Neuromodulation : journal of the International Neuromodulation Society
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Objectives. To document epileptiform discharges recorded within a mammillary body (MB) of a patient with chronic refractory epilepsy (CRE). Materials and Methods. A 37-year-old man, whose epilepsy was not controlled by medication or vagus nerve stimulation, was enrolled in a study of the effects of deep brain stimulation of the MB and mammillothalamic tract (MTT) in CRE. Surface and deep EEG recordings were obtained for 3 days before implantation of the macroelectrodes and for 4 days after implantation of the macroelectrodes but before implantation of the stimulator battery. ⋯ When these discharges were longer than 100 sec, they spread to the right MTT area and then to the left MB and MTT area. Simultaneously, the patient became agitated and confused. Conclusions. This original observation indicates that subcortical neuronal structures, such as the MB, may sustain epileptiform discharges in humans.
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Objectives. Electric peripheral nerve stimulation (PNS) is a neuromodulatory therapy in pain patients. The efficacy of this neurosurgical pain treatment is controversial because its antinociceptive effect in humans has not been objectively proven so far. Materials and Methods. Noxious infrared laser stimulation of the left hand dorsum evoked cortical potentials (LEP) by selective excitation of Aδ-fiber nociceptors in 15 healthy volunteers under control and PNS conditions. ⋯ Results. During PNS, LEP amplitudes (p < 0.001) and laser intensity ratings (p < 0.05) significantly decreased, and LEP latencies significantly increased (p < 0.05). Under control conditions LEP and intensity ratings remained unchanged. Conclusions. The electrophysiologic data provide evidence that electric stimulation of peripheral Aβ-fibers reliably suppresses Aδ-fiber nociceptive processing in human volunteers.
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A new neuroimplant system, namely the Tulgar implant, developed to solve the practical problems encountered with the presently available implants, was tested as a spinal cord stimulator in ten sheep. The response of living tissue and technical performance of the new system were evaluated. ⋯ Animal tests showed that the new system could reliably be implantable in the living tissue. Intra-operative radicular stimulation of the right dorsal root in T13-L1 levels, by means of burst mode of signals, resulted in observable contractions of hip muscles in the right upper leg.
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Objectives. Recent publications on dual program spinal cord stimulation (SCS) system demonstrate more flexible electrode programming, which helps to steer paresthesias towards all of the affected areas including the low back area. Materials and Methods. The following data were retrospectively sought from 20 nonrandomized failed back surgery patients at two centers treated by a dual quadripolar surgically implanted SCS lead: pain and paresthesia, VAS ratings, medication use, sleep patterns, daily activities, hardware problems, and willingness to repeat the procedure. The data were analyzed by the Wilcoxon signed rank test (p value < 0.05). ⋯ The number of patients taking benzodiazepines decreased. Sixty percent reported increased participation in social activities. Conclusions. This dual program surgical SCS technique is simple, respects patients' autonomy, and provides adequate analgesia with an increase in quality of life.