Neuromodulation : journal of the International Neuromodulation Society
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Case Reports
Peripheral neurostimulation for the treatment of refractory cluster headache, long-term follow-up: case report.
Cluster headache is a headache syndrome characterized by periodic episodes of intense headache with spontaneous remission. There are recent reports utilizing occipital nerve stimulation for the successful management of medically refractory cases of cluster headache. ⋯ Peripheral neurostimulation is safe and efficacious in the management of chronic, medically refractory cluster headache syndrome. The efficacy of treatment was found to be persistent after three years.
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In spinal cord stimulation, neurosurgeons increasingly tend to implant dual leads. Dual leads (longitudinal bipole/tripole) provide medio-lateral control over the recruited dorsal column (DC) area by steering the injected cathodal currents. However, the DC recruited area is suboptimal when dual aligned leads straddling the midline programmed as longitudinal guarded cathodes (+-+) are used instead of a single lead placed over the spinal cord midline with the same configuration. As a potential improvement, an additional third lead between the two aligned leads is modeled to maximize the medio-lateral extent of the DCs at the low-thoracic vertebral region (T10-T12). ⋯ Triple leads programmed to perform as longitudinal guarded cathodes provide more postoperative flexibility than single and dual leads in covering a larger width of the low-thoracic DCs. The transverse separation between the leads is a major determinant of the area and distribution of paresthesia.
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While reference is frequently made to the risk of spinal cord or nerve root injury with the surgical implantation of paddle type spinal cord stimulation (SCS) electrodes, data are lacking on the frequency, causes, and prevention of these complications. ⋯ This investigation, the first comprehensive evaluation of the incidence and frequency of neurologic injury as a result of SCS paddle electrode implantation, suggests that neurologic injury is a rare, but serious, complication of SCS. The incidence of these complications should be decreased by the adoption of approaches that improve procedural safety and by careful patient follow-up and complication management. Physicians should be aware of these approaches and take every precaution to reduce the risk of neurologic injury. Physicians also should report any adverse event leading to injury or death and work together to improve access to these data.
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Case Reports
Pathophysiology of the spreading of complex regional pain syndrome revisited: a case report.
To determine if there is a relationship in our patient developing complex regional pain syndrome from a jellyfish and its subsequent spread to the contralateral side. ⋯ Definite knowledge of the pathophysiology of complex regional pain syndrome would allow better identification of risk factors for the development of this condition after trauma. This patient is at higher risk of developing complex regional pain syndrome and should avoid surgeries (such as knee and wrist surgeries) and high risk physical activities.
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Spinal cord stimulation (SCS) may reduce pain scores and improve function in patients with various chronic abdominal pain syndromes including chronic pancreatitis. Here described is a large clinical experience in SCS for severe chronic pancreatitis. ⋯ SCS may be a useful therapeutic option for patients with severe visceral pain from chronic pancreatitis. Prospective trial is warranted.