Neuromodulation : journal of the International Neuromodulation Society
-
Introduction. The classic presentation of ankylosing spondylitis not only impairs spinal mobility but also imposes functional limitations, and fatigue is common. Methods. We report here the outcomes of spinal cord stimulation (SCS) in the case of a 47-year-old man with low back and hip/thigh pain due to ankylosing spondylitis, with failed responses to conservative therapies aimed at treating this pain. ⋯ SCS also resulted in improved socioeconomic outcomes with a return to work. Conclusions. With further research in patients with broader presentations of the disease, SCS may prove efficacious in suppressing intractable pain symptoms due to ankylosing spondylitis, thus improving quality of life measures.
-
Objectives. The pain associated with herpes zoster can be classified as acute phase, persistent phase, or chronic phase, but if it is prolonged, it becomes resistant to treatment. It is clinically important to prevent transition to postherpetic neuralgia after the onset of herpes zoster, and the outcome depends on whether continuous and potent pain management can be achieved between the acute and persistent phases. We evaluated the effect of pain management leading to quick termination of pain using temporary spinal cord stimulation (SCS) which does not require implantation of a device. ⋯ Less epidural analgesia was required and the adverse reactions of lowered blood pressure in three cases and urinary retention in seven cases disappeared soon. The self-rated satisfaction was higher with SCS than with CEB in all 14 cases, because it is highly controllable and has minimal activities of daily living-lowering effects. Conclusion. Temporary SCS, which does not require implantation of a device, may have a potent analgesic effect on severe pain in patients in the persistent phase after herpes zoster, and prevent transition to postherpetic neuralgia.
-
Objectives. The purpose of the present study was to show that the design of a neuroprosthesis for unsupported (arm-free) standing is feasible. We review findings suggesting that a closed-loop controlled functional electrical stimulation (FES) system should be able to facilitate arm-free quiet standing in individuals with spinal cord injury (SCI). Particularly, this manuscript identifies: 1) a control strategy that accurately mimics the strategy healthy individuals apply to regulate the ankle joint position during quiet standing and 2) the degrees of freedom (DOF) of the redundant, closed-chain dynamic system of bipedal stance that have to be regulated to facilitate stable standing. ⋯ Finally, perturbation simulations confirmed that the kinematics of this system are similar to those of healthy individuals during perturbed standing. Conclusions. The presented results suggest that stable standing can be achieved in individuals with SCI by controlling only six DOF in the lower limbs using FES, and that a PD controller actuating these DOF can stabilize the system despite a long sensory-motor time delay. Our finding that not all DOF in the lower limbs need to be regulated is particularly relevant for individuals with complete SCI, because some of their muscles may be denervated or difficult to access.
-
Objectives. This study aims to demonstrate the utility of spinal cord stimulation in a neuropathic pain syndrome and overall decline in health and functional independence following elapid envenomation in a morbidly obese, insulin-dependent diabetic. Materials and Methods. A two-lead, 16-electrode constant-current, independently controlled system is placed in the mid-cervical spine. Results. Noted were a improvement in overall health status with better glycemic control and return to work status in response to adequate pain control. Conclusions. The case serves as a model for other orphan pain cases with a seemingly esoteric etiology and adds to the existing body of literature that spinal cord stimulation and neuromodulation, in general, has a wide-ranging applicability peripheral neuropathic pain syndromes.