Neuromodulation : journal of the International Neuromodulation Society
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Objective. To determine the effect of electrical stimulation of hamstrings and L3/4 dermatome on the swing phase of gait. Materials and Methods. Five subjects with incomplete spinal cord injury (SCI) with spasticity were included. Two electrical stimulation methods were investigated, i.e., hamstrings and L3/4 dermatome stimulation. ⋯ Conclusion. It was concluded that hamstrings stimulation during the swing phase results in a reduction of the hip flexion in all five SCI subjects. The H/M ratio of the vastus lateralis was normalized using hamstrings stimulation in one of three subjects. Stimulation of the L3/4 dermatome provides no significant changes in gait performance, but in one subject the H/M ratio increased.
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Ziconotide is an N-type calcium channel (NCC) blocking conopeptide, acting primarily at the NCC-rich dorsal horn. Reported here is an early experience with intrathecal ziconotide in a 55-year-old man with chronic pain resulting from failed back surgery. ⋯ The dosing regimen, onset and resolution of adverse events, and improvement on the primary efficacy measure, the Visual Analog Scale of Pain Intensity, are discussed. Overall, the patient responded positively to ziconotide.
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Objective. We assessed the effects of bilateral extradural motor cortex stimulation (ECS) to areas of maximal functional MRI (fMRI) activation in a male patient with plegic stroke by using multiple sequential 1-month blocks of stimulation with single-blind design in a tertiary referral hospital. Measurements. Assessments included the European Stroke Scale, Fugl-Meyer scale, and Barthel Index at baseline and at the end of each stimulation period, in a blinded fashion, over 1 year, and GABA ligand SPECT (single photon emission computed tomography) pre- and post-stimulation. ⋯ Contralateral stimulation had mixed effects to the affected arm and leg. Conclusion. ECS may modestly boost rehabilitation effects in a chronic stroke patient, with a differential effect of ipsilateral vs. contralateral stimulation.
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Use of multicontact electrodes and programmable implanted pulse generators has increased the efficacy of spinal cord stimulation for pain. Some investigators find dual column electrodes advantageous for difficult-to-treat axial low back pain, but we have reported significantly improved measures with a single percutaneous midline electrode vs. dual percutaneous electrodes and even better results with an insulated, 1 × 4, midline electrode. ⋯ Compared with the 2 × 8, the 1 × 4 resulted in marginally better patient-rated (109%, p = 0.06) and computer-calculated pain/paresthesia overlap (107%, p = 0.17); higher scaled amplitude to cover the low back (106%, NS); and significantly lower voltage (78%, p = 0.0004), increased extraneous coverage (141%, p = 0.0000), and improved symmetry (25%, p = 0.001). Thus, we observed no significant technical advantage for the insulated 2 × 8 in treating axial low back pain.