Neuromodulation : journal of the International Neuromodulation Society
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Patients with refractory angina pectoris usually exhaust conventional treatment of ischemic heart disease. They frequently need opioids and still have angina pectoris despite earlier coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). In those cases, treatment strategies including neuromodulation techniques such as transcutaneous electrical neurostimulation (TENS) or spinal cord stimulation (SCS) often are successful. ⋯ This suggests that two electrodes implanted in the epidural space may stabilize each other mechanically. On the other hand the variety of program adjustments is enlarged, due to the additional poles on the second electrode. On the basis of these case reports, we suggest that implantation of a dual electrode SCS-device might be the solution in case of repeated displacement of a single SCS-electrode.
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We investigated the effects of one somatosensory stimulation technique, the cyclic pressure application (CPA), and compared them with the effects of left transcutaneous electrical stimulation (TENS) on the expression of left visuospatial exploration deficits in 13 stroke patients, as assessed by four visuospatial exploration tasks. Four treatment conditions were given: TENS, CPA, TENS + CPA, as well as a placebo condition. For each patient, the intensity of the TENS was determined, based on his/her perception threshold of paresthesia for the electrical impulses. ⋯ Unilateral disturbances in visuospatial exploration, often associated with the neurologic syndrome of hemispatial neglect and more frequently observed after right hemisphere damage, refers to the defective ability of patients with unilateral cerebral lesions to explore the side of space contralateral to the lesion. Many quantifiable tests have been developed to assess the expression of visuomotor exploration. These tests differ substantially in their sensitivity, but the Star Cancellation and Line Bisection tasks are cited as the most sensitive measurements of visuospatial exploration.
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Reliability and ease of use of the Itrel 3 System (Medtronic Inc., Minneapolis, MN) were prospectively assessed over 5 years in patients with a range of pain syndromes (mainly low back and/or leg pain, or ischemic pain due to peripheral vascular disease). The longevity of the implantable pulse generator (IPG) battery, the frequency with which system settings were changed, and the ease of use of the EZ patient programmer were assessed. Data on adverse events, pain relief, and patient satisfaction with therapy were also collected. ⋯ The intensity and duration of pain were reduced significantly and patient satisfaction with therapy was high. We conclude that the Itrel 3 System performed well over 5 years and was easy to use. Its safety and effectiveness for the relief of chronic intractable pain of the trunk or limbs were also confirmed.
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The objective of this report is to describe a surgical technique used successfully when a flat or paddle type spinal cord stimulator electrode cannot be properly positioned via a single laminotomy. Different and innovative surgical techniques useful in placement of spinal cord stimulators and analgesic infusion pump systems have not been well described. ⋯ A dual laminotomy technique can be useful and successful in positioning a flat spinal cord stimulator electrode that cannot be properly positioned via a single laminotomy approach. We report two patients who have been treated successfully with a dual laminotomy technique.
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The objective of this study was to develop a high bit-rate passive method for conveying ENG signals from implants which would work over a wide range of coupling coefficients. A novel method, Passive Phase Shift Modulation, was studied in theory, by simulation, and implemented in the laboratory. A binary signal of 222 kbit/s was passed on a 4-MHz carrier (ratio 1:18) with coil-coil spacings up to 70 mm (coil diameters are 45 and 60 mm) with an addition to the power consumption equivalent to 2 mW in the implant. We conclude that this is a satisfactory method to be used as part an implant for conditional neuromodulation that we are designing.