Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialDiaphragm pacing with a spinal cord stimulator: current state and future directions.
Diaphragm pacing with electrical stimulation of the phrenic nerve is an established treatment for central hypoventilation syndrome. The device, however, is not readily available. We tested the same spinal cord stimulator we use for pain control in phrenic nerve stimulation. ⋯ The amplitude of the output was adjusted to obtain sufficient tidal volume and to maintain PaCO2 at around 40 mm Hg. During a follow-up period up to four years, stable and sufficient ventilation was observed in all patients without any complications. Although further long follow-up is necessary, diaphragm pacing with the spinal cord stimulator is feasible and effective for the treatment of the central hypoventilation syndrome.
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialDrug-enhanced spinal stimulation for pain: a new strategy.
Neuropathic pain is notoriously difficult to manage and only a few classes of drugs may provide adequate benefits. Thus, in many cases spinal cord stimulation (SCS) is considered; however, in this group of patients, between 30-50% of the cases offered a percutaneous SCS trial may fail to obtain a satisfactory effect. Additionally, a certain number of patients with a good initial effect, report that after a period the benefits are reduced necessitating additional peroral drug therapy. ⋯ However, in a group of three patients with peroral baclofen therapy and SCS, complaints of side-effects were common and this therapy was terminated. Informal reports from collegues support the negative experience with additional peroral baclofen. In conclusion, in patients with neuropathic pain demonstrating inadequate response to SCS (small VAS reduction; short duration) a trial of intrathecal baclofen in combination with SCS may be warranted.
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialSpinal cord stimulation for the treatment of chronic non-malignant pain.
Over the past four decades, techniques and devices for spinal cord stimulation have undergone considerable refinement. Currently, percutaneous implantable electrodes are placed in the epidural space and a low-frequency electrical current is used to modify the transmission of chronic pain signals in the dorsal columns of the spinal cord. Before permanent implantation, the spinal cord stimulation will be examined during a test phase to determine its analgesic effect and tolerability. ⋯ At the end of the follow-up period, 50% of the patients were in a better psychological status and 86% of the patients reported an improvement in activities of their daily living and a reduction in the use of analgesic medication. Ninety percent of the patients stated that they would go through the procedure again for the same result. The findings of the present study indicate that spinal cord stimulation is an efficacious therapy for the treatment of chronic non-malignant pain.
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialFactors affecting spinal cord stimulation outcome in chronic benign pain with suggestions to improve success rate.
For patient selection, psychological factors like fear avoidance, depression, secondary gain or refusal to be weaned off narcotics should be avoided. Trial Stimulation is an important tool to reduce the rate of failed permanent implants, and to improve cost-effectiveness. The etiology of pain has a strong influence on the success rate. ⋯ The electrode fracture rate can be reduced by using the paramedian approach, the use of three wing silicone anchor placed immediately at the point of exit of the lead from the deep fascia and avoiding a hard plastic twist lock anchor. The displacements can be reduced by fixing the anchor to the deep fascia firmly, supplemented by the use of silicone glue, and by placing the implantable pulse generator (IPG) in the abdominal wall, instead of the gluteal region. The use of prophylactic antibiotics tends to reduce the infection rate.
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Acta Neurochir. Suppl. · Jan 2007
Case ReportsNeuromodulation of the inferior thalamic peduncle for major depression and obsessive compulsive disorder.
Neuromodulation of the inferior thalamic peduncle is a new surgical treatment for major depression and obsessive-compulsive disorder. The inferior thalamic peduncle is a bundle of fibers connecting the orbito-frontal cortex with the non-specific thalamic system in a small area behind the fornix and anterior to the polar reticular thalamic nucleus. Electrical stimulation elicits characteristic frontal cortical responses (recruiting responses and direct current (DC)-shift) that confirm correct localization of this anatomical structure. ⋯ GAF improved significantly in both cases. The neuropsychological tests battery showed no significant changes except from a reduction in the perseverative response of the obsessive-compulsive patient and better performance in manual praxias of the female depressive patient. Moderate increase in weight (5 kg on average) was observed in both cases.