Neuromodulation : journal of the International Neuromodulation Society
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Introduction. Spinal cord stimulation (SCS) is an accepted cost-effective therapy for many chronic pain syndromes. Its effects on pregnancy have not been studied because of stringent regulation and manufacturers' recommendations. However, childbearing women who had SCS become or choose to become pregnant despite these policies. ⋯ Therefore our case highlights the need to implant the IPG in a way that avoids stretching the lead extender by the expanding abdomen. Conclusion. SCS seems to be safe in the first two trimesters of pregnancy based on these two case reports and the abdominal wall should be avoided as a site for IPG implantation in these patients. However, more cases are required to establish the safety of SCS in pregnancy.
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Introduction. There is renewed interest in the use of electrical stimulation to control seizures in patients with medically refractory epilepsy. The evidence indicates that multiple nuclei are involved in the onset, spread, or termination of seizures. Establishing electrical stimulation parameters tailored to these nuclei that best control seizures is ongoing. ⋯ The advent of seizure detection devices used in closed-loop studies has in part redefined the strategy to prevent seizure occurrence and limit spread. Discussion. A number of studies in animals and humans indicate that electrical stimulation may be an alternative treatment for some patients with medically intractable epilepsy who are not candidates for conventional surgical options. Conclusion. The reduction in the number and/or severity of seizures found in some studies supports further investigation into the effects of electrical stimulation on the brain and the continuation of testing in animals and humans.
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Introduction. Loin pain-hematuria syndrome (LPHS) is a rare clinical entity causing unilateral or bilateral intractable flank and loin pain with hematuria. The etiology is poorly understood, and the diagnosis is made by exclusion of urological and nephrological conditions. The management is mainly symptomatic aiming for pain relief with nonopioid and opioids analgesics, and interventions such as capsaicin infusion into the renal pelvis, percutaneous regional nerve blocks, and laparoscopic or open surgical procedures, none of them providing lasting pain relief. ⋯ All our patients preferred low-frequency stimulation although its precise mode of action is uncertain. Conclusion. Our experience shows that lumbar sympathetic chain neuromodulation in intractable LPHS not amenable to conservative therapy is a reasonable alternative before radical interventions. More experience is needed in multiple centers before its recommendation for refractory LPHS.