Neuromodulation : journal of the International Neuromodulation Society
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Sacral chordoma is a rare malignant tumor arising from remnants of the notochord. Due to its propensity for recurrence, the treatment of choice is surgical resection. Orthopedic and neurosurgical literature describe bladder dysfunction as prevalent in these patients, specifically urinary incontinence, however urologic literature is lacking in the exact nature of this dysfunction. Thus far, Sacral Nerve Stimulation (SNS) has not been described as a treatment option for these patients. ⋯ We are the first to report the successful use of SNS to treat nonobstructive urinary retention after partial sacral resection. Additional patients and long term follow-up will be required to support consistent usage of neuromodulation in this patient population.
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High-frequency gastric electrical stimulation (GES) has emerged as a therapy for gastroparesis, but the mechanism(s) of action remain unclear. There is a need to refine stimulation protocols for clinical benefit, but a lack of accurate techniques for assessing mechanisms in clinical trials, such as slow wave modulation, has hindered progress. We thereby aimed to assess acute slow wave responses to GES in gastroparesis patients using high-resolution (HR) (multi-electrode) mapping, across a range of stimulation doses achievable by the Enterra stimulation device (Medtronic Inc., MN, USA). ⋯ High-frequency GES protocols achievable from a current commercial device did not acutely modulate slow wave activity or dysrhythmias. This study advances clinical methods for identifying and assessing therapeutic GES parameters, and can be applied in future studies on higher-energy protocols and devices.
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An invasive brain-computer interface (BCI) is a promising neurorehabilitation device for severely disabled patients. Although some systems have been shown to work well in restricted laboratory settings, their utility must be tested in less controlled, real-time environments. Our objective was to investigate whether a specific motor task could be reliably detected from multiunit intracortical signals from freely moving animals in a simulated, real-time setting. ⋯ Our results showed the feasibility of detecting a motor task in real time in a less restricted environment compared to environments commonly applied within invasive BCI research, and they showed the feasibility of using information extracted from multiunit recordings, thereby avoiding the time-consuming and complex task of extracting and sorting single units.
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Case Reports
NonInfectious Peri-Electrode Edema and Contrast Enhancement Following Deep Brain Stimulation Surgery.
Dramatic radiographic abnormalities seen after electrode placement (DRAAEP) in deep brain stimulation (DBS) surgery is rare and it has not been associated with infection or hemorrhage. It has consisted of peri-electrode low-attenuation signals on CT scans and extensive T2-hyperintense signals without associated contrast enhancement (CE) on MRI scans. ⋯ To our knowledge, this is the first reported case of DRAAEP with positive gadolinium enhancement. Despite the extensive contrast enhancement, these DRAAEP appear to remain benign transient events that, in the absence of clinical signs of infection or neurologic decline, may warrant no further aggressive intervention such as hardware removal.
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Case Reports
Optimizing Stimulation in a Case of Facial Pain Through "Cross-Talk" of Peripheral and Central Leads: A Case Report.
To describe inter-lead (cross-talk) stimulation between a trigeminal nerve lead and a cervical epidural lead for the treatment of facial pain in a 69-year-old patient with empty nose syndrome. ⋯ Cross-talk configuration between a peripheral and a central lead created a more efficient stimulation technique. The resulting paresthesia was superior to that obtained from either lead alone and exceeded the paresthesia obtained from the combination of the two leads when used simultaneously, without an inter-lead configuration.