Neuromodulation : journal of the International Neuromodulation Society
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Objective. To investigate the effect of interval training supported by Functional Electrical Stimulation (FES) on ambulation ability in complete spinal cord injury (SCI). Methods. We trained four men with sensorimotor-complete (ASIA A) SCI, who achieved gait through FES of the quadriceps femoris, gluteus maximus, and common peroneal nerve on each side on a motorized treadmill. Training involved progressive interval walking exercise, consisting of periods of activity followed by equal periods of rest, repeated until muscle fatigue. ⋯ Some subjects increased the total distance walked by as much as 300% with progressive improvement over the entire training period; however, others made more modest gains and appeared to reach a performance plateau within a few training sessions. Conclusions. FES-supported interval training offers a useful and effective strategy for strength-endurance improvement in the large muscle groups of the lower limb in motor-complete SCI. We believe that this training protocol offers a viable alternative to that of continuous walking training in people with SCI using FES to aid ambulation.
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Objectives. This technical report provides a detailed description of a method of transforaminal nerve root stimulation useful in the treatment of chronic pain conditions. Material and Methods. We describe a patient who presented with a medically refractory peripheral neuropathy and suffered from bilateral foot pain. We utilized transforaminal nerve root stimulation to provide robust stimulation paresthesias to the painful areas. ⋯ Results. The patient experienced appropriate pain relief after the stimulation and did not have any complications related to the procedure. Conclusions. We describe a method of transforaminal nerve root stimulation that can be easily implemented by providers using the standard tools available to them. Transforaminal nerve root stimulation may be appropriate for patients in whom more traditional approaches such as spinal cord stimulation or peripheral nerve stimulation are suboptimal.
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Objective. The aim of the present study was to describe the surgical and clinical outcomes of the implantation and stimulation of the pedunculopontine tegmental nucleus in humans. Materials and Methods. Fourteen patients affected by movement disorders (12 Parkinson's disease and 2 progressive supranuclear palsy) underwent surgery for bilateral or monolateral implantation of stimulating electrodes in the pedunculopontine tegmental nucleus. The correct placement of electrodes was established and verified by combining angio-CT scans with magnetic resonance imaging. ⋯ The correct positioning of stimulating electrodes in pontine structures such as the pedunculopontine nucleus may be ascertained not only through neuroimaging techniques but also through clinical neurophysiology. The evolution of the surgical planning that we have developed emphasizes the limited value of single-unit recordings to identify the pedunculopontine tegmental nucleus and highlights the opportunities offered by functional evaluations of neurophysiologic parameters. As far as the clinical efficacy is concerned, our data suggest a promising outcome for simultaneous implantations of different basal ganglia nuclei in Parkinsonian and in progressive supranuclear palsy patients as well.
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Ultrasound-Guided Localization of Difficult-to-Access Refill Port of the Intrathecal Pump Reservoir.
Introduction. Ultrasound guidance is being increasingly utilized in many chronic pain interventions. This is a report of the use of ultrasound imaging for accessing an intrathecal pump. Case Report. A 56-year-old patient with a programmable implanted intrathecal drug delivery system for chronic non-malignant pain needed a pump refill of sufentanil. ⋯ As the patient continued to have a collection of fluid during his following visit, the collection was aspirated under ultrasound guidance. The specimen revealed a proteinaceous collection with minimal quantities of sufentanil. Conclusion. This is a successful demonstration of ultrasound guidance to facilitate access to a difficult-to-access refill port of a pump reservoir secondary to the formation of a seroma.
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Objectives. Post-herpetic neuralgia (PHN) is a painful complication of herpes zoster infection and a common cause of chronic severe pain in elderly and/or debilitated patients. Although a wide range of treatments have been tried, a substantial number of patients continue to experience pain which remains refractory to all therapies. Increasingly, studies have demonstrated that oral opioids can have a beneficial effect on neuropathic pain. ⋯ Patients most commonly reported improvement in the deep component of their pain, next allodynia, and less so superficial lancinating pain. Conclusions. In conclusion, while a complex therapy, long-term use of intrathecal opioids is well tolerated, doses are titratable, administration is safe, and may help relieve severe short- and long-term neuropathic pain in selected PHN patients. Whether the addition of newer investigational intrathecal agents could improve these results is yet to be determined.