Neuromodulation : journal of the International Neuromodulation Society
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Case Reports
Spinal cord stimulation for electrical storm refractory to conventional medical treatment: an emerging indication?
To observe the effect of thoracic spinal cord stimulation with dual octipolar epidural electrodes on episodes of ventricular tachycardia and ventricular fibrillation in a patient with nonischemic familial cardiomyopathy and severe electrical storm refractory to conventional medical treatment. ⋯ Spinal cord stimulation may play an important therapeutic role in the treatment of refractory electrical storm when conventional medical treatments have failed. The mechanism by which stimulation of the spinal cord confers a therapeutic effect is not completely understood, although direct modulation of sympathetic and parasympathetic tone in the cardiac conduction system is most likely, based on animal models of ischemia-induced ventricular tachycardia.
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Sacral neuromodulation (SNM) is theorized to alter the neural pathways that mediate bladder and urethral sensation. We hypothesize that SNM affects current perception thresholds (CPTs) of afferent sensory nerve pathways. ⋯ With a measurable change in CPT values for Aδ-fibers and Aβ-fibers, these findings suggest that SNM modulates large myelinated afferent fibers in the bladder. Notably, little or no changes were found in the C-fiber CPT measurements. More research is needed with a larger sample size to determine the significance of these findings.
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Intrathecal baclofen (ITB) pump implantation for cerebral palsy (CP) patients is usually performed in the lateral position; however, it might be difficult for some patients with severe deformity to take a lateral position during surgery. ⋯ Our findings suggest that ITB therapy may be useful for CP patients with uncontrollable spasticity, dystonia, or opisthotonus who are not able to take a lateral position for pump implantation due to deformities of their extremities and spine.
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Models that simulate clinical conditions are needed to gain an understanding of the mechanism involved during spinal cord stimulation (SCS) treatment of chronic neuropathic pain. An animal model has been developed for continuous SCS in which animals that have been injured to develop neuropathic pain behavior were allowed to carry on with regular daily activities while being stimulated for 72 hours. ⋯ A continuous SCS model has been developed. Animals with neuropathic pain behavior that were continuously stimulated showed significant increase in withdrawal thresholds proportional to stimulation time.
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The aim of this review is to make specialists in a variety of disciplines familiar with basic aspects of spinal cord stimulation and the role of mathematical modeling in understanding its mechanisms of action and the solution of basic problems. ⋯ In particular the conclusions from several computer simulation studies are relevant and of interest to specialists in many disciplines.