Neuromodulation : journal of the International Neuromodulation Society
-
Objectives. Sacral root stimulation (SRS) is a technique to restore the idiopathic overactive bladder (IOB). However, its mechanism of action is yet to be elucidated. Hence, we studied whether SRS restored IOB through the mechanism of spinal neuromodulation. ⋯ This spinal excitability decreased and bladder function improved after SRS, an effect that outlasted actual stimulation by at least 30 min. Conclusions. Our results showed that spinal excitability was increased in response to somatic nociceptive afferents in IOB patients. SRS restored bladder function, at least, in part, through spinal neuromodulation.
-
Objectives. In spinal cord stimulation (SCS) therapy, limited pain relief during the temporary trial period is generally considered to be predictive of poor long-term benefit. To validate or refute this perception, the long-term outcomes of subjects who reported less than 50% pain relief during a temporary SCS trial were examined. Materials and Methods. Twelve subjects with intractable pain underwent implantation of trial SCS systems. ⋯ SCS appears to be a viable treatment option for patients who fail trials, raising some doubt as to the predictive sensitivity and specificity of the trial period. Thus, although outcome of a temporary trial period may be suggestive of later efficacy with SCS, it may not be the sole predictor of success. Alternatively, the arbitrary benchmark of 50% pain relief that is typically used to define the success of a temporary trial may be too stringent and unreliable.
-
Objectives. Identification, delimitation, and stereotactic localization of the human nucleus accumbens (Acc) in order to allow its accurate definition and three-dimensional targeting on magnetic resonance imaging (MRI) enabling its use for deep brain stimulation. Methods. Magnetic resonance imaging and anatomical coronal serial cuts were performed on 24 Acc from human cadaver brains perpendicular to the anterior commissure-posterior commissure line; identification, localization, and determination of its dimensions and three-dimensional stereotactic coordinates. ⋯ The stereotactic coordinates were obtained every millimeter along its length. Conclusion. It was possible to identify well the human Acc, define its limits and establish its three-dimensional coordinates as potential MRI-guided stereotactic target.
-
Objectives. This study aims to assess the safety and efficacy of long-term intrathecal (IT) ziconotide infusion. Materials and Methods. In this prospective study, 155 patients with severe chronic pain (48 with malignant pain, 107 with nonmalignant pain) who had been responsive to short-term IT ziconotide in a double-blind, placebo-controlled study received long-term, open-label IT ziconotide monotherapy. Efficacy assessments included the mean percentage change on the visual analog scale of pain intensity from baseline in the study of origin; safety was monitored by adverse event (AE) reports, periodic laboratory tests, and vital sign measurements. ⋯ The mean IT ziconotide dose remained stable over 12 months in the 31 patients who participated in the study for ≥ one year. Ziconotide-related AEs were reported in 147 out of 155 patients (94.8%); 39.4% of patients discontinued treatment because of AEs, the majority of which were considered ziconotide related. Conclusions. Ziconotide IT monotherapy provided patients with analgesia for 12 months in this open-label study, with an acceptable benefit/risk profile and no evidence of tolerance.
-
Objectives. This study aims to explore the relationship among the levels of interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α) produced by cortical glial cells, and identify any correlation between neuromodulation and brain lateralization. Material and Methods. Cortical glial cells from Balb/c neonatal mice were cultured in vitro and the effects of treating or not treating these cells from both hemispheres with lipopolysaccharide (LPS) (10 µg/mL) for 24 hours were tested. The levels of IL-1β, IL-6, and TNF-α in left and right cortical glial cell cultures and the time course of any changes were compared. ⋯ Conclusion. Lipopolysaccharide increases cytokine production in both cerebral cortices, three cytokines have different expression time course within 72 hours, but only IL-1β in right cortex and IL-6 releasing is time-dependent, and more so on the right side than the left in 24 hours. We proposed the increased immunosuppressive activity of right cortex was due to the higher expression of IL-1β, TNF-α, and IL-6 in the right cortical glial cells, whereas there would be more immunoenhancement activity of the left cortex due to the lower levels of these three kinds of cytokines, this being a less pronounced effect than that on the right side. One of the reasons for the brain lateralization may be the different production of cytokines by the cortical glial cells on either side.