Neuromodulation : journal of the International Neuromodulation Society
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Intrathecal baclofen is an established method of treating spasticity. However, this therapy is not without significant morbidity and mortality. The known morbidity associated with intrathecal pumps includes death, infection, and sepsis including central nervous system infection, accidental overdose, wrong drug administration as well as technical failures such as pump or battery failure, catheter migration or catheter breakage. Medtronic has issued a number of advisories, most recently in June 2013, regarding the safety of the Medtronic SynchroMed II intrathecal pumps. ⋯ Our unit continues to retain a high level of vigilance when dealing with potential complications of intrathecal pump therapy. Supplemental oral baclofen may have a role in this setting.
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Sacroiliac joint (SIJ) pain affects older adults with a prevalence of up to 20% among patients with chronic low back pain. While pain medication, joint blocks and denervation procedures achieve pain relief in most patients, some cases fail to improve. Our goal was to determine the effectiveness of SIJ peripheral nerve stimulation in patients with severe conservative therapy-refractory SIJ pain. ⋯ We conclude that SIJ stimulation is a promising therapeutic strategy in the treatment of intractable SIJ pain. Further studies are required to determine the precise target group and long-term effect of this novel treatment method.
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The human nucleus accumbens (Acc) has become a target for deep brain stimulation (DBS) in some neuropsychiatric disorders. Nonetheless, even with the most recent advances in neuroimaging it remains difficult to accurately delineate the Acc and closely related subcortical structures, by conventional MRI sequences. It is our purpose to perform a MRI study of the human Acc and to determine whether there are reliable anatomical landmarks that enable the precise location and identification of the nucleus and its core/shell division. ⋯ Advanced MRI techniques allow in vivo delineation and segmentation of the human Acc and represent an additional guiding tool in the precise and safe target definition for DBS.
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The aim of this open-label, non-randomized, clinical trial was to evaluate the feasibility of trialing ziconotide by intrathecal bolus injections. ⋯ Ziconotide bolus injection trialing seems feasible, but the proportion of responders in the present study was low. Adverse events were as expected, and no serious adverse event occurred. The predictive power of ziconotide bolus trialing remains unclear, and the pharmacological profile of ziconotide (slow tissue penetration due to high hydrophilicity) calls the rationale for bolus trialing into question.