Applied neurophysiology
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Applied neurophysiology · Jan 1979
Case ReportsEffect of dorsal column stimulation on pain-induced intracerebral impulse patterns.
Evoked electrical potentials were recorded via intracerebral electrodes in a patient with stump and phantom limb pain who had a previously implanted dorsal column stimulator. When pain was elicited by peripheral stimulation it was found that positive deflections appeared in the ventrolateral nucleus of the thalamus at time latencies corresponding to the propagation velocities of A delta- and C-fibres. Dorsal column stimulation completely eliminated the C-fibres. Dorsal column stimulation completely eliminated the C-fibre deflection and partially eliminated the A delta-fibre deflection.
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Applied neurophysiology · Dec 1978
ReviewAdverse effects of electrical energy applied to the nervous system.
Neural prostheses activated by radiofrequency transmission are currently being implanted to treat a variety of clinical problems. It is essential that neither the materials used in these prostheses, particularly the electrodes, nor the stimulus parameters that are employed will cause neural damage. The experiences of investigators engaged in both the experimental laboratory and clinical studies of the effects of electrical stimulation are reported herein.
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Applied neurophysiology · Dec 1978
Chronic dorsal column stimulation via percutaneously inserted epidural electrodes. Preliminary results in 31 patients.
31 patients suffering from intractable pain associated with chronic low back syndrome, terminal cancer, and other disorders have been studied after an average 6 months' treatment by electrical stimulation of the spinal cord applied via electrodes inserted through a Tuohy needle into the epidural space. As judged by three different subjective rating methods, epidural stimulation successfully relieved otherwise intractable chronic pain in from 23 to 26 of the 31 patients. ⋯ Spontaneous electrode displacements, leading to loss of analgesia and requiring minor surgery for repositioning, were encountered frequently, as were lead wire failures necessitating replacement. The partially implanted, externally powered stimulation system presently in use also suffers from problems of reliability and convenience to the patient.
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Applied neurophysiology · Dec 1978
Safety and clinical efficacy of implanted neuroaugmentive spinal devices for the relief of pain.
When applied under the circumstances of minimal patient risk, as documented in this paper, implanted neuroaugmentive spinal devices are a reasonable means of therapy for selected severe pain problems. With presently developed screening techniques, a 50% good-to-excellent result was obtained in 198 patients predominently consisting of 'failed back surgery syndrome' (94%). These figures represent a very significant improvement in success of treatment for this group of patients when compared to other present modes of therapy. With continued optimization of the use of spinal neuroaugmentive devices, it is likely that future clinical success can be significantly improved.
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Indications, technical procedures, and complications are discussed for the performance of thermal electrocoagulation of the trigeminal preganglionic rootlets and gasserian ganglion. Specific steps in preoperative evaluation, premedication, anesthetic management, and technical performance of graded lesion-making utilizing radiographic control, physiologic stimulation and intraoperative patient monitoring are discussed. A survey of complications is presented.