable angina after hospital discharge, in terms of hospital re-admission rates and long-term survival analysis. ⋯ The combined mortality and (re)infarction rate after one-year follow-up was 14%. Conclusion. The results of this observational study show long-term beneficial effects of electrical neurostimulation in a population of patients with unstable refractory angina. Therefore, electrical neurostimulation should be considered as a beneficial treatment for patients with unstable angina pectoris, refractory to conventional therapies.
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Objective. We studied long-term clinical efficacy of sacral neuromodulation (SNM) therapy in patients with refractory urgency incontinence (UI), urgency/frequency (UF) and voiding difficulty (VD), together with urodynamic data at baseline and six months postimplant. Materials and Methods. Twenty-two patients were implanted with a neurostimulator after a positive response to a percutaneous nerve evaluation test defined as a greater than 50% improvement in symptoms. Results. At five-year follow-up, the number of incontinent episodes and pad usage per day decreased significantly in 10 out of 15 UI patients. ⋯ Mean first sensation of filling at the six-month urodynamic investigation for the UI and UF patients increased from 78 to 241 mL and 141 to 232 mL, respectively, and the maximum bladder capacity increased from 292 to 352 mL and 223 to 318 mL, respectively. Five of 22 patients underwent device explant and one patient still has an inactive stimulator implanted. Conclusion. SNM is an effective treatment modality that offers sustained clinical benefit in the majority of patients with refractory UI, UF, and VD that do not respond to other, more conservative therapies.
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Objective. This case report presents an application of peripheral nerve stimulation to a patient with intractable postherpetic neuralgia that conventional treatment failed to ameliorate. Methods. The patient underwent an uneventful peripheral nerve stimulator trial with placement of two temporal eight-electrode percutaneous leads (Octrode leads, Advanced Neuromodulation Systems, Plano, TX, USA) into the right subscapular and right paraspinal area of the upper thoracic region. ⋯ Peripheral nerve stimulation offers an alternative treatment option for intractable pain associated with postherpetic neuralgia, especially for elderly patients where treatment options are limited due to existing comorbidities. Further studies are warranted.
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Objective. To determine the stability of ziconotide-clonidine hydrochloride admixtures with and without morphine sulfate during simulated intrathecal infusion under laboratory conditions at 37°. Materials and Methods. Admixtures of ziconotide (25 µg/mL) and clonidine hydrochloride (2 mg/mL) with and without morphine sulfate (35 mg/mL) were stored in Medtronic SynchroMed® II pumps at 37°. Pumps were sampled immediately after filling and at four additional time points over the course of 28 (ziconotide-clonidine hydrochloride admixture) or 20 (ziconotide-clonidine hydrochloride-morphine sulfate admixture) days. ⋯ When compounded with both clonidine and morphine, ziconotide and clonidine concentrations declined; statistical evaluation indicated that the ziconotide concentration was 70% of initial after 20 days, and that clonidine would remain 90% stable for 42 days. Morphine was stable in the presence of ziconotide and clonidine. Conclusions. A ziconotide-clonidine admixture was 90% stable for 60 days (extrapolated), and a ziconotide-clonidine-morphine admixture was 70% stable for 20 days.