Neuromodulation : journal of the International Neuromodulation Society
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Background. Expert panels of physicians and nonphysicians, all expert in intrathecal (IT) therapies, convened in the years 2000 and 2003 to make recommendations for the rational use of IT analgesics, based on the preclinical and clinical literature known up to those times, presentations of the expert panels, discussions on current practice and standards, and the result of surveys of physicians using IT agents. An expert panel of physicians and nonphysicians has convened in 2007 to update information known regarding IT therapies and to update information on new and novel opioid and nonopioid analgesic compounds that might show promise for IT use. ⋯ Results. The panelists identified several agents that were worthy of future studies for the clinical and rational use of IT agents that are presented in this article. Conclusions. A list of nonopioid IT analgesics, including gabapentin, adenosine, octreotide, the χ-conopeptide, Xen2174, the conopeptide, neurotensis 1 agonist, CGX-1160, the ω-conotoxin, AM-336, and physostigmine, were identified as worthy of future research by the panelists.
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Objective. Deep brain stimulation (DBS) increasingly attracts attention as a potential treatment of mental disorders. Beside depression and obsessive-compulsive disorders, DBS has already been shown to be beneficial for Tourette syndrome (TS). Clinical Presentation/Method. The authors report on the outcome of a patient with treatment-resistant TS who underwent bilateral DBS of the nucleus accumbens and the internal capsule. ⋯ Yet, as a side-effect of DBS, the patient developed a transient manic-like episode when primarily stimulated by the most proximally contact in the internal capsule. Conclusions. This case supports the hypothesis that DBS of the nucleus accumbens and the internal capsule represents an effective therapeutic alternative for otherwise treatment-resistant TS. Yet, future controlled studies are needed to determine optimal stimulation parameters and to reduce negative side-effects such as transient hypomanic episodes.
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Objectives. This study aims to assess tolerability and efficacy of stimulation parameters after vagus nerve stimulator (VNS) pulse generator replacement. Materials and Methods. We carried out an observational, retrospective study, reviewing our experience with VNS generator replacements in 28 epilepsy patients. Results. Seven patients had actual end of battery life (EOBL) (with symptoms), and 21 patients had asymptomatic projected EOBL. ⋯ Failure to return to baseline current was not related to previous VNS duration, same- vs. different-battery generator replacements, or antiepileptic medication changes. Conclusions. After VNS generator replacement, patients' common inability to tolerate preoperative current settings does not lead to more seizures. A chronic modification of the vagus nerve system's sensitivity to stimulation changes may be hypothesized.
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Background. Expert panel of physicians and nonphysicians, all expert in intrathecal (IT) therapies, convened in the years 2000 and 2003 to make recommendations for the rational use of IT analgesics based on the preclinical and clinical literature known up to those times, presentations of the expert panel, discussions on current practice and standards, and the result of surveys of physicians using IT agents. An expert panel of physicians and convened in 2007 to review previous recommendations and to form recommendations for the rational use of IT agents as they pertain to new scientific and clinical information regarding the etiology, prevention and treatment for IT granuloma. ⋯ Focused discussions concerning the rational use of IT agents and its relationship to the etiology of, prevention of, and treatment of IT granuloma were held. Results. This report presents here new knowledge of the etiology of catheter tip granuloma and guidelines for its prevention and treatment.
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Objectives. The study aims to assess the safety and efficacy of intrathecal (IT) ziconotide when delivered via an external infusion system. Materials and Methods. Patients with severe chronic pain were implanted with an external infusion system, and IT ziconotide was titrated over one to four weeks. Safety was evaluated via adverse event (AE) reports, and efficacy measures included the visual analog scale of pain intensity (VASPI), categorical pain relief scale (CPRS), and clinical global impression (CGI). ⋯ A significant (p ≤ 0.005) median percentage improvement in VASPI scores was seen at week 1 and maintained through week 4 (range: 11.0-32.6%); 53.6% of patients reported good to excellent pain control on the CGI and 52.2% of patients reported moderate to complete pain relief on the CPRS. Conclusions. The study results suggest that a short-term trial of IT ziconotide using an external infusion system may be sufficient to assess patient response. High rates of AEs were noted; however, ziconotide-related AEs were consistent with those reported in previous trials.