Neuromodulation : journal of the International Neuromodulation Society
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Studies of chronic pain show sleep disturbances to be a prevalent symptom in 50-88% of patients and studies show improved pain to correspond with improved sleep. The impact of spinal cord stimulation (SCS) on sleep in failed back surgery syndrome, complex regional pain syndrome, and neuropathic pain patients has not been studied prospectively. ⋯ We demonstrate that insomnia scores on ISI improve with SCS at six-month follow-up. Further, we find that improvements in pain correlate with these ISI improvements.
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As transcutaneous electrical stimulation (TES) increased defecation in children and adults with Slow-Transit Constipation (STC), we performed a pilot study to test if TES can improve symptoms (defecation and soiling) in children with chronic constipation without STC and transit delay in the anorectum. ⋯ TES improved symptoms of constipation in >50% of children with treatment-resistant constipation with isolated holdup in the anorectum. Further studies (RCTs) are warranted in these children.
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Chronic pain is a debilitating biologic and psychologic condition which affects nearly one third of the American population with an annual cost of $560 to $635 billion from associated health care costs and lost productivity. Treatment of chronic pain is difficult to objectively evaluate as it relies on subjective measure. An objective measure would be beneficial in assessing treatment efficacy and towards developing a closed loop system. We assess the efficacy of pedometry as an objective measure of treatment efficacy in spinal cord stimulation (SCS). ⋯ We demonstrate a mean improvement of more than 50% in distance walked, steps per hour, and total steps. Interestingly, total activity (number of hours spent active per day) was not dramatically improved. Our data suggests that as a group our patients' ambulation increased dramatically after successful SCS. The use of pedometry in conjunction with self-reporting can lend both quantitative and qualitative validity to pain, as well as allow objective assessment of efficacy of SCS in patients suffering from chronic low back and/or leg pain. Further, external sensors tracking these data may be a means of creating a closed loop system with SCS.
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This study characterizes and validates a recently developed dedicated circular rat coil for small animal repetitive Transcranial Magnetic Stimulation (rTMS). ⋯ The coil is suitable for rTMS in rats and achieves unprecedented high E-fields at high stimulation frequencies and long durations with however a rather unfocal rat brain stimulation. Reproducible MEPs as well as alterations in cerebral glucose metabolism following rTMS were demonstrated.
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Deep brain stimulation (DBS) is used for a variety of movement disorders, including Parkinson's disease. There are several theories regarding the biology and mechanisms of action of DBS. Previously, we observed an up-regulation of neural progenitor cell proliferation in post-mortem tissue suggesting that DBS can influence cellular plasticity in regions beyond the site of stimulation. We wanted to support these observations and investigate the relationship if any, between DBS, neural progenitor cells, and microglia. ⋯ We conclude that in this animal model, acute DBS results in modest local progenitor cell proliferation and influenced the total number of activated microglia. This could be of clinical significance in patients with PD, as it is thought to progress via neuroinflammatory processes involving microglia, cytokines, and the complement system. Further studies are required to comprehend the behavior of microglia in different activation states and their ability to regulate adult neurogenesis under physiologic and pathologic conditions.