Neuromodulation : journal of the International Neuromodulation Society
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Hemidystonia is a unilateral clinical presentation of dystonia, and it is usually refractory to current methods of medical treatment. Recently, deep brain stimulation has given some hope of recovery to dystonic patients. ⋯ We present a unique case of secondary posttraumatic hemidystonia treated with contralateral GPi stimulation with an excellent outcome. Pallidal stimulation can be a good treatment option for posttraumatic hemidystonia in selected cases.
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The detrimental effects of post-thoracotomy pain syndrome is experienced worldwide; however, an effective treatment regimen remains elusive. ⋯ Although the data are limited, in the aforesaid case report, post-thoracotomy syndrome was effectively treated with the use of PNfS. This resulted in a significant pain perception reduction, increased quality of life and mobility, as well as decreased usage of oral pain medications. This adds to the accumulating case report and case series data that suggest PNfS is showing great promise as a pain reduction modality. Further, it is minimally invasive, can be trialled prior to implantation, and is reversible. Large prospective studies will be required in the future to further evaluate its efficacy before it can be widely accepted and adopted.
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Our goal was to determine the efficacy of spinal cord stimulation for patients with intractable post-herniorrhaphy pain which conventional treatment failed to ameliorate. ⋯ We conclude that SCS offers an alternative treatment option for intractable post-herniorrhaphy pain. This type of treatment should be considered for use in a select group of patients when all conventional treatments failed.
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We compared the role of subthalamic nucleus deep brain stimulation (STN-DBS) in the management of medically refractory idiopathic Parkinson's disease in patients with relatively young onset (<40 years of age) Parkinson's disease (YOPD) and patients with relatively late onset Parkinson's disease (≥ 56 years of age, rLOPD). ⋯ Patients with YOPD and rLOPD exhibited comparable UPDRS motor scores and LEDD six months postoperatively. Levodopa could be prescribed at optimum doses following STN-DBS in patients with YOPD as abnormal movements are better controlled following STN-DBS implantation. Stimulation parameters were not different between the two groups. Our results suggest the age of onset does not influence response to STN-DBS Parkinson's disease patients.
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The use of spinal cord stimulation (SCS) is a form of neuromodulation used to treat chronic pain in those patients who are refractory to conventional medical management. Not uncommonly, SCS can dramatically improve a patient's quality of life, and those who are in the childbearing years may go on to become pregnant. The purpose of this case series is to describe: 1) implantation considerations in women of childbearing age; 2) use of rechargeable systems; 3) the obstetric and anesthetic concerns in patients with spinal cord stimulators; 4) risks of using SCS in the peripartum period. ⋯ Implantation of SCS devices in women of childbearing years should take into account the future needs of both obstetric and anesthetic care by avoiding the abdomen and lower lumbar spine whenever possible. There was no appreciable decline of battery capacity in present day constant current rechargeable generators when deactivated for the duration of pregnancy.