Neuromodulation : journal of the International Neuromodulation Society
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This testing was conducted to determine if exposure from a particle accelerator used to treat cancer patients would alter the performance of the EndoStim® neurostimulator when programmed either passively or actively and while being irradiated. ⋯ EndoStim I and EndoStim II implant pulse generators appear to be immune to x-ray radiation from the particle accelerator at energies up to 18 MV, at dose rates of up to 6 Gy/min, and up to cumulative doses of minimally 80 Gy. As there were no observable effects on neurostimulation requirements, the EndoStim LES Stimulation System implantable neurostimulators are capable of withstanding direct radiation. The recommendations of the manufacturer should be followed further regarding the labeling requirements for insured safety to patients.
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Conflicting data regarding the efficacy of high-frequency spinal cord stimulation (HF SCS) has prompted the issue of the possible importance of the shape of the stimulating pulses. The aim of this pilot study was to compare HF SCS applied with monophasic and biphasic pulses of two different durations with conventional SCS in a rat model of neuropathic pain. ⋯ There is no significant difference in efficacy between HF SCS applied with low amplitude ("subparesthetic") monophasic and biphasic pulses. However, short PWs providing only 12 μsec of cathodal stimulation was ineffective, presumably because of insufficient electric charge transfer from the lead contacts to the nervous tissue.
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This study compares the stability of three variations of the conductive polymer poly(3,4-ethylenedioxythiophene) or PEDOT for neural micro-stimulation under both in vitro and in vivo conditions. We examined PEDOT films deposited with counter-ions tetrafluoroborate (TFB) and poly(styrenesulfonate) (PSS), and ⋯ TFB may be an enabling material for achieving long lasting micro-stimulation and recording.
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Spinal cord stimulation has now been used for four decades and has become an established treatment for neuropathic pain. Spinal cord compression by formation of excessive fibrous tissue at the level of an epidural neurostimulation electrode is a rare, delayed, but serious complication of neuromodulation for chronic neuropathic pain that may appear at various timings after the initial surgery, but is usually preceded by progressive tolerance and fading of the pain-relieving effect of the neurostimulation. ⋯ Careful surgical removal of the fibrous tissue can be performed to allow decompression of the spinal cord and may help to obtain a more efficient pain management. As large surgical electrodes could be specifically associated with compressive scar tissue formation, they should therefore be considered as a second line of treatment after percutaneous leads.
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High-frequency spinal cord stimulation (HF SCS) is a relatively new modality of SCS. The present general advice concerning pregnancy and SCS, in general, is to turn the device off because of insufficient knowledge concerning the impact on the developing fetus. As HF stimulation generates higher energies, potential adverse fetal effects could be theoretically stronger. ⋯ This case describes both a miscarriage and the birth of a healthy baby in a patient treated with HF SCS. It is not possible to rule out that the HF SCS could have caused the miscarriage. Also, the birth of the healthy baby after the second pregnancy in which HF SCS was used the whole period, is not a valid reason to declare HF SCS and SCS, in general, safe during pregnancy. As no sufficient data are available, we must remain cautious about any unknown possible adverse effects or delayed adverse events because of SCS and maybe especially HF stimulation. All outcome data on pregnancies during all types of SCS ideally should be collected and analyzed.