Neuromodulation : journal of the International Neuromodulation Society
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Background. Patients with unstable angina pectoris may become refractory to conventional therapies. Electrical neurostimulation with transcutaneous electrical stimulation and/or spinal cord stimulation has been shown to be effective for patients with refractory unstable angina pectoris in hospital settings. Our aim was to investigate the effects of electrical neurostimulation on outcomes of unstable angina after hospital discharge, in terms of hospital re-admission rates and long-term survival analysis. ⋯ The combined mortality and (re)infarction rate after one-year follow-up was 14%. Conclusion. The results of this observational study show long-term beneficial effects of electrical neurostimulation in a population of patients with unstable refractory angina. Therefore, electrical neurostimulation should be considered as a beneficial treatment for patients with unstable angina pectoris, refractory to conventional therapies.
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Objective. We studied long-term clinical efficacy of sacral neuromodulation (SNM) therapy in patients with refractory urgency incontinence (UI), urgency/frequency (UF) and voiding difficulty (VD), together with urodynamic data at baseline and six months postimplant. Materials and Methods. Twenty-two patients were implanted with a neurostimulator after a positive response to a percutaneous nerve evaluation test defined as a greater than 50% improvement in symptoms. Results. At five-year follow-up, the number of incontinent episodes and pad usage per day decreased significantly in 10 out of 15 UI patients. ⋯ Mean first sensation of filling at the six-month urodynamic investigation for the UI and UF patients increased from 78 to 241 mL and 141 to 232 mL, respectively, and the maximum bladder capacity increased from 292 to 352 mL and 223 to 318 mL, respectively. Five of 22 patients underwent device explant and one patient still has an inactive stimulator implanted. Conclusion. SNM is an effective treatment modality that offers sustained clinical benefit in the majority of patients with refractory UI, UF, and VD that do not respond to other, more conservative therapies.
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Objective. This case report presents an application of peripheral nerve stimulation to a patient with intractable postherpetic neuralgia that conventional treatment failed to ameliorate. Methods. The patient underwent an uneventful peripheral nerve stimulator trial with placement of two temporal eight-electrode percutaneous leads (Octrode leads, Advanced Neuromodulation Systems, Plano, TX, USA) into the right subscapular and right paraspinal area of the upper thoracic region. ⋯ Peripheral nerve stimulation offers an alternative treatment option for intractable pain associated with postherpetic neuralgia, especially for elderly patients where treatment options are limited due to existing comorbidities. Further studies are warranted.
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Objective. To determine the stability of admixtures combining ziconotide with commercially formulated or powdered baclofen during simulated intrathecal infusion under laboratory conditions at 37°. Materials and Methods. Admixtures of ziconotide (25 µg/mL) with commercially formulated (1.5 mg/mL) or powdered (2.0 mg/mL) baclofen were stored in implantable intrathecal pumps at 37°. Drug concentrations were determined with high-performance liquid chromatography, and the length of time that the concentrations of both drugs remained ≥90% and ≥80% of initial (ie, the 90% and 80% stability, respectively) was estimated based on lower 95% confidence bounds obtained via linear regression. ⋯ In the commercially formulated baclofen admixture, the mean ziconotide concentration declined to 82.2% of initial in 30 days; the estimates for 90% and 80% stability were 12 and 29 days, respectively. In the powdered baclofen admixture, the mean ziconotide concentration declined to 87.4% of initial in 30 days; the estimates for 90% and 80% stability were 20 and 41 days, respectively. Conclusion. Ziconotide-baclofen admixtures were more stable when prepared using powdered baclofen rather than a commercial baclofen formulation.