Neurological research
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An increasing number of patients are suffering from angina pectoris that is chronically refractory to standard anti-ischemic treatment such as pharmacological and surgical strategies. To improve the quality of life of these severely disabled patients, without adversely affecting their prognosis, a number of adjunct therapies are available. One of the most promising appears to be spinal cord stimulation. We will review the literature and discuss the efficacy, safety and mechanisms of neuromodulation as an adjuvant therapy for chronic refractory angina pectoris.
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Electrical stimulation of selected peripheral nerves for treatment of intractable pain has been used inconsistently over the past 30 years due to difficulties in clarifying appropriate indications, utilizing approved device technology, and standardizing the surgical techniques. Circumferential electrodes treating mononeuropathies have given way to paddle electrode techniques and, most recently, the application of percutaneous wire electrode methods will allow for minimally invasive peripheral nerve stimulation for certain intractable CRPS and other painful monoeuropathies.
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Neurological research · Apr 2000
ReviewA neuromodulation strategy for rational therapy of complex brain injury states.
We review initial efforts at neuromodulation in the vegetative state and organize several aspects of recent studies of the underlying neurobiology of catastrophic brain injuries. An innovative strategy for patient and target selection for neuromodulation of impaired cognitive function is outlined. Scientific and ethical issues that will attend future efforts to appropriately risk-stratify patients and initiate interventions with therapeutic intent are considered.
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The understanding of the mode of action of spinal cord stimulation (SCS) as treatment of neuropathic pain is still fragmentary. SCS evolved from the gate-control theory postulating a spinal modulation of noxious inflow, but there is little evidence that SCS influences nociceptive pain; pain relief in peripheral vascular disease and angina pectoris is presumably secondary to other SCS effects. In man, SCS may effectively abolish both continuous and evoked pain (tactile/thermal allodynia) whereas induced, acute nociceptive pain is unaffected. ⋯ Preliminary results indicate that gabapentin may have a similar effect. GABAergic and adenosine-related mechanisms conceivably represent only examples of a number of putative receptor systems involved in SCS. Clinical trials have been initiated exploring the possibility to improve the efficacy of SCS by concomitant pharmacotherapy.
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Spinal cord stimulation (SCS) has been available for about 30 years, but only in the past five years has it met with widespread acceptance and recognition by the medical community. Traditionally performed by neurosurgeons, SCS is being increasingly utilized by anesthesiologists, orthopedic surgeons and physiatrists. Pain management continues to be the most widespread application of SCS. ⋯ This has increased greatly the efficacy, safety and reliability of the modality. In the future, SCS will undoubtedly move several steps up in the treatment ladder of chronic pain conditions, while new applications will be discovered. The future of neural implantable technologies is bright, with an increasingly important role in the medical management of chronic conditions affecting the nervous system.