Neuromodulation : journal of the International Neuromodulation Society
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Vagal nerve stimulation (VNS) has been approved for treatment of refractory depression (or treatment-resistant deperssion) and bipolar disorder in Europe and Canada since 2001 and in United States since 2004 by the Food and Drug Administration. Several lines of evidence support an effective antidepressant effect with such treatment modality, outcomes being mainly evaluated with Hamilton Rating Scale for Depression (HRSD). We here report a series of nine patients with severe treatment-resistant deperssion. ⋯ The preoperative psychiatric status and postoperative clinical outcome were both evaluated with the 21-item version of the HRSD (HRSD(21) ). Five out of nine patients, having at least one-year follow-up, were responders (≥50% reduction of HRSD scoring) and four of these also were remitters (HRSD < 10). One patient with bipolar II disorder and one patient with melancholic depression did not significantly benefit from the procedure; the latter three patients have follow-ups shorter than three months and one of them meets the remittance criteria; nonetheless, for the other two , HRSD(21) score is gradually decreasing with time.
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Objectives. This study is to evaluate long-term lead failure in spinal cord stimulation. Materials and Methods. One hundred and seven patients with permanently implanted spinal cord stimulators were studied for 14 years. All suspected paddle-lead failures were studied prospectively using preoperative radiography and intraoperative electric interrogation. ⋯ The mean time to primary lead failure was 37.9 months and to recurrent lead failure was 23.7 months. Conclusion. The incidence of primary lead failure remains low at 14.9% in the long run, but it is a significant adverse risk factor for recurrent paddle-lead failure. Great care should be undertaken to prevent lead failures by appropriate anchoring.
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Two cases of chronic pelvic pain of unknown etiology with symptoms referable to the low abdominal wall are presented. These patients are often difficult to manage because of multiple causes and multiple pathways for pain transmission from the pelvis. ⋯ The patients reported excellent relief of their chronic pelvic pain. The use of neuromodulation via peripheral stimulation deserves further investigation as an alternative to spinal cord stimulation for chronic pelvic pain.
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Objectives. The aims of this study were to clarify the direction and degree of brain shift, and to determine the predictive factors for a brain shift during deep brain stimulation (DBS) of the subthalamic nucleus (STN). Materials and Methods. To evaluate the brain shift during bilateral STN-DBS, the position of the anterior commissure (AC), posterior commissure (PC), midcommissure point (MC), and tip of the frontal lobe and anterior horn of the lateral ventricle were calculated pre- and poststereotactic operations in the three-dimensional direction employing special software (Leksell SurgiPlan). To determine the predictive factors for a brain shift, patient's age, operation hours, width of the third ventricle, bicaudate index (BCI), and cella media index (CMI) were compared with the shift of MC. ⋯ Among the predictive factors examined, namely, the patient's age, operation hours, width of the third ventricle, BCI, and CMI, only the CMI showed a correlation with the shift of the MC (r = 0.42, p < 0.01, Pearson's correlation coefficient; and p < 0.05, logistic regression analysis). Conclusions. In bilateral STN-DBS, brain shift occurred mainly in the posterior direction, and the CMI is useful for the prediction of a brain shift. Enlargement of the body part of the lateral ventricle is the most reliable factor for predicting a brain shift.
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Introduction. Spinal cord stimulation is a widely used treatment modality for chronic pain, especially failed back surgery syndrome. However, migration of the lead or leads, coverage of axial pain, and the selection of an optimal system configuration continue to be subjects for serious debate. Materials and Methods. A retrospective study of the use of the method of "midline anchoring" of a single Octrode® lead, in 54 patients with low back and/or lower extremity pain, was done to assess the efficacy of this technique. ⋯ A "guarded cathode" array was used in the vast majority of the cases, with a relatively low position of the lead. Conclusions. "Midline anchoring" of the spinal cord stimulation lead is an effective implantation technique, allowing the use of a single, percutaneous, Octrode® lead, while preventing lead migration and allowing capture of axial and lower extremity pain, unilateral as well as bilateral. This study revives the idea of a single lead as a possible optimal configuration.