Neuromodulation : journal of the International Neuromodulation Society
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Introduction. There is renewed interest in the use of electrical stimulation to control seizures in patients with medically refractory epilepsy. The evidence indicates that multiple nuclei are involved in the onset, spread, or termination of seizures. Establishing electrical stimulation parameters tailored to these nuclei that best control seizures is ongoing. ⋯ The advent of seizure detection devices used in closed-loop studies has in part redefined the strategy to prevent seizure occurrence and limit spread. Discussion. A number of studies in animals and humans indicate that electrical stimulation may be an alternative treatment for some patients with medically intractable epilepsy who are not candidates for conventional surgical options. Conclusion. The reduction in the number and/or severity of seizures found in some studies supports further investigation into the effects of electrical stimulation on the brain and the continuation of testing in animals and humans.
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Introduction. Loin pain-hematuria syndrome (LPHS) is a rare clinical entity causing unilateral or bilateral intractable flank and loin pain with hematuria. The etiology is poorly understood, and the diagnosis is made by exclusion of urological and nephrological conditions. The management is mainly symptomatic aiming for pain relief with nonopioid and opioids analgesics, and interventions such as capsaicin infusion into the renal pelvis, percutaneous regional nerve blocks, and laparoscopic or open surgical procedures, none of them providing lasting pain relief. ⋯ All our patients preferred low-frequency stimulation although its precise mode of action is uncertain. Conclusion. Our experience shows that lumbar sympathetic chain neuromodulation in intractable LPHS not amenable to conservative therapy is a reasonable alternative before radical interventions. More experience is needed in multiple centers before its recommendation for refractory LPHS.
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Introduction. Peripheral nerve stimulation (PNS) has been used for many years to treat neuropathic pain syndromes. Technical advances in neurostimulation hardware have led to a renewed interest in the use of PNS for control of intractable pain caused by peripheral mononeuropathies. One such application includes intractable groin pain. ⋯ Discussion. The successful use of ultrasound as described in these two cases suggests an important role for ultrasound in localization of targeted nerves in percutaneous trial stimulation of injured peripheral nerve. The use of ultrasound may also play a role in permanent lead placement as well. Conclusion. More studies are needed to further qualify the role of ultrasound in isolating peripheral nerves, but the success of trial stimulation in these two cases holds promise for continued advancements in the field of neuromodulation.