Neuromodulation : journal of the International Neuromodulation Society
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Case Reports
Successful peripheral nerve field stimulation for thoracic radiculitis following Brown-Sequard syndrome.
The objective of this study is to present a novel approach to the treatment of thoracic radiculitis following Brown-Sequard syndrome with peripheral nerve field stimulation (PNFS). Furthermore, we endeavor to discuss the role of PNFS in the management of refractory neuropathic pain conditions including post-traumatic and post-surgical neuropathy particularly with regards to the post-surgical spine. ⋯ Chronic radicular pain may be difficult to manage in the post-surgical patient and often requires the use of multiple therapeutic modalities. In this case, we successfully utilized PNFS as it demonstrated greater technical feasibility when compared with dorsal column stimulation and repeat surgery; therefore, it may be considered for the management of post-surgical neuropathy. Further controlled studies are needed to evaluate the efficacy of PNFS as a treatment option.
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The use of deep brain stimulation (DBS) is growing. While these patients may suffer from traumatic brain injuries, treatment guidelines for these patients have not yet been reported. This case report demonstrates a strategy for traumatic brain injury after DBS implantation. ⋯ We recommend removing only the hematoma, leaving the electrodes in position, and then reassessing the electrode position using merged images. The clinical correlation with electrode migration also should be checked. If the patient can tolerate stimulation with a minor displacement, the electrodes should be left in position and the stimulation parameter needs to be adjusted. If not, the stimulation electrodes should be deactivated or repositioned appropriately, depending on the patient's conditions.
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Case Reports
Spinal cord stimulation for Raynaud's syndrome: long-term alleviation of bilateral pain with a single cervical lead.
Spinal cord stimulation (SCS) has been described in a variety of neuropathic and vasospastic pain conditions including Raynaud's syndrome. ⋯ Treatment of bilateral pain in Raynaud's syndrome with SCS in a single technique is feasible. Advantages and disadvantages as compared with stimulation with bilateral leads are discussed.
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Ziconotide is a reversible blocker of the N-type neuronal voltage-sensitive calcium channels with analgesic effects. The main adverse effects of ziconotide are ataxia, dizziness, gait disorder, confusion, hallucinations, and gastrointestinal symptoms. ⋯ A psychiatric disorder with cholinergic-noradrenergic system impairment could increase some side-effects of treatment with N-type calcium channel blockers.