Neuromodulation : journal of the International Neuromodulation Society
-
Disorders of consciousness (DoC) represent a range of clinical states, affect hundreds of thousands of people in the United States, and have relatively poor outcomes. With few effective pharmacotherapies, neuromodulation has been investigated as an alternative for treating DoC. To summarize the available evidence, a systematic review of studies using various forms of neuromodulation to treat DoC was conducted. ⋯ While clinical outcomes were mixed and possibly confounded by natural recovery or pharmacologic interventions, deep brain stimulation appeared to facilitate greater improvements in DoC than other modalities. However, repetitive transcranial magnetic stimulation also demonstrated clinical potential with much lower invasiveness.
-
Diabetes-induced peripheral nerve fiber damage can cause painful diabetic polyneuropathy (PDPN), induced by central sensitization through proinflammatory processes in the spinal dorsal horn. Disturbances in spinal dorsal horn lipid metabolism play a major role in proinflammatory regulation. Conventional (Con)-spinal cord stimulation (SCS) is an alternative treatment for pain relief in PDPN, whereas differential target multiplexed (DTM)-SCS could be more effective than Con-SCS, specifically targeting the spinal inflammatory response. We hypothesize that Con- and DTM-SCS differentially affect lipid metabolism in the spinal cord of PDPN animals. To study pain relief mechanisms, we analyzed lipid expression in the spinal dorsal horn using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry imaging (MSI). ⋯ Both Con- and DTM-SCS provide pain relief and decrease spinal dorsal horn lipid expression of PDPN animals, highlighting the complex effects of SCS on the spinal cord physiology. STZ-induced PDPN has a limited effect on lipid expression in the spinal dorsal horn.
-
Sympathetically mediated orofacial pain is a rare form of craniofacial pain that may be refractory to conventional medical management. We report two cases of orofacial pain with sympathetic features treated with cervical spinal cord stimulation (SCS) using burst waveform with passive recharge. In addition, we present a narrative review of cervical SCS use in the management of orofacial pain. ⋯ Cervical SCS is a viable therapeutic option for patients with orofacial pain syndromes including those with sympathetic features, although further randomized clinical studies are warranted that should include a comprehensive set of outcomes measuring pain intensity, physical function, emotional function, quality of life, and general well-being.
-
This study aimed to characterize the pelvic floor muscles (PFM) motor response provoked during sacral neuromodulation (SNM) lead placement, determining its utility in improving therapy delivery. ⋯ Intraoperative PFM electromyography obtained during lead placement aids in more accurate targeting of the lead to the nerve. To our knowledge, this is the first study to correlate tined lead placement based on electrodiagnostic testing and outcome in SNM. It has been proved to be a reliable measurement tool, serving as a physiological biomarker of treatment response during the test phase. A strong motor response can make the surgeon confident that the correct position of the lead has been established for maximal benefit.
-
Clinical interest in and utilization of peripheral nerve stimulation (PNS) for treating chronic pain has significantly increased in recent years owing to its potential for providing analgesia and improved function and quality of life in comparison with pharmacologic treatments. However, the relative infancy of PNS-specific systems and limited clinical practice guidance likely contribute to significant variation in PNS utilization patterns. ⋯ There is significant practice variation regarding the utilization of PNS across numerous key clinical considerations. Future research that explores the reasons driving these differences might help optimize patient selection, target selection, periprocedural management, and ultimately outcomes.