Neuromodulation : journal of the International Neuromodulation Society
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We performed bilateral PNE (peripheral nerve evaluation) tests to identify which diagnostic groups are the most likely to profit from bilateral sacral neuromodulation since the results published so far have been obtained exclusively on the basis of unilateral sacral root stimulation. In contrast to the original unilateral technique, we performed bilateral PNE test stimulation in 62 patients (36 with urinary retention symptoms and 26 with overactive detrusor; 21 with idiopathic and 41 with neurogenic bladder dysfunction) over 3-4 days. We used an advanced electrode, model #3057 (Medtronic, Inc. ⋯ Of these, 27 suffered from neurogenic bladder dysfunction; in five cases the cause was idiopathic. We conclude that bilateral PNE test stimulation with side-specific amplitude adjustment and the use of advanced PNE electrodes led to a positive PNE result in 51.6% of the patients, which is a substantially increased response rate compared to previous studies. Of the diagnostics groups, the group with neurogenic bladder dysfunctions showed the highest response rate.
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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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In this article we will discuss the treatment of Occipital Neuralgia (ON) and Transformed Migraine (TM) using a paddle style surgical stimulator lead. A paddle style electrode may have advantages to the cylindrical style in reducing migrations from cervical tension or anchor dislodgement. It should be considered in refractory "neuropathic" cervicocranial syndromes such as ON and TM before moving on to more aggressive surgical interventions.
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Drop foot stimulators today operate open loop with a trapezoidal stimulation profile. The traditionally applied profile originated as much from technological constraints as suitability for the physical pathology. It was proposed that by increasing the stimulation intensity during the loading response phase of gait, the ankle angle trajectory would become closer to that of normal gait and a more efficient heel rocker would be introduced. ⋯ Statistical analysis revealed that this was significant at p = 0.05 level. Increasing stimulation intensity during loading response prolongs the heel rocker. This is an essential mechanism for advancement over the stance limb and providing shock absorption during weight acceptance, thus, we conclude that this improves the gait pattern of the drop foot sufferer.