Neuromodulation : journal of the International Neuromodulation Society
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There is a rapidly growing number of patents on methods of modulating brain regions. Despite this trend, and the massive potential of neuromodulation for treating patients, researchers and physicians who use neuromodulation techniques and technologies often have little idea of the significant ways these patents could affect their work. ⋯ As neuromodulation rapidly matures into a commercial and medical reality it is important to consider these effects in a forward thinking and value driven manner. The paper concludes with recommendations concerning how neuromodulation method patents may be used, or not, depending on the values of the inventor.
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Randomized Controlled Trial
Does Bilateral Deep Brain Stimulation of the Subthalamic Nucleus Modify Ano-Rectal Motility in Parkinson's Disease? Results of a Randomized Cross-Over Study.
Ano-rectal motility impairment is often observed during Parkinson's disease (PD), generating symptoms as constipation and/or incontinence with impaired quality of life. Subthalamic nuclei (STN) deep brain stimulation (DBS) improves motor symptoms of PD, but its effects on anorectal motility are unknown. This study aimed to assess the effects of STN-DBS on the anorectal motility in PD patients, in a randomized cross-over study. ⋯ STN-DBS increased anal squeezing pressure, but did not modify anorectal dyssynergia in PD patients, This study demonstrated the involvement of STN in the voluntary control of anorectal motility in PD patients.
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Detailed biophysical modeling of deep brain stimulation (DBS) provides a theoretical approach to quantify the cellular response to the applied electric field. However, the most accurate models for performing such analyses, patient-specific field-cable (FC) pathway-activation models (PAMs), are so technically demanding to implement that their use in clinical research is greatly limited. Predictive algorithms can simplify PAM calculations, but they generally fail to reproduce the output of FC models when evaluated over a wide range of clinically relevant stimulation parameters. Therefore, we set out to develop a novel driving-force (DF) predictive algorithm (DF-Howell), customized to the study of DBS, which can better match FC results. ⋯ DF-Howell represents an accurate predictor for estimating axonal pathway activation in patient-specific DBS models, but errors still exist relative to FC PAM calculations. Nonetheless, the tractability of DF algorithms helps to reduce the technical barriers for performing accurate biophysical modeling in clinical DBS research studies.
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Cluster headaches are a set of episodic and chronic pain syndromes that are sources of significant morbidity for patients. The standard of care for cluster headaches remains medication therapy, however a minority of patients will remain refractory to treatment despite changes to dosage and therapeutic combinations. In these patients, functional neuromodulation using Deep Brain Stimulation (DBS) presents the opportunity to alleviate the significant pain that is experienced by targeting the neurophysiological substrates that mediate pain. ⋯ In patients with chronic cluster headache, functional neuromodulation using DBS presents the opportunity to alleviate the significant pain that is experienced by targeting the neurophysiological substrates that mediate pain.