Neuromodulation : journal of the International Neuromodulation Society
-
An isokinetic functional electrical stimulation leg cycle ergometer (iFES-LCE) was developed for individuals with spinal cord injury (SCI). The iFES-LCE was designed to allow cycle training over a broad range of pedalling cadences (5-60 rev/min) to promote both muscular strength and cardiorespiratory fitness. A commercially available motorized cycle ergometer was integrated with a custom built FES system, a laptop computer, and a specialized chair that restricted lateral leg movements. ⋯ The iFES-LCE was shown to work well across a range of pedaling cadences. We conclude that the new iFES-LCE system may offer improved training potential by allowing cycling over a broad range of pedaling cadences, especially low cadence. This device also improves upon the accuracy of other ergometers by adjusting for the passive load of the legs.
-
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 compression from catheter tip granulomatous masses following intrathecal drug administration may produce devastating permanent neurologic deficits. Some authors have advocated intrathecal catheter placement below the conus medullaris to avoid the possibility of spinal cord involvement. Multiple cases of catheter tip granulomas in the thoracolumbar region have been reported. ⋯ Histologic examination of the mass confirmed a sterile inflammatory mass. It has been suggested that intrathecal catheters be placed below the conus medullaris to avoid the possibility of spinal cord involvement. We present an unusual case documenting devastating permanent neurologic deficits from a catheter tip granuloma in the sacral region.