Neuromodulation : journal of the International Neuromodulation Society
-
The objective of this study was to assess the usability and safety of BION injectable neuromuscular microstimulators for therapeutic electrical stimulation (TES) to treat two conditions involving disuse atrophy: poststroke shoulder subluxation in hemiplegic subjects and knee osteoarthritis. Clinicians were provided with PC-based software to track implants and to design the exercise programs. Subjects self-administered TES (3 sessions/day, 10-30 min/session) for 6 or 12 weeks. ⋯ The devices did not migrate and did not cause inflammation or pain. Thresholds were stable over time. We conclude that the use of BION implants to exercise atrophic muscles was well-accepted and provided effective rehabilitation in these two clinical conditions.
-
Hypothalamic deep brain stimulation for the treatment of chronic cluster headaches: a series report.
The objective of this study was to introduce a new surgical treatment for drug-resistant chronic cluster headaches (CH). Because recent functional studies suggested that a hyperactivity of the posterior hypothalamus might be the primary cause of Cluster Headaches (CH) bouts, we designed a prospective study to explore the therapeutic effectiveness of chronic high-frequency stimulation of this region for the treatment of CH. Nine electrodes were stereotactically implanted in the posterior hypothalamus in eight patients suffering from intractable chronic CH. ⋯ Tolerance was not observed. We conclude that these preliminary results indicate that hypothalamic stimulation is safe and effective for the treatment of drug-resistant, chronic CH. In addition, these data confirm the "central" pathogenesis for chronic CH.
-
Internally powered, implanted pulse generators (IPGs) have been an important advance in spinal cord stimulation for the management of pain, but they require surgical replacement, with attendant cost and risk, when the implanted battery is depleted. Battery life is determined by the programmed settings of the implant, but until now the technical means to optimize settings for maximal battery life, delaying surgical replacement as long as possible, Materials and Methods. We have developed a patient-interactive, computerized programmer for use with IPGs. It has been designed for easy operation and comprehensive data management, which have not been features of the standard programmers available until now. ⋯ We conclude that significant potential savings in longevity of the implanted battery are possible in the majority of patients with implanted spinal cord stimulators, but have not been realized until now for lack of appropriate methods. Computerized, patient-interactive programming addresses this problem and allows optimization of estimated battery life along with other treatment goals. Long-term clinical followup will be required to establish the full magnitude of the resulting savings.
-
Spinal cord stimulation (SCS) is a popular method of treatment of chronic pain. Unfortunately, migration of the lead continues to be a serious complication of this therapy. ⋯ The use of "midline anchoring" resulted in a decrease in lead migration from 23% to 6% after trial insertion and from 24% to 7% after implantation. We conclude that "midline anchoring" of the SCS lead is an effective method of preventing lead migration.
-
Deep brain stimulation (DBS) therapy is a continually expanding field of functional neurosurgery for the treatment of movement disorders and neuropathic pain. However, occurrence of adverse events related to implanted hardware cannot be ignored, particularly in patients with dystonic conditions. We report on two such patients who required emergency hospital admission and pulse generator re-implantation following sudden and unexpected cessation of DBS effectiveness resulting from battery failure.