Neuromodulation : journal of the International Neuromodulation Society
-
Intractable neuropathic facial pain resulting from injury to the peripheral branches of the trigeminal nerve presents a significant challenge for neurologists, pain specialists, and neurosurgeons. In this paper, we describe our technique of peripheral nerve stimulation of the infraorbital and supraorbital nerves to treat patients with medically intractable facial pain. Stimulation of the infraorbital and supraorbital nerves is performed using percutaneously inserted electrodes that are positioned in the epifascial plane, traversing the course of the infraorbital or supraorbital nerves. ⋯ In patients who underwent permanent electrode implantation, stimulation resulted in long lasting pain relief; complications were rare and minor. We conclude that trigeminal branch stimulation is a simple technique that can be used in selected patients with neuropathic pain in the distribution of the infraorbital or supraorbital nerves. This procedure may provide relief of medically intractable pain, without the need for destructive procedures or more central modulation approaches.
-
During the course of rehabilitation hemiplegic patients who have Chedoke McMaster Stages of Motor Recovery scores 4 and 5 measured three weeks after onset of stroke often improve their arm and hand function to the point that they can later use it in the activities of daily living (ADL) (1). These patients can be considered to have mild arm and hand paralysis since they can grasp objects and manipulate them with minor restrictions in the range of movement and force. On the other hand, hemiplegic patients who have Chedoke McMaster Stages of Motor Recovery scores 1 and 2 measured three weeks after onset of stroke, during the course of rehabilitation seldom improve their arm and hand function, and when they do, the improvements are not sufficient to allow these patients to use the arm and hand in ADL (1). ⋯ The treated and control patients had approximately the same time allocated for arm and hand therapy. After the treatment program was completed, the patients treated with the neuroprosthesis significantly improved their reaching and grasping functions and were able to use them in ADL. However, the majority of the control patients did not improve their arm and hand functions significantly and were not able to use them in ADL.
-
We present here a descriptive article on the development of a national quality system for neuromodulatory techniques in the Netherlands. In 1994, due to reimbursement difficulties in the Netherlands, a Neuromodulation Working Group (WGN) undertook an initiative to develop a national quality system for neuromodulation. It was believed that with official recognition of neuromodulation as a therapy by the health authorities in the Netherlands, a quality system for monitoring would then follow. ⋯ We therefore conclude that developed quality systems can provide a basis for medical specialists to cooperate around groups of patients or diseases. These quality systems can facilitate implementation and innovation within the health care system. The role of medical specialists and their will to cooperate is essential.
-
Introduction. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and of the pars interna of Globus Pallidus (GPi) is used to improve parkinsonian symptoms and attenuate levodopa-induced motor complications in Parkinson's disease (PD) (DBS for PD study group, 2001). It is still not clear what the best anatomic structures to stimulate are or what the physiologic effects of DBS are. ⋯ Most patients remained were chronically treated with bilateral stimulation of both targets. Conclusion. We conclude that DBS of STN and GPi was effective, with most patients treated chronically with both targets stimulated.
-
The objective of this study was to objectively assess the physical activity of daily living in chronic pain patients treated with spinal cord stimulation (SCS). Changes in pain and spontaneous physical activity following SCS were evaluated under real life conditions. Five series of measurements were performed before the implant (baseline) and at one, three, six, and 12 months after the implantation of an SCS system. ⋯ The average total walking distance increased up to 389% at 12 months, reaching statistical significance (p < 0.05) after three months. The stride length and the speed increased (p < 0.01) at all times. We conclude that the reduction in pain intensity due to SCS is associated with a progressive and sustained improvement in physical activity. j.