Neuromodulation : journal of the International Neuromodulation Society
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Direct testing of deep brain stimulation (DBS) mechanisms in humans is needed to assess therapy and to understand stimulation effects. ⋯ IPG replacement occurs when the DBS/brain interface is stable and patients demonstrate symptom reduction with known stimulation parameters. Conducting research at this time point avoids DBS implant issues, including temporary microlesion effects, fluctuating electrode impedances, and technical limitations of contemporary IPGs, providing advantageous conditions to conduct translational DBS research with minimal additional risk to research subjects.
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The study aims to determine the functionality of a wireless-controlled implantable stimulator designed for stimulation and block of the pudendal nerve. ⋯ The wireless-controlled implantable stimulator successfully generated the required waveforms for stimulation and block of pudendal nerve, which will be useful for restoring bladder functions after spinal cord injury.
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Transcutaneous electrical neurostimulation (TENS) and spinal cord stimulation have been shown to increase peripheral and cerebral blood flow. We postulate that certain pathological conditions attenuate cerebral autoregulation, which may result in a relative increase of the importance of neurogenic regulation of cerebral blood flow, which could be decreased by electrical modulation. We therefore assess the effects of TENS on cerebral blood flow velocities (CBFVs) and cerebral saturation in patients with cerebral vasospasm after subarachnoid hemorrhage (SAH). ⋯ Our data suggest improved cerebral blood flow when using cervical TENS in patients with cerebral vasospasm. Several factors could have attenuated the effects: the electrodes were poorly tolerated, ETCO2 increased during TENS, few vessels showed prolonged vasospasm, and overall flow velocities were low. Still, an on-off effect of TENS over time was detected.
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Spinal cord stimulators (SCS) are increasingly placed in the United States in both the inpatient and outpatient setting. Although these interventions appear to be safe, the characteristics of the patients selected for ambulatory procedures have not been investigated. ⋯ Access to ambulatory SCS placement appears to be more common for Caucasians, male patients, with private insurance, and fewer comorbidities, in the setting of higher volume hospitals. Further investigation is needed in the direction of mapping these disparities for appropriate resource utilization.
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In spinal cord stimulation, anodes tend to have a strong effect over the area of dorsal column (DC) activation, when configured as both longitudinal guarded cathodes (LGCs) and transverse tripoles (TTs). Inclusion of a small spacing step (LGC+) in the center-center (C-C) spacing of the LGC can be an efficient method to study the local effects around the electrode. The primary aim of this computer modeling study is to investigate if enhanced DC recruitment is achieved when anodal currents in TT and LGC combinations (both LGC and LGC+) are increased up to 30% with respect to the cathodal current. Secondly, the merits of anodal intensification (AI) are evaluated by comparing the DC recruitment areas (S(RA)) and energy consumption (EDT ) of LGC+ with AI, against stimulation using an LGC without AI. ⋯ AI of TTS is not advantageous. LGC and LGC+ with AI allow additional DC stimulation, which may increase the likelihood of activating fibers inaccessible with conventional programming. LGC+ with AI can be more efficient than LGCs without AI, as a larger SRA and UR is achieved at lower EDT .