Neuromodulation : journal of the International Neuromodulation Society
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We report the outcome after vagus nerve stimulation (VNS) in children with secondary generalized epilepsy. ⋯ Our study showed that VNS was effective in reducing atypical absence, generalized tonic-clonic, and myoclonic seizures (but not atonic or tonic seizures) in children with Lennox-Gastaut or Lennox-like syndrome. A concomitant improvement in attention level and quality of life and health also was noted. Secondary generalized epilepsy represents a subset of good candidates for VNS.
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Spinal cord stimulation (SCS) is an effective treatment for intractable complex regional pain syndrome type I pain. Long-term data are scarce on effectiveness, degree of pain relief, predictors, and complications. ⋯ SCS provides an effective long-term pain treatment for 63% (95%CI: 41-85) of implanted patients. Forty-one percent (95%CI: 27-55) of SCS treated patients have at least 30% pain reduction at measurement end point. The number of reinterventions after implantation due to equipment-related problems, battery changes, and complications is 122 over 12 years of follow-up. Sixty-one percent (N = 51) of the patients had at least one reintervention. Mean pain relief of at least 50% (visual analog scale) one week after the test stimulation is associated with long-term treatment success.
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Spinal cord stimulation (SCS) by high-frequency electrical pulses has been used since the early 1970s for relief of chronic intractable pain following limb amputation. The long-term effectiveness of SCS for amputation-related pain with ongoing after-care is reviewed by assessment of all such cases managed over 20 years in the Neurostimulator Clinic at the Royal London Hospital. ⋯ Successful SCS in some patients with amputation-related pain otherwise resistant to treatment indicates that the procedure merits continued use with further efforts to refine technique.
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Letter Case Reports
C2 subcutaneous stimulation for failed back surgery syndrome: a case report.
Failed back surgery syndrome (FBSS) is a term embracing a constellation of conditions that describes persistent or recurring low back pain, with or without sciatica following one or more spine surgeries. It has been shown in animals that electrical stimulation of the high cervical C2 area can suppress pain stimuli derived from the L5-S1 dermatome. It is unknown whether C2 electrical stimulation in humans can be used to treat pain derived from the L5-S1 area, and a case is reported in which subcutaneous C2 is applied to treat FBSS. ⋯ The burst design is capable of both suppressing the least and worst pain effectively, and she has remained almost pain-free for over three years.
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The study aims to evaluate the long-term clinical and technical efficacy of recently developed percutaneously introducible plate electrodes for spinal cord stimulation. ⋯ Percutaneous implantation of small profile paddle leads in patients with FBSS and lumboischialgia produces favorable results over the long term that are at least comparable with surgical implanted paddle leads. The percutaneous approach also allows nonsurgically trained pain physicians to introduce paddle leads. Indices like if patients would redo the procedure may be more appropriate for analyzing long-term outcomes than the arbitrarily taking 50% reduction in VAS scores.