Neuromodulation : journal of the International Neuromodulation Society
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Objectives The objective of this paper is to report the clinical protocols that we have developed and used for titrating constant flow implantable pumps to an effective dose in de novo pain and spasticity pump patients and, thereby, highlight the similarities and differences in our techniques. As a group, we have implanted over 1600 pumps and currently manage over 800 pump patients. ⋯ This compares favorably to reports of programmable pumps requiring 5.3 ± 3.5 adjustments over a period of 3-6 months to reach an effective dose. Conclusions A comparison of our protocols shows that after an initial stabilization period, dose adjustments can be made at subsequent refill, that it is not necessary to adjust the dose by prematurely emptying and filling constant flow pumps, and that it is not necessary to adjust the dose as often as has been done with programmable pumps.
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Sjögren syndrome is a chronic autoimmune disease. This disease mainly involves salivary and lacrimal glands, although it may also involve the musculoskeletal, respiratory, gastrointestinal, renal, hepato-biliary, hematological, neurological, vascular, or both systems. Small vessel disease may appear in up to 30% of the cases. ⋯ In our pain unit, a percutaneous posterior spinal cord stimulator (SCS) was placed. SCS clinically reduced her pain by 90% and helped to improve her quality of life and significantly reduced her intake of analgesics. We conclude spinal cord stimulation may be a good alternative to conservative therapies in patients with vasculitis of Sjögren syndrome.
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Objective To compare the technical performance of different percutaneous lead types for spinal cord stimulation. Methods Using the ut-scs software (University of Twente's spinal cord stimulation), lead models having similar characteristics such as the 3487A PISCES-Quad (PQ), 3887 PISCES-Quad Compact (PC), 3888 PISCES-Quad Plus (PP) (Medtronic Inc., Minneapolis, MN), and the AB SC2108 (AB) (Advanced Bionics Corp., Valencia, CA) were simulated in monopolar and tripolar (guarded cathode) combinations on a single lead, placed just outside the dorsal dura mater and both centered on the spinal cord midline, and at 1 mm lateral. The influence of displacing a lead dorsally in the epidural fat was examined as well. ⋯ Conclusions Complex pain syndromes are treated best with lead having a small contact spacing, being programmed as a tripole (guarded cathode) and centered on the spinal cord midline just outside the dura mater. This is because dorsal column fiber recruitment is more extensive than with any other combinations, including dual leads. Improved recruitment of dorsal column fibers is accompanied by increased energy consumption.
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In recent years, part of the muscle resistance in spastic patients has been explained by changes in the elastic properties of muscles. However, the adaptive spinal mechanisms responsible for the exaggeration of stretch reflex activity also contribute to muscle stiffness. The available data suggest that no single spinal mechanism is responsible for the development of spasticity but that failure of different spinal inhibitory mechanisms (reciprocal IA inhibition, presynaptic inhibition, IB inhibition, recurrent inhibition) are involved in different patients depending on the site of lesion and the etiology of the spastic symptoms. ⋯ This is ensured by increasing transmission in several spinal inhibitory pathways. In spastic patients, this control is inadequate, and therefore stretch reflexes in antagonist muscles are easily evoked at the beginning of voluntary movements or in the transition from flexor to extensor muscle activity. This problem is contradicted by the fact that antispastic therapy to improve voluntary movements should be directed.
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The objective of this study was to evaluate the long-term infection risk from refilling intrathecal drug delivery devices. We studied 25 patients (14 females and 11 males) with intrathecal infusion pumps placed for spasticity (23 patients) and chronic pain (two patients). In this study group there were 890 refill procedures (mean 35.6 ± 20.5; range 8-72 times) performed on an outpatient basis by four different physicians. ⋯ All cultures, in all pumps, were negative for aerobic and anaerobic bacteria. We conclude that periodic refills of intrathecal implanted pumps do not seem to be a risk factor for infection if standard sterile refill procedures are performed. In this study, it was clear that comorbid infections from other parts of the body do not present as a risk for device contamination.