Neuromodulation : journal of the International Neuromodulation Society
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This report outlines a case of refractory insomnia temporally related to migration of cervical spinal cord stimulator leads. To our knowledge this association is previously unreported. ⋯ A brief review of insomnia and its complex relationship to chronic pain is presented. We hope that this case will stimulate further discussion and possibly bring to light new insights into spinal cord stimulation and insomnia and alert others to this possible clinical association of symptoms.
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The objective of this study was to compare the technical performance of laminectomy and percutaneous spinal cord stimulation leads with similar contact spacing by computer modeling. Monopolar and tripolar (guarded cathode) stimulation with both lead types in a low-thoracic spine model was simulated using UT-SCS software. Dorsal column and dorsal root fiber thresholds were calculated as well as the area of recruited fibers in the dorsal columns, the rostrocaudal span of recruited dorsal root fibers and the energy consumption at discomfort threshold. ⋯ A deterioration of all performance parameters is predicted when a percutaneous lead is placed more dorsally in the epidural tissue. When positioned next to the dura mater, a percutaneous lead has a similar performance (fiber recruitment in the dorsal columns and the dorsal roots) as a laminectomy lead with similar contact spacing, but substantially higher energy consumption. The superior clinical performance of the laminectomy lead is most probably due to the difference in volume and insertion technique of the two lead types.
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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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We had shown in our previous research that the stability assessment and control are essential for generation of faster and more energy efficient functional electrical stimulation (FES) and/or crutch-assisted gait. The objective of our recent research work has been to design a wearable and portable system for gait stability analysis with online capabilities that is also applicable to crutch-assisted gait modes. The developed wearable stability assessment system for as yet only biped gait consists of foot switches and goniometers attached to the leg joints. ⋯ The wearable system was tested on five healthy subjects and one above-knee amputee. It proved to be reasonably accurate if compared to the classical, motion analysis system based method. However, additional work is required to port the system to the FES assisted and/or crutch assisted gait.
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We report on the use of a new percutaneous technique for peripheral nerve stimulation (PNS) treatment of chronic pain. A 56-year-old woman was diagnosed with algodystrophic syndrome, now called Complex Regional Pain Syndrome, type 2 (CRPS2), due to a lesion of the right medial nerve despite surgical revascularization, angioplasty and stent insertion. ⋯ After one year of follow-up, the patient was still experiencing good pain relief. We conclude that this novel percutaneous PNS technique offers the advantage of being a minimally invasive approach that can be easily adopted for the management of chronic pain.