Neuromodulation : journal of the International Neuromodulation Society
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Development of effective chronic pain treatment strategies has been hampered by the lack of an objective pain biomarker. Magnetoencephalography (MEG) has demonstrated cortical disorganization corresponding to the affected limb of complex regional pain syndrome (CRPS) patients and spinal cord stimulation (SCS) can acutely treat CRPS in a reversible and adjustable fashion. In order to better define a potential MEG-sensitive biomarker for chronic pain, our goal was to study the effects of therapeutic SCS on cortical disorganization in patients with unilateral limb CRPS. ⋯ This is the first report of a MEG study showing D1/D5 cortical disorganization and its apparent reversal or restoration with cervical SCS therapy. Ours also is the first report of an apparent acute reversible interchange in the cortical representations of D1 and D5. Our limited data demonstrate that disorganization of SI cortex might be a neurophysiologic marker of chronic pain as shown with instantaneous normalization of SI disorganization or restoration of SI organization with therapeutic SCS. As a clinically proven tool for functional mapping, MEG might be shown to provide an objective measure of chronic pain. More data are required to further investigate this possibility.
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Review Multicenter Study
A case series review of spinal cord stimulation migration rates with a novel fixation device.
A retrospective review of a consecutive case series of 66 permanent spinal cord stimulation implants utilizing a novel tissue fixation device was performed. The purpose of this case series review is to examine the impact of a novel lead anchor to tissue fixation system and determine if it is a viable alternative to standard tissue fixation methods. ⋯ These data suggest this novel method of tissue fixation may be a viable alternative for fixation of spinal cord stimulator leads to soft tissue. In this case series there were no reported incidents of migration or complications related to the novel device.
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Randomized Controlled Trial Comparative Study
Neuronavigated vs. conventional repetitive transcranial magnetic stimulation method for virtual lesioning on the Broca's area.
This study was undertaken to test the hypothesis that repetitive transcranial magnetic stimulation (rTMS) using a neuronavigational TMS system (nTMS) to the Broca's area would elicit greater virtual aphasia than rTMS using the conventional TMS method (cTMS). ⋯ nTMS leads to more robust neuromodulation of Broca's area, resulting in delayed verbal reaction time as well as more accurate targeting of the intended stimulation location, demonstrating superiority of nTMS over cTMS for therapeutic use of rTMS in neurorehabilitation.
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Randomized Controlled Trial Comparative Study
Patient-perceived differences between constant current and constant voltage spinal cord stimulation systems.
Spinal cord stimulation (SCS) systems employ implantable pulse generators that use either a constant current (CC) or a constant voltage (CV) power source. CC power sources adjust voltage in response to resistance (impedance) to ensure that consistent current is delivered to the patient. CV power sources do not adjust voltage in response to impedance; therefore, current delivered to the patient will vary in response to changes in impedance. Both systems produce paresthesia and have been shown to treat chronic pain; however, it has been suggested that patients prefer CC stimulation over CV stimulation. ⋯ The results from this study indicate that patients preferred and experienced greater satisfaction and pain relief with the CC system during an SCS trial period. Differences between the two systems following long-term use has yet to be compared. However, the benefits of the CC system seen with short-term use should be considered when selecting an SCS system.