Neuromodulation : journal of the International Neuromodulation Society
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Objective. Classically, a decerebrated animal by mesencephalic lesioning is considered the paradigm for experimental study of spasticity that accompanies cerebral palsy, but, the model does not actually correspond with anatomical and pathologic realities. Therefore, a new and novel animal model is needed. Our objective was to create a more adapted animal model to be used in neuromodulation and functional electrical stimulation research. ⋯ Conclusions. This animal model presents anatomic similarities to lesions currently present in cerebral palsy and related diseases. The model also shows electrophysiologic differences that signal chronic brain damage. Therefore, this method is useful in research when spastic syndromes produced by upper motor lesions need to be modeled.
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Evidence-based medicine is gaining increasing penetrance in the United States. Neuromodulation providers need to know how to use this resource and how to get what we do appropriately evaluated and included in structured reviews and meta-analyses. Randomized clinical trials are not the only form of evidence for patient care activities; other, equally valid strategies are available and should be used for interventions that may preclude blinding and randomization. Those who determine payment are going to use evidence-based medicine to make decisions that may not be in the best interests of our patients or our profession.
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Objectives. The probability of success with spinal cord stimulation (SCS) depends largely on appropriate patient selection. Here, we have assessed the predictive value of pain etiology as it relates to pain relief with SCS as part of a prospective multicenter clinical trial. Methods. Sixty-five subjects with chronic and intractable pain tested an epidural SCS system. ⋯ No predictive value of pain etiology was observed. Conclusions. Spinal cord stimulation is an effective therapy for neuropathic pain arising from a variety of causes. Failed back surgery syndrome, complex regional pain syndrome, and pain of other etiologies responded equally well to SCS.
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Objective. In a randomized controlled trial comparing manual with automated computerized adjustment of spinal cord stimulators in patients with implanted power generators, automated adjustment conferred the following advantages: 1) more settings tested in a given time, 2) significantly greater pain/paresthesia overlap, 3) increased battery life, and 4) a $303,756 (95% confidence intervals = $116,503-491,009) reduction in lifetime per patient cost. The current study analyzes the sensitivity of this cost-savings to usage time/day, inflation, discount rate, and years of use. ⋯ This savings is attributable to increased battery life. Conclusion. Sensitivity analyzes reveal that the significant cost-savings achieved with computerized, patient-directed adjustment of spinal cord stimulation in selected patients with chronic pain is robust across a representative range of parameters.
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Long-term outcomes of 115 patients treated with continuous intrathecal baclofen infusion are reported. A prospective follow-up study was conducted in eight centers. Patients were followed up over a 12-month period. ⋯ Types of adverse events reported were wound complications (22%), catheter problems (36%), cerebrospinal fluid leakage (25%), and other complications (17%). Intrathecal baclofen reduces spasticity and severity of patient-reported problems but its effect on quality of life and functionality is less apparent. Improvements are desired in selection criteria, design of spinal catheters, and outcome scales.