Neuromodulation : journal of the International Neuromodulation Society
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Spinal cord stimulation has been extensively utilized in the treatment of conditions including complex regional pain syndrome, ischemic limb pain, failed back surgery syndrome, and angina pectoris. Recognized complications include infection, dural tap, and electrode movement. We report the case of a patient who experienced a sensation of extremely enhanced stimulation in the area covered by the spinal cord stimulator while in the vicinity of a high-tension electricity substation. Full resolution of symptoms occurred when the spinal cord stimulator was switched off, indicating that active stimulators may be susceptible to the effects of external electrical fields.
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This paper presents a critical review of brain-computer interfaces (BCIs) and their potential for neuroprosthetic applications. Summaries are provided for the command interface requirements of hand grasp, multijoint, and lower extremity neuroprostheses, and the characteristics of various BCIs are discussed in relation to these requirements. The review highlights the current limitations of BCIs and areas of research that need to be addressed to enhance BCI-FES integration.
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The objective of this study was to evaluate the stimulation responses on each channel of an implantable two-channel stimulator that stimulates the peroneal nerve branches innervating the muscles for dorsiflexion and eversion movements. Currently five Dutch patients and five English patients have been implanted with this system. Isometric ankle torque measurements were carried out in the patient with the longest follow-up period (1 y). ⋯ Eversion moments are determined mainly by channel 2 and to a lesser extent by channel 1. Both channels determined abduction/adduction moments. We conclude that stimulation responses in both dorsiflexion and eversion direction can be set individually and with great accuracy and are reproducible over a prolonged period.
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The objective of this study was to investigate di-acetyl morphine as an alternative opioid analgesic for use in implanted intrathecal drug delivery systems because of its greater solubility through evaluation of its stability in vivo and analgesic efficacy in the period between pump refills. Contents of intrathecal drug delivery system reservoirs (SynchroMed, Medtronic, Inc., Minneapolis, MN) that had been filled with di-acetyl morphine dissolved in saline (21), bupivacaine (9), or in both bupivacaine and clonidine (19) were sampled in vivo between 1 and 125 days after refill. The samples were assayed for di-acetyl morphine and its breakdown products by micellar electrokinetic capillary chromatography. ⋯ Mono-acetyl morphine decayed to morphine with a maxima estimated at 125 days. There was no clinically significant change in average weekly pain scores for up to ten weeks in either group (range, 2.5 to 2.8 for diamorphine and 2.7 to 3.1 for morphine) (2-way repeated ANOVA, F(9,220) = 0.98, n.s.). We conclude that di-acetyl morphine and its breakdown products, 6 mono-acetyl morphine and morphine, provide similar analgesia to morphine alone when administered by intrathecal pump for a period of at least ten weeks and may be a useful alternative when a more soluble agent is favored.
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Baseline and 12-month follow-up data from a prospective controlled study on patients treated with SCS for neuropathic limb pain (NLP) are analyzed critically. The outcome on pain, use of medication, and quality of life are reported and compared with the literature. Patients enrolled from April 1999 to December 2001 were part of a quality system study by the Dutch Working Group on Neuromodulation. ⋯ The difference between baseline and 12-m follow-up is statistically significant for all measures. We conclude that the outcome measures indicate that SCS significantly reduces pain and enhances quality of life in patients having NLP not responding to other adjuvant therapy. Recommendations are proposed to make studies more comparable.