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1.
Neuromodulation ; 18(7): 610-6; discussion 616-7, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26268453

RESUMEN

OBJECTIVES: Phantom limb pain (PLP) is a neuropathic condition in which pain is perceived as arising from an amputated limb. PLP is distinct from, although associated with, pain in the residual limb and nonpainful phantom sensations of the missing limb. Its treatment is extremely challenging; pharmaceutical options, while commonly employed, may be insufficient or intolerable. Neuromodulatory interventions such as spinal cord stimulation have generated mixed results and may be limited by poor somatotopic specificity. It was theorized that dorsal root ganglion (DRG) neuromodulation may be more effective. MATERIALS AND METHODS: Patients trialed a DRG neurostimulation system for their PLP and were subsequently implanted if results were positive. Retrospective chart review was completed, including pain ratings on a 100-mm visual analogue scale (VAS) and patient-reported outcomes. RESULTS: Across eight patients, the average baseline pain rating was 85.5 mm. At follow-up (mean of 14.4 months), pain was rated at 43.5 mm. Subjective ratings of quality of life and functional capacity improved. Some patients reduced or eliminated pain medications. Patients reported precise concordance of the paresthesia with painful regions, including in their phantom limbs; in one case, stimulation eliminated PLP as well as nonpainful phantom sensations. Three patients experienced a diminution of pain relief, despite good initial outcomes. CONCLUSIONS: DRG neuromodulation may be an effective tool in treating this pain etiology. Clinical outcomes in this report support recent converging evidence suggesting that the DRG may be the site of PLP generation and/or maintenance. Further research is warranted to elucidate mechanisms and optimal treatment pathways.


Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Ganglios Espinales/fisiología , Miembro Fantasma/terapia , Adulto , Anciano , Femenino , Fluoroscopía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Escala Visual Analógica
2.
Pain Pract ; 15(4): 293-9, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24690212

RESUMEN

BACKGROUND: Spinal cord stimulation (SCS) is a standard treatment option for chronic neuropathic pain. However, some anatomical pain distributions are known to be difficult to cover with traditional SCS-induced paresthesias and/or may also induce additional, unwanted stimulation. We present the results from a retrospective review of data from patients with groin pain of various etiologies treated using neuromodulation of the dorsal root ganglion (DRG). METHODS: Data from 29 patients with neuropathic groin pain were reviewed. Patients underwent trial therapy where specifically designed leads were implanted at the target DRGs between T12 and L4. Patients who had a successful trial (> 50% improvement) received the fully implantable neuromodulation system. Pain scores were captured on a visual analog scale (VAS) at baseline and at regular follow-up visits. RESULTS: Twenty-five patients (86.2%) received fully implantable neurostimulators, and the average follow-up period was 27.8 ± 4.3 (standard error of the mean, SEM) weeks. The average pain reduction was 71.4 ± 5.6%, and 82.6% (19/23) of patients experienced a > 50% reduction in their pain at the latest follow-up. Individual cases showed improvement with a variety of etiologies and pain distributions; a subanalysis of postherniorrhaphy cohort also showed significant improvement. CONCLUSIONS: Early findings suggest that neuromodulation of the DRG may be an effective treatment for chronic neuropathic pain conditions in the groin region. This technique offers a useful alternative for pain conditions that do not always respond optimally to traditional SCS therapy. Neuromodulation of the DRG provided excellent cross-dermatomal paresthesia coverage, even in cases with patients with discrete pain areas. The therapy can be specific, sustained, and independent of body position.


Asunto(s)
Ganglios Espinales , Dolor Pélvico/diagnóstico , Dolor Pélvico/terapia , Estimulación de la Médula Espinal/métodos , Estudios de Cohortes , Femenino , Ganglios Espinales/fisiología , Ingle , Humanos , Masculino , Persona de Mediana Edad , Neuralgia/diagnóstico , Neuralgia/terapia , Dimensión del Dolor/métodos , Estudios Retrospectivos , Resultado del Tratamiento
3.
Acta Neurochir (Wien) ; 151(6): 663-7; discussion 667, 2009 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-19373432

RESUMEN

BACKGROUND: The authors investigated the possibility of improving positioning of stimulation leads in patients with chronic neuropathic peripheral nerve pain and good pain relief from implantation of a peripheral nerve stimulator (PNS). METHODS: This pilot study includes four patients suffering from Chronic Regional Pain Syndrome type II (CRPS II) or neuropathic mononeuropathy treated with PNS therapy. The affected extremities and corresponding implantation sites were examined using computer tomographic scans (CT), additional CT angiography (CTA), reconstruction techniques and postprocessing procedures. RESULTS: It was possible to prove a close relation between the implanted device and the neurovascular bundle in each of these cases. Thus, indirect lead position control was obtained. CONCLUSIONS: Computer tomographic techniques represent a reliable method for the position control of implanted peripheral nerve electrodes. Hence, this procedure should surpass general radiographies in detecting lead displacements.


Asunto(s)
Angiografía/métodos , Terapia por Estimulación Eléctrica/métodos , Nervios Periféricos/irrigación sanguínea , Nervios Periféricos/diagnóstico por imagen , Enfermedades del Sistema Nervioso Periférico/terapia , Tomografía Computarizada por Rayos X/métodos , Anciano , Vasos Sanguíneos/anatomía & histología , Enfermedad Crónica/terapia , Terapia por Estimulación Eléctrica/instrumentación , Electrodos Implantados , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio/métodos , Neuralgia/fisiopatología , Neuralgia/terapia , Procedimientos Neuroquirúrgicos/métodos , Nervios Periféricos/cirugía , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Enfermedades del Sistema Nervioso Periférico/cirugía , Proyectos Piloto
4.
Childs Nerv Syst ; 23(8): 907-12, 2007 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-17440736

RESUMEN

CASE REPORT: The reported female patient underwent sub-total resection of an intra-medullary cervicothoracic astrocytoma classified as WHO grade II in 1984 at the age of 18 months and received local irradiation. In 1989, a local recurrence was diagnosed and a partial resection was performed. Sixteen years later, a small recurrent cervicothoracic tumour was found and spinal seeding to the equine nerve roots and the left cerebellar cortex was apparent on MRI. The patient was implanted with a ventriculoperitoneal shunt for a pseudo-tumour cerebri producing papilloedema, which eventually lead to amaurosis. After an extended biopsy, the invasive lumbosacral tumour was classified as glioblastoma multiforme. Two months later, the patient died after rapid progression of the caudal cranial nerve dysfunction. DISCUSSION AND CONCLUSION: Anaplastic progression and dissemination of spinal astrocytomas even two decades after initial diagnosis and treatment are rare. Therapies and diagnostic follow-up strategies are discussed.


Asunto(s)
Astrocitoma/complicaciones , Glioblastoma/complicaciones , Neoplasias Meníngeas/complicaciones , Neoplasias de la Médula Espinal/complicaciones , Adulto , Astrocitoma/patología , Dolor de Espalda/etiología , Ceguera/complicaciones , Ceguera/patología , Derivaciones del Líquido Cefalorraquídeo , Ojo/patología , Resultado Fatal , Femenino , Glioblastoma/patología , Humanos , Lordosis/etiología , Imagen por Resonancia Magnética , Neoplasias Meníngeas/patología , Enfermedades del Sistema Nervioso Periférico/complicaciones , Hipófisis/patología , Seudotumor Cerebral/patología , Seudotumor Cerebral/fisiopatología , Neoplasias de la Médula Espinal/patología
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