Neuromodulation : journal of the International Neuromodulation Society
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Striatal hand is a deformity encountered in Parkinson's disease and other parkinsonisms. It is characterized by extension that occurs at all the interphalangeal joints, flexion at the metacarpophalangeal joints, and ulnar deviation. It can be differentiated from levodopa-induced dystonia and primary dystonia, since the deformity exists continuously even during sleep. ⋯ Although the precise mechanism remains unclear, rigidity is assumed to contribute to the limb deformities. Based on our experience, it seems possible therefore that the effect of STN-DBS on the hand deformity was a secondary effect on muscular rigidity. STN-DBS is assumed to represent a useful treatment option for striatal hand deformity.
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Objectives. This study aims to investigate the effect of functional electrical stimulation (FES) on gait in people with Parkinson's disease. Materials and Methods. Seven subjects with idiopathic Parkinson's disease received single-channel electrical stimulation for eight weeks to the common peroneal nerve to improve heel strike and provide sensory stimulus during the swing phase of gait. Stride length, time, and number of steps to complete a 20-m walk and distance completed in 3 min were assessed. ⋯ An immediate effect of FES was demonstrated over a 3-min walk but not over a 20-m walk. Improvements in gait largely persisted on reassessment four weeks after stopping use of FES although the frequency of falls returned to pretreatment levels. A larger study is required to support these findings, to understand the mechanisms of the effects of electrical stimulation on gait and to identify those most likely to benefit from it.
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Objectives. Over the past few years, there has been an increased reliance on the intrathecal delivery of drugs for patients suffering from intractable pain. We sought to demonstrate the effectiveness of the intrathecal pain pump by examining self-reported pre- and postimplantation pain levels. Methods. Eighty-four patients who had elected to implant a Medtronic SynchroMed 1 or 2 system in order to control their pain were asked to complete a survey. ⋯ Results. Perceived success rate for implantation is 68%, when measured by the ability to reduce reliance on oral medication. When measured by willingness to undergo the procedure again, the success rate is 86%. Conclusions. Overall, the implantation of an intrathecal pain pump is an effective way for most people to manage their intractable pain and reduce reliance on oral medications.
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Objective. This article aims to present a case of the use of an alternative form of neuromodulation for the treatment of axial back pain associated with postlaminectomy syndrome. Materials and Methods. An elderly patient with long-standing axial back pain in the setting of a prior decompressive laminectomy presented for evaluation and treatment. ⋯ The permanent system consisted of four Medtronic Quad Plus leads, two on each side of midline oriented horizontally over the L4-5 paraspinous muscles. Our patient was ultimately weaned off of all narcotic medications and, at one year follow-up, continues to report > 90% reduction of pain.