Neuromodulation : journal of the International Neuromodulation Society
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Sacral neuromodulation (SNM) is an approved method for second-line treatment of different therapy refractory disorders of the urinary bladder. Alongside success in overactive bladder symptoms for detrusor overactivity, SNM also was shown to succeed in chronic urinary retention (UR) of various etiology. ⋯ SNM can be a successful and secure second-line therapy option for patients with chronic UR. Data suggest a more success-promising situation for idiopathic cause of disease, but the number of patients was too small to reach statistical significance. Further prospective, randomized multicenter data concerning indications and number of electrodes are necessary and highly appreciated.
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Editorial Review Historical Article
Evidence-based review of neuromodulation for complex regional pain syndrome: a conflict between faith and science?
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Spinal cord stimulation (SCS) is a valid option for intractable neuropathic pain syndromes, yet some patients cannot undergo the standard awake procedure. Our retrospective study chronicles laminectomy-electrode placement for SCS under general anesthesia and use of compound muscle action potentials (CMAPs) to guide placement in the absence of patient verbal feedback. ⋯ With electrophysiologic monitoring and fluoroscopy guidance, placement of SCS laminectomy leads in select patients under general anesthesia may result in appropriate stimulation coverage and pain relief in most.
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Ziconotide is a peptide that blocks N-type calcium channels and is antihyperalgesic after intrathecal (IT) delivery. We here characterize the spinal kinetics of IT bolus and infused ziconotide in dog. ⋯ After IT bolus or infusion, ziconotide displays linear kinetics that are consistent with a hydrophilic molecule of approximately 2500 Da that is cleared slightly more rapidly than inulin from the LCSF. Behavioral effects were dose dependent and reversible.
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To demonstrate that spinal cord stimulators (SCSs) may be placed safely and accurately under general anesthesia (GA) and that the proposed evaluation method activates structures predominantly in the dorsal columns. ⋯ GA SCS is safe and appears to be at least as accurate and efficacious as using the awake SCS placement technique based on a 50% improvement in the VAS. In addition, the technique presented herein demonstrates that the test stimuli activate the same fiber tracts as that of the therapeutic stimulation.