Neuromodulation : journal of the International Neuromodulation Society
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The objective of this study is to determine the usefulness of single-patient, randomised, controlled trials (N-of-1 trials) in assessing the efficacy of deep brain stimulation (DBS) in neuropathic pain. Seven patients with various causes of intractable neuropathic pain underwent insertion of deep brain stimulating electrodes into the periventricular gray area or ventroposterolateral nucleus of the thalamus. Preoperatively, pain was measured using Visual Analog Scales (VAS) and the McGill Pain Questionnaire (MPQ). ⋯ The results of the N-of-1 trials were most similar to the MPQ scores and showed that three of seven patients could accurately predict whether the DBS was on or off. In the N-of-1 trials, the time between changing the DBS from on to off (or vice versa) had an effect on the results and probably underestimated the efficacy. We conclude that N-of-1 trials are a useful tool for assessing DBS efficacy.
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Irritable Bowel Syndrome (IBS) is a functional gastrointestinal (GI) disorder, characterized by abdominal pain, altered bowel habit (diarrhea and/or constipation), and bloating in the absence of demonstrable organic pathology. It is the most common GI disorder seen in primary care and gastroenterology practices. Conservative therapies for IBS are directed at both pain and correction of altered GI motility. ⋯ Symptoms of IBS cannot be explained entirely by changes in motility alone and may also arise from complex feedback and feed-forward interactions between supraspinal circuits, the spinal cord, and the periphery, in effect, a neuropathic process, that might be amenable to neuromodulation, that is, spinal cord stimulation. We present here a single case report of a patient with IBS who responded positively to SCS after failing all conservative therapies to alleviate or manage her abdominal pain and diarrheal episodes. Our discussion is focused on the reasons why SCS might work in patients with IBS.
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Electric Spinal Cord Stimulation (SCS) in the Treatment of Angina Pectoris: A Cost-Utility Analysis.
For the last 15 years electric spinal cord stimulation (SCS) has been employed in patients with confirmed ischemic heart disease who suffer from refractory angina pectoris despite maximum medical/surgical treatment. The purpose of this investigation was to assess not only the economic consequences of SCS treatment (cost-utility analysis) but also altered quality of life in SCS patients. The retrospective study includes 18 consecutive patients, six women and 12 men, with an average age of 56.5 years (range 50-68), submitted to implantation of a SCS system at Odense University Hospital. ⋯ SCS is a simple treatment for the patient to use. The implantation technique is not more invasive than permanent cardiac pacing. The decisive part of the procedure is the insertion of the electrode and follow-up with support and adjustments of the stimulation.
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The aim of the present study was to investigate the modulation and functional importance of nociceptive withdrawal reflexes elicited from the sole of the foot and recorded from the soleus (SOL) and tibialis anterior (TA) muscles during gait. Cutaneous electrical stimulation delivered at four locations of the sole of the foot was used to elicit the withdrawal reflex. Reflexes were recorded from eight healthy subjects during treadmill walking. ⋯ The TA reflex, expressed as a proportion of the electromyogram during unperturbed gait, was smallest during swing (p < 0.05, compared with stance) whereas the SOL reflex was maximal during swing (p < 0.05, compared with stance). The results suggest that the modulation of the reflex promotes an appropriate withdrawal while preserving balance and continuity of motion. These results may have applications in assisting gait of hemiplegics.