Neuromodulation : journal of the International Neuromodulation Society
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Objectives. To examine the effect of using a common peroneal stimulator on an even and an uneven surface, and to compare measures with perceived response to stimulation. Method. Participants had a drop-foot caused by a stroke (N = 13) or multiple sclerosis (N = 7) and had used a common peroneal stimulator for > 3 months prior to the study. Walking speed and physiological cost index (PCI) were recorded under four conditions: with and without stimulation over an even and an uneven surface. ⋯ A correlation between perceived benefit of stimulation and a measured decrease in PCI was detected. Conclusion. Stimulation may be particularly beneficial for the more difficult task of walking on an uneven surface. Perceived benefit was related to a reduction in effort of walking, not in increased speed.
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Objectives. This pilot study aims to validate the hypothesis that a smaller distance between spinal cord stimulation (SCS) lead and spinal cord results in more extensive paresthesia and less energy consumption. Materials and Methods. After insertion of a percutaneous SCS lead in patients with chronic pain (condition A), a first catheter was temporarily placed alongside the lead (condition B), and a second catheter was placed on the other side of the lead (condition C). ⋯ Results. Paresthesia coverage in all six patients was increased markedly in condition C when compared to condition A, whereas the mean values of PT, MC, and therapeutic range (MC/PT) dropped by 22%, 14%, and 13%, respectively. Conclusions. The results suggest that paresthesia coverage is increased when the space between the SCS lead and spinal cord gets smaller, whereas PT and energy consumption are reduced.
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Objective and Importance. Several previous reports have documented cord compression resulting from the formation of an intrathecal inflammatory mass in patients using intrathecal drug delivery systems. We present the first reported case of an intramedullary abscess and intrathecal inflammatory mass associated with an intrathecal drug delivery system. Clinical Presentation. A 47-year-old man was transferred to our institution from an outside hospital with a 3-week history of the inability to ambulate or move his legs. ⋯ The abscess was linked to infection with Streptococcus anginosus. Conclusion. Generally, inflammatory masses forming along the catheter tip are not associated with infections. We report the first case of an intramedullary abscess associated with an intrathecal drug delivery pump.
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Objective. To present different aspects and advantages of the laparoscopic implantation of a peripheral nerve stimulator adjacent to the pelvic nerves, aimed at treating intractable pelvic neuralgia by means of neuromodulation-the laparoscopic implantation of neuroprothesis (LION) procedure. Materials and Methods. We report here a series of three patients with different types and etiologies of chronic pelvic neuralgia who underwent laparoscopy for implantation of a peripheral nerve stimulator for neuromodulation, the first for neuromodulation of the ilioinguinal and pudendal nerves, the second for neuromodulation of the sciatic nerve, and the third for neuromodulation of the sacral nerve roots. ⋯ Conclusions. Laparoscopy allows optimal implantation of electrodes on all pelvic nerves through a minimally invasive approach. In addition, it permits new applications of neuromodulation for pelvic polyneuropathies or mononeuropathy, not covered by classical spinal cord or transcutaneous techniques.