Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialDiaphragm pacing with a spinal cord stimulator: current state and future directions.
Diaphragm pacing with electrical stimulation of the phrenic nerve is an established treatment for central hypoventilation syndrome. The device, however, is not readily available. We tested the same spinal cord stimulator we use for pain control in phrenic nerve stimulation. ⋯ The amplitude of the output was adjusted to obtain sufficient tidal volume and to maintain PaCO2 at around 40 mm Hg. During a follow-up period up to four years, stable and sufficient ventilation was observed in all patients without any complications. Although further long follow-up is necessary, diaphragm pacing with the spinal cord stimulator is feasible and effective for the treatment of the central hypoventilation syndrome.
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Acta Neurochir. Suppl. · Jan 2007
Neuromodulatory approaches to chronic pelvic pain and coccygodynia.
Intractable chronic pelvic pain (CPP) despite a multidisciplinary approach is challenging to treat. Every structure in the abdomen and/or pelvis could have a role in the etiology of CPP. Management of chronic pelvic pain may require a combination of interventions, including pharmacological, physical and psychological therapy. ⋯ Targeted and PNS probably are underused treatment modalities given the simplicity of the technique. The introduction of a stimulating electrode directly to the center of peripherally affected, painful areas, thereby bypassing the spinal cord and peripheral nerves is a novel simple procedure with effectiveness in the control of intractable neuropathic pain. Development of newer devices and miniaturization of electrodes will play a role in refinement and further simplification of subcutaneous neuromodulation.
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialSpinal cord stimulation for the treatment of chronic non-malignant pain.
Over the past four decades, techniques and devices for spinal cord stimulation have undergone considerable refinement. Currently, percutaneous implantable electrodes are placed in the epidural space and a low-frequency electrical current is used to modify the transmission of chronic pain signals in the dorsal columns of the spinal cord. Before permanent implantation, the spinal cord stimulation will be examined during a test phase to determine its analgesic effect and tolerability. ⋯ At the end of the follow-up period, 50% of the patients were in a better psychological status and 86% of the patients reported an improvement in activities of their daily living and a reduction in the use of analgesic medication. Ninety percent of the patients stated that they would go through the procedure again for the same result. The findings of the present study indicate that spinal cord stimulation is an efficacious therapy for the treatment of chronic non-malignant pain.
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Acta Neurochir. Suppl. · Jan 2007
ReviewStimExplorer: deep brain stimulation parameter selection software system.
StimExplorer is a Windows-based software package intended to aid the clinical implementation of deep brain stimulation (DBS) technology. StimExplorer uses detailed computer models to provide a quantitative description of the 3D volume of tissue activated (VTA) by DBS as a function of the stimulation parameters and electrode location within the brain. The stimulation models are tailored to the individual patient by importing their magnetic resonance imaging (MRI) data and interactively scaling 3D anatomical nuclei to fit the patient anatomy. ⋯ The software then provides theoretically optimal stimulation parameter suggestions, intended to represent the start point for clinical programming of the DBS device. The software system is packaged into a clinician-friendly graphical user interface that allows for simultaneous interactive 3D visualization of the MRI, anatomical nuclei, DBS electrode, and VTAs for a wide range of stimulation parameter settings (contact, impedance, voltage, pulse width, and frequency). The goals of the StimExplorer system are to educate clinicians on the impact of stimulation parameter manipulation, and improve therapeutic outcomes by providing quantitative anatomical and electrical information useful for customizing DBS to individual patients.
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Acta Neurochir. Suppl. · Jan 2007
ReviewElectrical stimulation and gene-based neuromodulation for control of medically-refractory epilepsy.
The failure of available antiepileptic medications to adequately control seizures in a substantial number of patients underscores the need to develop novel epilepsy therapies. Recent advancements in technology and the success of neuromodulation in treating a variety of neurological disorders have spurred interest in exploring promising therapeutic alternatives, such as electrical stimulation and gene-based synaptic control. A variety of different stimulation approaches to seizure control targeting structures in the central or peripheral nervous system have been investigated. ⋯ Gene delivery to epileptogenic targets or targets implicated in regulating seizure threshold has been investigated as an alternative means of neuromodulation in animal models. In summary, positive preliminary results and the lack of alternative treatment options provide the impetus for further exploration of electrical stimulation and gene-based therapies in pharmacoresistant epilepsy. Various specific targets and approaches to modulating their activity have been investigated in human studies.