Neuromodulation : journal of the International Neuromodulation Society
-
Implantation of an intrathecal infusion pump is now accepted as a valuable technique to treat chronic pain. The most frequently reported complications associated with it are catheter fractures or migrations, usually resulting in a recurrence of pain and the onset of withdrawal symptoms. ⋯ The unusual complication of intradural catheter migration responsible for sciatica is presented here. Treatment consisted of catheter replacement, leading to immediate disappearance of the sciatica.
-
Introduction. Since its first application in 1967, numerous case series indicate that spinal cord stimulation (SCS) is an effective treatment for the management of failed back surgery syndrome (FBSS). However, only one randomized controlled trial has demonstrated that SCS provides more effective pain relief than re-operation and conventional medical management. The PROCESS randomized, controlled, multicenter trial aims to assess the clinical effectiveness and cost-effectiveness of SCS when added to conventional medical management compared to conventional medical management alone in patients with FBSS. ⋯ At the 6-month visit, patients will be classified as successful (≥ 50% pain relief in the legs) or unsuccessful (< 50% pain relief in the legs). If the results of the randomized treatment are unsuccessful, patients can cross over to the alternative treatment arm. Discussion. This paper highlights the rationale, design, methods, and challenges of an ongoing prospective, randomized, controlled, multicenter clinical trial that has been undertaken to obtain conclusive evidence of the clinical efficacy and cost-effectiveness of an SCS system in patients with FBSS.
-
Objectives. To document epileptiform discharges recorded within a mammillary body (MB) of a patient with chronic refractory epilepsy (CRE). Materials and Methods. A 37-year-old man, whose epilepsy was not controlled by medication or vagus nerve stimulation, was enrolled in a study of the effects of deep brain stimulation of the MB and mammillothalamic tract (MTT) in CRE. Surface and deep EEG recordings were obtained for 3 days before implantation of the macroelectrodes and for 4 days after implantation of the macroelectrodes but before implantation of the stimulator battery. ⋯ When these discharges were longer than 100 sec, they spread to the right MTT area and then to the left MB and MTT area. Simultaneously, the patient became agitated and confused. Conclusions. This original observation indicates that subcortical neuronal structures, such as the MB, may sustain epileptiform discharges in humans.
-
Introduction. Neuromodulation, mediated by invasive electric stimulation, has been shown to be effective when applied to patients with refractory and intractable neuropathic pain. Recent advances in neurostimulation have broadened the therapeutic uses of this therapy, with the placement of extraspinal electrodes for peripheral nerve stimulation. Methods. Four patients with long-evolving, persistent, severe, uncontrolled, and localized pain in the occipital region, in whom other management options had been tried and failed, were treated with a peripheral, occipital, extraspinal electric stimulation (C1-C2-C3). ⋯ Results. In all cases, stimulation of the occipital region yielded good or very good global results. In all patients, continuous pain disappeared, the frequency and severity of the episodic pain decreased, function improved, and restful sleep improved. As a result of stimulation we were either able to reduce or discontinue medication usage in all of our patients.
-
Objective. To determine the stability of admixtures combining ziconotide with morphine or hydromorphone under simulated intrathecal infusions. Materials and Methods. Admixtures of ziconotide (25 µg/mL) with morphine or hydromorphone (both at 35 mg/mL) were stored in Medtronic SynchroMed® II pumps at 37°C, and in control vials at 37°C and 5°C. Drug concentrations were determined using high-performance liquid chromatography. ⋯ A statistical evaluation of the two combinations shows ziconotide-hydromorphone retaining 80% stability for 40 days (extrapolated), compared to 15 days for ziconotide-morphine. Morphine and hydromorphone were stable in the presence of ziconotide under all conditions. Conclusions. Ziconotide-hydromorphone admixtures were more stable than ziconotide-morphine admixtures.