Neuromodulation : journal of the International Neuromodulation Society
-
Objectives. The purpose of this research was to understand the effects of surface functional electrical stimulation (FES) of the tibial nerve on the activation of the gastrocnemius medialis of the stimulated side. Methods. FES was carried out on six healthy subjects, initiated at three different times during gait: early, mid, and late stance. Each stimulation burst consisted of 15 pulses, applied for 300 msec, at 50 Hz stimulation frequency. ⋯ The most prominent effects found in the intervals between the stimulation pulses (interpulse intervals) were found when stimulation was applied early in the stance phase. This study revealed that the only statistically significant effect on burst timing was a delay in offset timing due to mid-timed stimulation. Conclusions. We conclude that additional activation may have been compensated, at least in part, by blocking of the physiological activation during the stimulation burst.
-
Background. The treatment of chronic low back and leg pain remains a difficult medical challenge, particularly for patients with postlaminectomy syndrome. While spinal cord stimulation (SCS) has been a significant addition to the available options, it is often inadequate in relieving both the back and leg pain components. We hypothesized that for some patients the combination of SCS with peripheral nerve field stimulation (PNFS) would be a safe, effective alternative that would be more effective than either modality alone. ⋯ Conclusions. Due to the availability of 16 contact capacity generators, neurostimulation with multiple leads in various combinations-including both epidural and peripheral nerve field stimulation simultaneously-can be applied safely and effectively. The availability of this combined approach for a trial of stimulation prior to implant allows patients to compare SCS to PNFS and to indicate a preference for one over the other or for the combination. We conclude that PNFS may be used in combination with SCS as a safe and effective alternative treatment for patients with chronic low back and leg pain, and further suggest that the combined approach should be considered as a treatment option for this population.
-
Subcutaneous targeted neuromodulation is one part of the wider new peripheral neuromodulation development in the treatment of neuropathic pain. Although it has not received wider acceptance, there are many reports in the literature of successful use of this technique.
-
Objectives. Identification, delimitation, and stereotactic localization of the human nucleus accumbens (Acc) in order to allow its accurate definition and three-dimensional targeting on magnetic resonance imaging (MRI) enabling its use for deep brain stimulation. Methods. Magnetic resonance imaging and anatomical coronal serial cuts were performed on 24 Acc from human cadaver brains perpendicular to the anterior commissure-posterior commissure line; identification, localization, and determination of its dimensions and three-dimensional stereotactic coordinates. ⋯ The stereotactic coordinates were obtained every millimeter along its length. Conclusion. It was possible to identify well the human Acc, define its limits and establish its three-dimensional coordinates as potential MRI-guided stereotactic target.
-
Objectives. In spinal cord stimulation (SCS) therapy, limited pain relief during the temporary trial period is generally considered to be predictive of poor long-term benefit. To validate or refute this perception, the long-term outcomes of subjects who reported less than 50% pain relief during a temporary SCS trial were examined. Materials and Methods. Twelve subjects with intractable pain underwent implantation of trial SCS systems. ⋯ SCS appears to be a viable treatment option for patients who fail trials, raising some doubt as to the predictive sensitivity and specificity of the trial period. Thus, although outcome of a temporary trial period may be suggestive of later efficacy with SCS, it may not be the sole predictor of success. Alternatively, the arbitrary benchmark of 50% pain relief that is typically used to define the success of a temporary trial may be too stringent and unreliable.