Neuromodulation : journal of the International Neuromodulation Society
-
We present data collected from a multicenter study using a new neurostimulation system. This new system uses a current-shifting programming technique for spinal cord stimulation. The system maintains a continuous, suprathreshold stimulation field while adjusting the distribution of anodic and cathodic current among contacts along a multi-contact array. ⋯ This multicenter study evaluated the performance of the CEFA technique. The results of the study showed that paresthesia coverage could be shifted in real-time to different regions on the patient's body in a comfortable fashion, with the patient always feeling paresthesia during the adjustment process. The results of the study also show that the process was time-efficient: intraoperatively, the median time to assess 71 combinations on a single 8-contact lead across 18 patients was 4.1 (3.6-5.0) minutes.
-
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.
-
This study investigated the activation dynamics of electrical stimulation-evoked muscle contractions performed by individuals with spinal cord injury (SCI). The purpose was to determine whether electrical stimulation (ES) firing patterns during cycling exercise should be altered in response to fatigue-induced changes in the time taken for force to rise and fall with ES. Seven individuals with SCI performed isometric contractions and pedaled a motorized cycle ergometer with stimulation applied to the quadriceps muscles. ⋯ Cycling power output fell approximately 50% during the five minutes of exercise, however, there was no change in the time taken for torque to rise or fall. The magnitude of ES-evoked muscle torques decline substantially with fatigue, however, the overall pattern of torque production remained relatively unchanged. These results suggest there is no need to alter stimulation firing patterns to accommodate fatigue during ES-evoked exercise.
-
Ever since its initial development in the late 1960s, spinal cord stimulation (SCS) has been used to treat a number of painful conditions. European practice, in contrast to that in North America, has used peripheral arterial disease (PAD) as a primary indication for SCS. First employed in patients with PAD in 1976, SCS was shown by Cook et al. to heal chronic leg ulcers. ⋯ Recent randomized prospective studies have questioned some of the conclusions from these preceding retrospective data. In addition to the questions related to outcomes, theories regarding exact mechanisms by which SCS improves circulatory parameters remain unclear. A thorough Medline literature review on the subject of SCS in peripheral vascular disease was thus undertaken to attempt to clarify questions regarding which patients are best suited for SCS therapy, pinpoint possible methodologic flaws in previous studies, and to review the background, outcomes, mechanisms of action, complications, and alternatives for SCS in patients with PAD.