Neuromodulation : journal of the International Neuromodulation Society
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Case Reports
Treatment of chronic chest wall pain in a patient with Loeys-Dietz syndrome using spinal cord stimulation.
Spinal cord stimulation (SCS) has been used with increased frequency for the treatment of intractable pain including chronic chest pain. ⋯ SCS provides an effective, alternative treatment option for select patients with Loeys-Dietz syndrome who underwent repair of pectus excavatum with subsequent chronic chest wall pain who have failed conservative treatment. SCS may provide pain relief with advantages over conservative treatments and more invasive techniques.
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To assess the effects of intrathecal baclofen (ITB) therapy for the treatment of poststroke spastic hemiparesis on quality of life, functional independence, and upper, lower extremity (UE, LE) motor functions. ⋯ Regardless of duration of spastic hemiparesis, a reduction in tone with ITB therapy facilitates motor strength improvement and is associated with clinically significant improvements in functional independence and quality of life.
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The use of cervical spinal cord stimulators for the treatment of refractory neck and upper extremity pain is widely accepted and growing in use as a treatment modality. This case highlights a previously unreported potential complication of spinal cord stimulators. ⋯ As more patients are undergoing implantation of spinal cord stimulators we must be aware of the long-term risks that can be encountered.
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Patients suffering from severe chronic angina pectoris (AP) that has become therapeutically refractory to medication and revascularization can be adequately treated with spinal cord stimulation (SCS). However, following SCS implantation for angina, not all patients show a consistent improvement in quality of life (QoL). Therefore, we sought to study the association of baseline characteristics and chronic multimorbidities on QoL following SCS implantation. ⋯ Men showed a larger improvement in QoL following SCS implantation, compared with women. As SCS improves rAP, other chronic morbidities such as COPD, DM, and BMI may become the limiting factors for exercise and subsequently adversely affect QoL following implantation of an SCS system. As a consequence of the present relatively small single-center study, we recommend studies regarding rAP and SCS to also address the effect of comorbidities on outcomes.
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Neuromodulation with spinal cord stimulation has become an increasingly employed intervention for treatment of a variety of neuropathic pain states. As prevalence increases, so does the incidence of complications. Currently, there is sparse literature describing spinal cord stimulation lead placement and stimulation characteristics in the subdural space. In this case report we describe subdural lead placement and the associated stimulation parameters, and provide evidence-based support to initiate a dialog to further reduce procedural morbidity and mortality. ⋯ Evidence suggesting subdural lead placement include the lack of cerebrospinal-fluid despite lavage, the absence of post-dural puncture headache, the recent evidence of intentional and reproducible subdural anesthesia, and the conductive properties of the dural spinal elements. It can be argued that subdural lead placement may occur unrecognized more frequently than originally anticipated.