Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 520
Filtrar
1.
Medicine (Baltimore) ; 99(12): e19541, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195960

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is a common degenerative joint disorder that affects 250 million people globally. KOA can lead to disability and is often associated with cardiovascular disease, poor quality of life, and mortality. The most common treatment for KOA is non-steroidal anti-inflammatory drug administration. However, the analgesic effect is limited and often accompanied by multiple side effects. Hence, many KOA patients opt for complementary and alternative medicine. Acupuncture is one of the most popular complementary treatments with great analgesic effect and minimal side effect. Electroacupuncture (EA) and laser acupuncture (LA) have been known to reduce pain in KOA patients. However, to date, no study has assessed the benefits of combining these two therapies. METHODS: Fifty participants diagnosed with KOA, aged 50 years or older, and with consistent knee pain for more than 3 months were recruited and randomly assigned to the treatment group (EA plus LA) or control group (EA plus sham LA without laser output). All subjects in the treatment group will undergo a combined EA and LA treatment thrice a week for 4 weeks. The acupuncture will be performed on GB33, GB34, SP9, SP10, and ST36 sites. The treatment group will receive acupuncture with a transcutaneous electrical nerve stimulator at GB33, GB34, SP9, and SP10 sites and with LA at EX-LE5, ST35, and BL40 sites. The subjects in the control group will undergo the same treatment modality as the treatment group, except these subjects will not be exposed to laser output. Outcome measurements will include visual analog scale, Western Ontario McMaster Universities Osteoarthritis Index, Knee injury and osteoarthritis outcome, body composition analysis, knee range of motion, quadriceps muscle stiffness, one-leg standing with eyes open test, and the 30-s chair stand test before and after 4 weeks of intervention. OBJECTIVES: This protocol aims to investigate the combined effect of EA and LA in KOA patients.


Assuntos
Terapia por Acupuntura/métodos , Eletroacupuntura/métodos , Terapia a Laser/métodos , Osteoartrite do Joelho/terapia , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Terapia por Acupuntura/tendências , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Humanos , Joelho/patologia , Terapia com Luz de Baixa Intensidade , Pessoa de Meia-Idade , Osteoartrite do Joelho/radioterapia , Avaliação de Resultados em Cuidados de Saúde , Dor , Manejo da Dor/métodos , Amplitude de Movimento Articular/fisiologia , Taiwan/epidemiologia , Escala Visual Analógica
2.
J Dermatolog Treat ; 31(2): 200-203, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30799667

RESUMO

Introduction: Powered muscle stimulators have been popularized in recent years due to their muscle toning effects. This study aims to describe marketing trends and reporting of adverse effects of powered muscle stimulators.Methods: We performed a cross-sectional retrospective analysis of records from the United States FDA database for 510(k) premarket approval of powered muscle stimulators between January 1, 2000 and December 31, 2018. The FDA MAUDE database was reviewed for adverse events reported with device usage.Results: One hundred and seventeen devices received 510(k) premarket approval between 2000 and 2018, with the first approval occurring in 2001. Initially, devices were marketed to assist with muscle toning and strengthening, but more recent indications include the treatment of pain, increased local muscle blood circulation, and prevention of post-surgical venous thrombosis. Thirty-six adverse event reports have been submitted and published in the MAUDE database over the past 10 years by 11% of manufacturers.Discussion: Powered muscle stimulators are growing increasingly popular amongst consumers and healthcare providers due to their ease of use and perceived esthetic, muscle strength, and pain relief benefits. Additional investigation to determine optimal treatment parameters and potential adverse effects is necessary due to the growing popularity of these devices.


Assuntos
Músculos/fisiologia , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Estudos Transversais , Bases de Dados Factuais , Aprovação de Equipamentos , Estética , Humanos , Estudos Retrospectivos , Estimulação Elétrica Nervosa Transcutânea/métodos , Estados Unidos , United States Food and Drug Administration
3.
Chiropr Man Therap ; 27: 24, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31244992

RESUMO

Background context: Lumbar spinal stenosis (LSS) leads to diminished blood flow to the spinal nerves causing neurogenic claudication and impaired walking ability. Animal studies have demonstrated increased blood flow to the spinal nerves and spinal cord with superficial para-spinal electrical stimulation of the skin. Purpose: The aim of this study was to assess the effectiveness of active para-spinal transcutaneous electrical nerve stimulation (TENS) compared to de-tuned TENS applied while walking, on improving walking ability in LSS. Study design: This was a two-arm double-blinded (participant and assessor) randomized controlled trial. Patient sample: We recruited 104 participants 50 years of age or older with neurogenic claudication, imaging confirmed LSS and limited walking ability. Outcome measures: The primary measure was walking distance measured by the self-paced walking test (SPWT) and the primary outcome was the difference in proportions among participants in both groups who achieved at least a 30% improvement in walking distance from baseline using relative risk with 95% confidence intervals. Methods: The active TENS group (n = 49) received para-spinal TENS from L3-S1 at a frequency of 65-100 Hz modulated over 3-s intervals with a pulse width of 100-200 usec, and turned on 2 min before the start and maintained during the SPWT. The de-tuned TENS group (n = 51) received similarly applied TENS for 30 s followed by ramping down to zero stimulus and turned off before the start and during the SPWT.Study funded by The Arthritis Society ($365,000 CAN) and salary support for Carlo Ammendolia funded by the Canadian Chiropractic Research Foundation ($500,000 CAN over 5 years). Results: From August 2014 to January 2016 a total of 640 potential participants were screened for eligibility; 106 were eligible and 104 were randomly allocated to active TENS or de-tuned TENS. Both groups showed significant improvement in walking distance but there was no significant difference between groups. The mean difference between active and de-tuned TENS groups was 46.9 m; 95% CI (- 118.4 to 212.1); P = 0.57. A total of 71% (35/49) of active TENS and 74% (38/51) of de-tuned TENS participants achieved at least 30% improvement in walking distance; relative risk (RR), 0.96; 95% CI, (0.7 to 1.2) P = 0.77. Conclusions: Active TENS applied while walking is no better than de-tuned TENS for improving walking ability in patients with degenerative LSS and therefore should not be a recommended treatment in clinical practice. Registration: ClinicalTrials.gov ID: NCT02592642. Registration October 30, 2015.


Assuntos
Estenose Espinal/fisiopatologia , Estenose Espinal/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Resultado do Tratamento , Caminhada
4.
Pain Res Manag ; 2019: 5646143, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31198477

RESUMO

Background: Temporomandibular joint dysfunction (TMD) therapy remains an open challenge for modern dentistry. Herein, we propose a new neuromuscular lingual device able to reduce signs and symptoms of TMD in female patients with chronic orofacial pain. Methods: 50 females with myofascial TMD according to RDC/TMD were randomly assigned to study (n = 25) and control groups (n = 25). At T0, both groups received sEMG/KNG and pain evaluation by the VAS scale. The study group received the ELIBA device (lingual elevator by Balercia) constructed under ULF-TENS (ultra-low-frequency transcoutaneous electrical nervous stimulation). Subjects were instructed to use ELIBA at least for 16 h/day. After 6 months (T1), both groups underwent to sEMG/KNG and VAS revaluation. Results: T1 study group compared to controls showed a significant reduction in total (p < 0.0001) and mean (p < 0.0001) sEMG values, as well as a significant increase in both maximum vertical mouth opening (p=0.003) and maximum velocity in mouth opening (p=0.003) and closing (p < 0.0001). Interestingly, a significant reduction in pain measured by VAS (p < 0.0001) was reported. Conclusions: After 6 months, the ELIBA device is able to significantly reduce TMD-associated myogenous pain and to promote the enhancement of sEMG/KNG values. Practical Implications: ELIBA can be considered as a new device, potentially useful for head-neck pain relief in patients suffering from chronic TMD. In addition, its use promotes a muscles relaxation inducing freeway space increase. This characteristic makes it particularly useful for rehabilitation of patients with not enough space for construction of conventional orthotics or neuromuscular bites.


Assuntos
Aparelhos Ortodônticos , Transtornos da Articulação Temporomandibular/terapia , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade
5.
Pain Manag ; 9(4): 347-354, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31099305

RESUMO

Peripheral nerve stimulation or peripheral neuromodulation is a modality utilized for decades to manage chronic pain. There have been recent studies published describing its use in managing acute surgical pain for orthopedic surgery. The postoperative acute pain associated with several types of surgeries often outlasts the analgesia duration provided by single and continuous peripheral nerve blocks. Ultrasound-guided percutaneous peripheral nerve stimulation has the potential to provide much longer analgesia for acute pain while avoiding some limitations associated with local anesthetic-based peripheral nerve blocks. We summarize the current devices used in published studies to demonstrate feasibility with a focus on acute pain control.


Assuntos
Dor Aguda/prevenção & controle , Analgesia/instrumentação , Manejo da Dor/instrumentação , Dor Pós-Operatória/prevenção & controle , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Analgesia/métodos , Humanos , Manejo da Dor/métodos , Nervos Periféricos/fisiopatologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Resultado do Tratamento , Ultrassonografia de Intervenção
6.
Neuromodulation ; 22(6): 709-715, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31039291

RESUMO

BACKGROUND: Lead placement within the sacral foramen in sacral neuromodulation patients is guided by visual assessment of the contraction of the pelvic floor musculature (PFM) and/or verbal assessment of the sensation and location of sensation upon stimulation. Generally, lead placement is proceeded by needle probing. This study evaluates which location inside a single sacral foramen would be most ideal for the release of the permanent electrode lead, by measuring electromyographic (EMG) motor responses of the PFM upon stimulation of a peripheral nerve evaluation (PNE) needle. MATERIALS AND METHODS: In eight patients, four standard PNE needles, and in one patient, two PNE needles, were introduced into the same foramen, parallel to the midline and parallel to each other. Position was verified by X-ray. Needles were stimulated (square pulsed waves, 210 µsec, 14 Hz) at increasing amplitudes (1-2-3-5-7-10 mA). PFM EMG was measured using the Multiple Array Probe (MAPLe) placed intravaginally or intrarectally, with 24 derivations. For this study, the mean (normalized) EMG was taken of all electrodes and different positions within the foramen were compared using the Wilcoxon signed rank test. RESULTS: A total of 202 PFM EMG measurements were recorded upon stimulation. EMG motor responses of the PFM for current stimulation = <2 mA showed statistically significant higher mean (normalized) EMG values for needles positioned cranial, medial, and cranial-medial, in comparison to needles positioned caudal, lateral, and caudal-lateral (p = 0.004; p = 0.021; p = 0.002). CONCLUSIONS: Our data suggest stronger PFM contractions are elicit in cranial- and medial-placed PNE needles upon stimulation with clinically relevant current amplitudes (≤ 2 mA). Placement of the lead should aim for this spot in the foramen.


Assuntos
Eletrodos Implantados , Eletromiografia/métodos , Agulhas , Diafragma da Pelve/fisiologia , Sacro/fisiologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletromiografia/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diafragma da Pelve/diagnóstico por imagem , Diafragma da Pelve/inervação , Sacro/diagnóstico por imagem , Sacro/inervação , Estimulação Elétrica Nervosa Transcutânea/instrumentação
7.
Neuromodulation ; 22(5): 537-545, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30701655

RESUMO

OBJECTIVE: To evaluate the safety and effectiveness of a wrist-worn peripheral nerve stimulation device in patients with essential tremor (ET) in a single in-office session. METHODS: This was a randomized controlled study of 77 ET patients who received either treatment stimulation (N = 40) or sham stimulation (N = 37) on the wrist of the hand with more severe tremor. Tremor was evaluated before and immediately after the end of a single 40-minute stimulation session. The primary endpoint compared spiral drawing in the stimulated hand using the Tremor Research Group Essential Tremor Rating Assessment Scale (TETRAS) Archimedes spiral scores in treatment and sham groups. Additional endpoints included TETRAS upper limb tremor scores, subject-rated tasks from the Bain and Findley activities of daily living (ADL) scale before and after stimulation as well as clinical global impression-improvement (CGI-I) rating after stimulation. RESULTS: Subjects who received peripheral nerve stimulation did not show significantly larger improvement in the Archimedes spiral task compared to sham but did show significantly greater improvement in upper limb TETRAS tremor scores (p = 0.017) compared to sham. Subject-rated improvements in ADLs were significantly greater with treatment (49% reduction) than with sham (27% reduction; p = 0.001). A greater percentage of ET patients (88%) reported improvement in the stimulation group as compared to the sham group (62%) according to CGI-I ratings (p = 0.019). No significant adverse events were reported; 3% of subjects experienced mild adverse events. CONCLUSIONS: Peripheral nerve stimulation in ET may provide a safe, well-tolerated, and effective treatment for transient relief of hand tremor symptoms.


Assuntos
Atividades Cotidianas , Tremor Essencial/diagnóstico , Tremor Essencial/terapia , Nervos Periféricos/fisiologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Atividades Cotidianas/psicologia , Idoso , Idoso de 80 Anos ou mais , Tremor Essencial/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Punho/inervação , Punho/fisiologia
8.
PLoS One ; 14(2): e0212479, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30794630

RESUMO

Transcutaneous electrical nerve stimulation (TENS) allows the artificial excitation of nerve fibres by applying electric-current pulses through electrodes on the skin's surface. This work involves the development of a simulation environment that can be used for studying transcutaneous electrotactile stimulation and its dependence on electrode layout and excitation patterns. Using an eight-electrode array implementation, it is shown how nerves located at different depths and with different orientations respond to specific injected currents, allowing the replication of already reported experimental findings and the creation of new hypotheses about the tactile sensations associated with certain stimulation patterns. The simulation consists of a finite element model of a human finger used to calculate the distribution of the electric potential in the finger tissues neglecting capacitive effects, and a cable model to calculate the excitation/inhibition of action potentials in each nerve.


Assuntos
Modelos Neurológicos , Estimulação Elétrica Nervosa Transcutânea/métodos , Potenciais de Ação , Simulação por Computador , Eletrodos , Desenho de Equipamento , Dedos/inervação , Análise de Elementos Finitos , Humanos , Mecanorreceptores/fisiologia , Potenciais da Membrana , Fibras Nervosas/fisiologia , Pele/inervação , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Estimulação Elétrica Nervosa Transcutânea/estatística & dados numéricos
9.
Neuromodulation ; 22(5): 645-652, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30629320

RESUMO

BACKGROUND: Trigeminal Neuropathic Pain (TNP) is a chronic facial pain syndrome caused by a lesion or disease affecting one or more branches of the trigeminal nerve. It may, for example, result from accidental injury to a branch of the trigeminal nerve by trauma or during surgery; it may also be idiopathic. TNP is typically constant, in contrast to most cases of the commoner trigeminal neuralgia. In some cases, pain may be refractory to pharmacological treatment. Peripheral nerve field stimulation is recognized as an effective minimally invasive surgical treatment option for this debilitating condition. To date, stimulation has used conventional tonic waveforms, which generate paraesthesia in the stimulated area. This is the first report of the use of paraesthesia-free burst pattern stimulation for TNP. METHODS: Seven patients were treated at the John Radcliffe Hospital for TNP from 2016 to 2018. Mean duration of preoperative symptoms was five years. All patients had exhausted pharmacological measures to limited effect. The initial three patients had tonic stimulation with the subsequent four having burst stimulation. Outcome was assessed using the numeric pain rating scale preoperatively and postoperatively at three and six months and one year. Side-effects and complications were also assessed as well as reduction in analgesic medication use. RESULTS: All patients achieved pain reduction of at least 50% at 6 months (range 50-100%, mean 81%, p = 0.0082). Those in the burst stimulation group were paraesthesia free. One patient developed a postoperative infection for which the system had to be removed and is awaiting reimplantation. There were no other complications in either group. CONCLUSION: Burst stimulation conferred similar pain control to tonic stimulation in our small cohort, and there were similar reductions in pain medication use. An additional benefit of burst stimulation is freedom from paraesthesia. Larger scale studies are needed to further evaluate burst stimulation and compare its efficacy with that of tonic stimulation.


Assuntos
Terapia por Estimulação Elétrica/métodos , Neuralgia Facial/terapia , Manejo da Dor/métodos , Nervos Periféricos/fisiologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Neuralgia do Trigêmeo/terapia , Adulto , Idoso , Terapia por Estimulação Elétrica/instrumentação , Eletrodos Implantados , Neuralgia Facial/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/instrumentação , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Resultado do Tratamento , Neuralgia do Trigêmeo/diagnóstico por imagem
10.
Neuromodulation ; 22(6): 730-737, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30609180

RESUMO

PURPOSE: This five-year, retrospective, multicenter study evaluated the long-term safety and efficiency of sacral neuromodulation (SNM) in Chinese patients with urinary voiding dysfunction. PATIENTS AND METHODS: This is a Chinese national, multicenter, retrospective study that included 247 patients (51.2% female) who received an implantable pulse generator (IPG) (InterStim, Medtronic, Minneapolis, MN, USA) between 2012 and 2016. Success was considered if the initial ≥50% improvement in any of primary voiding diary variables persisted compared with baseline. The results were further stratified by identifying patients who showed >50% improvement and those although showed <50% improvement but still wanted to receive IPG; these data were collected and analyzed for general improvement. RESULTS: Following test stimulation, 187 patients (43%) declined implantation and 247 (57%) underwent implantation using InterStim®. Among 247 patients, 34 (13.7%) had overactive bladder (OAB), 59 (23.8%) had interstitial cystitis/bladder pain syndrome (IC/BPS), 47 (19%) had idiopathic urinary retention (IUR), and 107 (44.1%) had neurogenic bladder (NB). IPG efficiency rate for OAB, interstitial cystitis/bladder pain syndrome, idiopathic urinary retention, and neurogenic bladder were 42.5, 72.4, 51.6, and 58.8%, respectively. The mean duration of follow-up was 20.1 ± 12.8 months. CONCLUSIONS: SNM appears effective in the long term, with a total IPG implantation rate of approximately 57% (ranging between 42.5 and 72.4% depending on indication). Interstitial cystitis/bladder pain syndrome appear to be the best indication for stage I testing. Chinese neurogenic bladder patients are most inclined to choose SNM. SNM is relatively safe, with low postoperation adverse events of 16.1% and reoperation rate of 3.2% during the follow-up period.


Assuntos
Eletrodos Implantados , Sacro/inervação , Estimulação Elétrica Nervosa Transcutânea/métodos , Transtornos Urinários/epidemiologia , Transtornos Urinários/terapia , Adulto , Idoso , China/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sacro/fisiologia , Fatores de Tempo , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Resultado do Tratamento , Transtornos Urinários/fisiopatologia
11.
Neuromodulation ; 22(5): 661-666, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30238573

RESUMO

OBJECTIVE: To report a retrospective review of the longer-term results of peripheral neuromodulation in 12 patients with significant chronic sacroiliac joint pain who had previously failed multiple conservative and interventional pain therapies. METHODS: To allow for the assessment of meaningful longer-term outcome, implants for all 12 patients had been in place for a minimum of 18 months to a maximum of 36 months prior to the formal review. RESULTS: Compared to the preimplantation baseline, the longer-term follow-up revealed a significant and sustained reduction in visual analog scale pain scores from 8.7T 1.1 to 1.1T 1.0 (p < 0.001), with a 75% reduction in analgesia requirement, and improvement in pain impact on daily function from 94.1% T 5.9% to 5.8% T 6.0% (p < 0.001). CONCLUSION: This initial case series has highlighted that SIJ neuromodulation results in the reduction in pain intensity and improved functionality in patients who have already failed conventional medical management and interventional techniques, including RF denervation. These preliminary results merit a prospective randomized trial of peripheral neuromodulation.


Assuntos
Artralgia/diagnóstico por imagem , Artralgia/terapia , Manejo da Dor/métodos , Articulação Sacroilíaca/diagnóstico por imagem , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Neuroestimuladores Implantáveis , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Resultado do Tratamento
12.
Neuromodulation ; 22(6): 684-689, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29633438

RESUMO

OBJECTIVES: In rodents, we reported that short pulse-width (PW) neuromodulation might provide more efficient therapy delivery than traditional 0.21 msec PW. Using fully implanted, commercialized systems in the sheep, the goal of this study was to characterize the relationship of electromyographic (EMG) responses of the external anal sphincter (EAS) to different PWs of sacral neuromodulation (SNM). MATERIALS AND METHODS: In seven sheep, InterStim® quadripolar tined leads were implanted adjacent to the S3 nerve root bilaterally to deliver SNM and two pairs of intramuscular leads were placed on either side of the EAS for EMG sensing. The EMG responses to SNM with different PWs were examined using variable intensities in both anesthetized and conscious conditions. RESULTS: The EMG responses from ipsilateral EAS (IEAS ) and contralateral EAS (CEAS ) were compared. The area under the curve of EMG responses from IEAS were significantly stronger than that from CEAS. The late component EMGs were more sensitive to nerve stimulation with a higher response amplitude in awake sheep. The response threshold-PW relationship from the IEAS as ascertained visually and with EMG in anesthetized and awake sheep were fitted with a monoexponential nonlinear regression; the resulting chronaxies were of 0.05 msec (n = 6), and 0.04 msec (n = 6), and 0.04 msec (n = 8), respectively. CONCLUSIONS: In both anesthetized and awake conditions, a similar motor response may be evoked in the EAS at PWs much shorter (0.04-0.05 msec) than the 0.21 msec typically used with SNM. Potential battery savings manifested by shorter PW would provide more efficient therapy delivery and increased longevity of the stimulator.


Assuntos
Eletrodos Implantados , Eletromiografia/métodos , Sacro/fisiologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Animais , Eletromiografia/instrumentação , Feminino , Sacro/inervação , Ovinos , Estimulação Elétrica Nervosa Transcutânea/instrumentação
13.
Neuromodulation ; 22(5): 597-606, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30117624

RESUMO

OBJECTIVES: Kilohertz high-frequency alternating current (KHFAC) electrical nerve stimulation produces a reversible nerve block in peripheral nerves in human patients with chronic pain pathologies. Although this stimulation methodology has been verified with nonselective extrafascicular electrodes, the effectiveness of producing a selective nerve block with more-selective intrafascicular electrodes has not been well documented. The objective of this study was to examine whether intrafascicular electrodes can block painful stimuli while preserving conduction of other neural activity within the implanted nerve. MATERIALS AND METHODS: We analyzed the effects of various stimulation waveforms delivered through Utah Slanted Electrode Arrays (USEAs) implanted in the median nerve of a male human subject with a left brachial plexus injury. We compared KHFAC stimulation with a sham control. RESULTS: KHFAC stimulation through USEA electrodes produced a reduction in pain sensitivity in the palmar aspect of the left middle finger. KHFAC had limited effects on the patient's ability to feel tactile probing in the same area or move the digits of his left hand. Other tested stimulation parameters either increased or showed no reduction in pain. CONCLUSIONS: KHFAC stimulation in peripheral nerves through intrafascicular electrodes demonstrated a selective reduction in pain sensitivity while preserving other nerve functions. This treatment may benefit patient populations who have chronic pain originating from peripheral nerves, but who do not want to block whole-nerve function in order to preserve sensory and motor function reliant on the implanted nerve. Furthermore, KHFAC may benefit patients who respond negatively to other forms of peripheral nerve stimulation therapy.


Assuntos
Plexo Braquial/lesões , Plexo Braquial/fisiologia , Eletrodos Implantados , Hiperalgesia/terapia , Nervo Mediano/fisiologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Idoso , Humanos , Hiperalgesia/diagnóstico por imagem , Hiperalgesia/fisiopatologia , Masculino , Nervos Periféricos/fisiologia , Estimulação Elétrica Nervosa Transcutânea/instrumentação
14.
Neuromodulation ; 22(5): 519-528, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29704437

RESUMO

OBJECTIVES: To compare the effectiveness of peripheral nerve stimulation utilizing a subcutaneous lead implant technique-subcutaneous nerve stimulation (SQS) plus optimized medical management (SQS + OMM arm) vs. optimized medical management alone (OMM arm) in patients with back pain due to failed back surgery syndrome. PATIENTS AND METHODS: Patients were recruited from 21 centers, in Europe, Israel, and Australia. Eligible patients were randomized (1:1) to SQS + OMM or OMM arms. Those in the SQS arm were implanted with a neurostimulator and up to two subcutaneous percutaneous cylindrical leads in the area of pain. Patients were evaluated pre-randomization and at one, three, six, and nine months post-randomization. The primary endpoint was the proportion of subjects with a ≥50% reduction in back pain intensity ("responder") from baseline to nine months. Secondary outcomes included proportion of responders with a ≥50% reduction in back pain intensity at six months and ≥30% reduction at nine months, and the mean change from baseline in back pain intensity at six and nine months between the two arms. RESULTS: Due to the slow rate of recruitment, the study was terminated early with 116 subjects randomized. A total of 33.9% (19/56, missing: n = 20 [36%]) of subjects in the SQS + OMM arm and 1.7% (1/60, missing: n = 24 [40%]) in the OMM arm were responders at Month 9 (p < 0.0001). Secondary objectives showed a significant difference in favor of SQS + OMM arm. CONCLUSION: The results indicate that the addition of SQS to OMM is more effective than OMM alone in relieving low back pain at up to nine months.


Assuntos
Dor nas Costas/diagnóstico , Dor nas Costas/terapia , Síndrome Pós-Laminectomia/diagnóstico , Síndrome Pós-Laminectomia/terapia , Neuroestimuladores Implantáveis , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Dor nas Costas/etiologia , Síndrome Pós-Laminectomia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Estudos Prospectivos , Tela Subcutânea , Estimulação Elétrica Nervosa Transcutânea/instrumentação
15.
Neuromodulation ; 22(5): 630-637, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30549376

RESUMO

OBJECTIVES: Until now, the vagus nerve stimulation (VNS) treatment in epilepsy has consisted of two different modes: normal and magnet stimulation. A new vagus nerve stimulator model (106 AspireSR®, LivaNova, Houston, TX, USA) also allows automatic stimulation (AutoStim). The purpose of this study is to examine the effect of autostimulation on seizure frequencies together with energy consumption. MATERIALS AND METHODS: The study material consisted of 14 patients whose former stimulator model (102/103) was replaced with model 106. We calculated the theoretical charge (Q) in Coulombs for one day in both of those groups. We evaluated the follow-up data of the patients' seizure counts, with a mean follow-up time of 18.1 months (SD 8.1). RESULTS: The total charge, "VNS dose," was reduced with model 106 in comparison with models 102 or 103 (p = 0.001, Mann-Whitney test). The average charge (Qtotal ) for one day with AutoStim was 142.56 mC; without AutoStim, it was 321.09 mC. We were able to assess seizure diaries in 11 out of 14 patients. Four patients (36%) had >50% seizure reduction and two patients (18%) experienced a reduction in seizure severity with VNS with autostimulation. Five patients (46%) remained unchanged. In three out of four patients with improved seizure control, the duty cycle was maintained at the original level. The patients whose duty cycle was modified for a more prolonged OFF-time had unchanged seizure frequencies. CONCLUSION: VNS with AutoStim achieves maintenance of prior-established seizure control with markedly less energy consumption and can also improve seizure control as compared to former stimulator model.


Assuntos
Epilepsia/diagnóstico , Epilepsia/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Estimulação do Nervo Vago/métodos , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Resultado do Tratamento , Estimulação do Nervo Vago/instrumentação
16.
Neuromodulation ; 22(6): 669-679, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30451336

RESUMO

OBJECTIVES: Postoperative ileus occurs in approximately 5-15% of patients following major abdominal surgery, and poses a substantial clinical and economic burden. Electrical stimulation has been proposed as a means to aid postoperative gastrointestinal (GI) recovery, but no methods have entered routine clinical practice. A systematic review was undertaken to assess electrical stimulation techniques and to evaluate their clinical efficacy in order to identify promising areas for future research. MATERIALS AND METHODS: Literature was searched using MEDLINE, EMBASE, Google Scholar and by assessing relevant clinical trial databases. Studies investigating the use of electrical stimulation for postoperative GI recovery were included, regardless of methods used or outcomes measured. A critical review was constructed encompassing all included studies and evaluating and synthesizing stimulation techniques, protocols, and clinical outcomes. RESULTS: A broad range of neuromodulation strategies and protocols were identified and assessed. Improved postoperative GI recovery following electrical stimulation was reported by 55% of studies (10/18), most commonly those assessing transcutaneous electrical nerve stimulation and electroacupuncture therapy (7/10). Several studies reported shorter time to first flatus and stool, shorter duration of hospital stay, and reduced postoperative pain. However, inconsistent reporting and limitations in trial design were common, compromising a definitive determination of electrical stimulation efficacy. CONCLUSIONS: Electrical stimulation appears to be a promising methodology to aid postoperative GI recovery, but greater attention to mechanisms of action and clinical trial quality is necessary for progress. Future research should also aim to apply validated and standardized gut recovery outcomes and consistent neuromodulation methodologies.


Assuntos
Trato Gastrointestinal/fisiologia , Cuidados Pós-Operatórios/métodos , Recuperação de Função Fisiológica/fisiologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Eletrodos Implantados , Humanos , Íleus/etiologia , Íleus/terapia , Cuidados Pós-Operatórios/instrumentação , Estimulação Elétrica Nervosa Transcutânea/instrumentação
17.
Neuromodulation ; 22(5): 529-536, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30444276

RESUMO

OBJECTIVES: The study objectives were to perform a clinical audit of patients implanted with 10 kHz spinal cord (SCS) and peripheral nerve (PNS) stimulators for treating chronic pain and to investigate the effect of 10 kHz PNS on pain and other sensory modalities in a double-blind cross-over trial. METHODS: Pain, disability, and medication status were audited for 12 months after stimulator implantation in 58 SCS patients and in 11 PNS patients with an electrode positioned along a branch of the occipital or trigeminal nerve (four patients), a limb nerve trunk (four patients), or the S1 nerve root, genito-femoral nerve or ileo-inguinal nerve (one patient each). In PNS patients, pain and other sensory modalities were also assessed double-blind before and after the stimulator was switched either ON or OFF for two hours (protocol 1) or four hours (protocol 2). RESULTS: Decreases in pain and disability after stimulator implantation were maintained in both groups at 3-6 months, but these decreases were greater in PNS than SCS patients. In PNS trial patients, pain increased after the system had been turned OFF overnight for at least 12 hours before testing. Pain did not change after two hours of PNS but had decreased significantly after four hours. Other sensory modalities were minimally affected either by two or four hours of stimulation. CONCLUSIONS: These findings suggest that PNS at 10 kHz decreases pain when conducted for at least four hours. Stimulation analgesia does not appear to be due to sensory conduction block.


Assuntos
Dor Crônica/diagnóstico , Dor Crônica/terapia , Medição da Dor/métodos , Nervos Periféricos/fisiologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Cross-Over , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Neuroestimuladores Implantáveis , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Resultado do Tratamento , Adulto Jovem
18.
Acta fisiátrica ; 25(4)dez. 2018.
Artigo em Inglês | LILACS | ID: biblio-1000039

RESUMO

The conservative treatment of osteoarthritis (OA) of the hip is essentially symptomatic, seeking to relieve pain and optimize function. Despite presenting great clinical effect, hip arthroplasty may have restrictions, and in these situations, the neurolytic blockade of the anterior branch of the obturator nerve can be a therapeutic alternative, since it stops the afferent pain from the hip joint. Objective: To describe the results of treating patients with severe OA of the hip by applying phenol to the obturator nerve. Method: Twelve consecutive patients with OA of the hip, refractory to conservative treatment, were recruited to have the obturator nerve localized through electrostimulation and blocked with phenol. They were evaluated in terms of pain intensity via the visual analogue scale (VAS), pressure dolorimetry in the medial and lateral gluteus medius, gluteus minimus, and piriformis, and quality of life by the Harris Hip Score (HHS) at baseline (BL) after 1 (M1), 2 (M2), and 6 months (M6). Results: The patients were between 30 and 72 years old with an avarege of 47.5 ± 1.7 years old, 5 of them were women. Three patients were excluded for not being able to come for follow up evaluations. VAS values vaieded from 8.2 ±.0.9 at BL to 6.6 ± 1.7 at M1, 6.5 ± 1.7 at M2, and 7.3 ± 1 in M6 (p=0.0094). As to the HHS, the values were BL:33.27 ± 2.9; M1:39.2 ± 6.4; M2:40.2 ± 8.1, and M6: 38.8 ± 9.7 in the final evaluation (p=0,040). For dolorimetry, non significant variation was BL: 11±5.7, M1: 7.9±2.2; M2: 10.9±5.6; M6: 8.1 ± 1.6 (p 0.69). Conclusion: The application of phenol to the anterior branch of the obturator nerve can be an alternative in the treatment of severe OA of the hip in patients with restrictions to Total Hip Replacement (THR), since it reduces pain and improves quality of life.


O tratamento conservador da osteoartrite (OA) do quadril é essencialmente sintomático, visando alívio da dor e otimização da funcionalidade. Apesar de apresentar grande efeito clínico, a artroplastia quadril pode ter restrições, nestas situações o bloqueio do ramo anterior do nervo obturador (RAO) pode ser uma alternativa terapêutica, uma vez que interrompe a aferência dolorosa da articulação do quadril. Objetivo: Descrever os resultados do tratamento de pacientes com OA grave do quadril por meio da aplicação de fenol no nervo obturatório. Método: Nove pacientes com OA de quadril resistente ao tratamento conservador que se apresentaram consecutivamente ao nosso serviço foram submetidos à aplicação de fenol no nervo obturatório com localização por meio de eletroestimulação e avaliados quanto a intensidade de dor pela escala visual analógica (EVA), dolorimetria de pressão e qualidade de vida pelo Haris Hip Score (HHS) após 01, 02 e 06 meses. Resultados: Foram selecionados 12 pacientes que preenchiam os critérios de inclusão e exclusão, destes, 3 foram excluídos após não conseguirem mais comparecer para as avaliações. Os valores médios de EVA variaram de 8,2 ±.0,9 na medida basal para 6,6 ± 1,7 ao final de um mês, 6,5 ± 1,7 ao final de dois meses e 7,3 ± 1 com 06 meses (p=0,0094). Quanto ao HHS, os valores foram 33,27 ± 2,9; 39,2 ± 6,4; 40,2 ± 8,1 e 38,8 ± 9,7, na avaliação final. A última variável analisada foi a Dolorimetria, onde foi realizada a média entre os valores atingidos pela avaliação com o dolorímetro no glúteo médio medial, glúteo médio lateral, glúteo mínimo e piriforme. Na avaliação inicial média de 11±5,7, 7,9±2,2 no final do primeiro mês, 10,9±5,6 no segundo e no 6º mês 8,1±1,6. Ao aplicarmos o teste ANOVA, não foi observado diferença estatística (p 0,69). Conclusão: A aplicação de Fenol em RAO pode ser uma alternativa no tratamento da OA de quadril grave em pacientes com restrições à realização de ATQ, pois implica em redução da dor e melhora da qualidade de vida.


Assuntos
Humanos , Osteoartrite do Quadril/patologia , Bloqueio Nervoso/instrumentação , Nervo Obturador , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Doença Crônica
19.
Brasília; CONITEC; dez. 2018. ilus, tab.
Não convencional em Português | BRISA/RedTESA | ID: biblio-997937

RESUMO

CONTEXTO: A epilepsia é uma condição neurológica caracterizada por crises epilépticas recorrentes. A epilepsia resistente a medicamento (do inglês, Drug-Resistant Epilepsy ­ DRE) ocorre quando há persistência de crises epilépticas apesar do uso de dois fármacos anticonvulsivantes de primeira linha, em doses adequadas. O tratamento disponível no SUS inclui fármacos antiepilépticos (FAE) e a cirurgia cerebral que é recomendada pelo PCDT do Ministério da Saúde. A cirurgia pode ser considerada curativa para alguns tipos específicos de crises epilépticas, porém 20 a 30% dos pacientes, não evoluem bem ou não são candidatos à cirurgia. A utilização da terapia de eletroestimulação do nervo vago seria uma opção para estes pacientes. TECNOLOGIA: Estimulação elétrica do nervo vago com dispositivo implantável. PERGUNTA: O uso da terapia de eletroestimulação do nervo vago é eficaz, segura e custo-efetiva no tratamento de pacientes pediátricos com epilepsia resistente a medicamento para diminuição do número de crises quando comparado ao sham do método (estimulação em baixa frequência) ou aos FAE apenas? EVIDÊNCIAS CIENTÍFICAS: Há revisões sistemáticas (RS) com metanálises que avaliaram a terapia de eletroestimulação do nervo vago em população mista (adultos e crianças) e apresentam resultados favoráveis no desfecho de redução de ≥ 50% na frequência de crises epilépticas, principal desfecho avaliado. Entre os resultados das RS, verificou-se que a terapia está relacionada à um risco relativo (RR) de até 1,73 em comparação ao sham do método. No entanto, o ECR que incluiu apenas pacientes menores de 18 anos não verificou diferença estatisticamente significante entre os grupos avaliados (estimulação de alta frequência do nervo vago vs sham do método). O ECR que comparou a terapia de eletroestimulação do nervo vago ao tratamento com FAE, em pacientes menores de 17 anos, apresentou redução de ≥ 50% na frequência de crises em 39,4% dos pacientes do grupo tratado com a terapia e em 24,0% dos pacientes tratados com os FAE. AVALIAÇÃO ECONÔMICA: Foi realizada uma análise de custo-efetividade e apresentada uma razão de custo efetividade incremental (RCEI) de 84.666,02 em 10 anos e em 20 anos(caso base), uma RCEI de 51.088,55 com a utilização do dispositivo, em adição aos FAE. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: A análise estimou um impacto orçamentário incremental, considerando uma possível redução dos recursos em saúde, de R$ 63.036.945,75. RECOMENDAÇÃO PRELIMINAR: De acordo com o exposto, a CONITEC em sua 64ª reunião, no dia 08 de março de 2018, recomendou a incorporação no SUS do gerador de pulso para nervo vago na terapia adjuvante em pacientes pediátricos com epilepsia resistente a medicamentos, sem indicação para cirurgia ressectiva de epilepsia. A matéria foi disponibilizada em consulta pública. CONSULTA PÚBLICA: Foram recebidas 14 contribuições técnico-científicas e 33 contribuições de experiência ou opinião, sendo a maioria concordante com a recomendação preliminar da CONITEC. As contribuições, na sua totalidade, apontaram os benefícios da tecnologia analisada aos pacientes que apresentam epilepsia resistente aos medicamentos e descreveram pontos positivos e negativos da mesma. Os participantes também descreveram sua experiência negativa com medicamentos e a dieta cetogênica, utilizados no tratamento da epilepsia. A CONITEC entendeu que não houve argumentação suficiente para alterar sua recomendação inicial. RECOMENDAÇÃO FINAL: Os membros da CONITEC, na 66ª reunião ordinária em 10 de maio de 2018, deliberaram por recomendar a criação de um procedimento para estimulação elétrica do nervo vago para terapia adjuvante em pacientes com epilepsia resistente a medicamentos, sem indicação para cirurgia ressectiva de epilepsia, em Centros e Unidades Habilitados conforme Protocolo de Uso. Foi assinado o Registro de Deliberação nº 349/2018. A estimulação elétrica do nervo vago também foi avaliada em outro relatório, cuja solicitação foi proveniente da atualização do PCDT de Epilepsia, como terapia adjuvante ao tratamento farmacológico em crianças e adultos com epilepsia focal ou generalizada refratária a pelo menos dois esquemas com medicamentos anticonvulsivantes. DECISÃO: Incorporar o procedimento para estimulação elétrica do nervo vago para terapia adjuvante em pacientes com epilepsia resistente a medicamentos, sem indicação para cirurgia ressectiva de epilepsia no âmbito do Sistema Único de Saúde ­ SUS, dada pela Portaria nº 24 de 11 de setembro de 2018, publicada no DOU de 12/09/2018. A portaria de incorporação contemplou as duas indicações solicitadas.


Assuntos
Humanos , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Epilepsia/reabilitação , Avaliação da Tecnologia Biomédica , Avaliação em Saúde/economia , Sistema Único de Saúde , Brasil , Resistência a Medicamentos , Análise Custo-Benefício/economia
20.
Brasília; CONITEC; dez. 2018.
Não convencional em Português | BRISA/RedTESA | ID: biblio-997938

RESUMO

CONTEXTO: A epilepsia é uma desordem crônica neurológica prevalente, caracterizada por sinais e sintomas característicos (crises convulsivas) associados a descargas elétricas cerebrais anormais. O tratamento da epilepsia geralmente inclui o uso contínuo em longo prazo de medicamentos com efeito anticonvulsivante. Atualmente, os tratamentos disponíveis no SUS são aqueles preconizados pelo Protocolo Clínico e Diretrizes Terapêuticas (PCDT) de epilepsia. TECNOLOGIA: Estimulação elétrica do nervo vago com dispositivo implantável. PERGUNTA: A estimulação do nervo vago (ENV) com dispositivo implantável como terapia adjuvante ao tratamento farmacológico, em crianças e adultos com epilepsia focal ou generalizada refratária, a pelo menos dois esquemas com medicamentos anticonvulsivantes é eficaz e seguro, quando comparado à terapia padrão (conforme preconizado no PCDT de epilepsia)? EVIDÊNCIAS CIENTÍFICAS: A ENV é eficaz na redução de crises convulsivas em adultos e adolescentes com mais de 12 anos portadores de epilepsia parcial refratária, levando a redução de pelo menos 50% das crises em cerca de 30% dos casos. Ausência total de crises é obtida em menos de 10% dos casos. O benefício absoluto (diferença entre o grupo tratado com alta estimulação e o grupo com baixa estimulação) é de cerca de 15%, para redução de 50% de crises ou mais. Para os desfechos selecionados de eficácia e segurança, a qualidade geral da evidência é moderada em adultos e baixa em crianças. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: Dependendo da taxa de difusão da tecnologia a estimativa de impacto orçamentário varia entre aproximadamente R$ 65 milhões e R$ 262 milhões no primeiro ano e entre R$ 371 milhões e R$ 1,5 bilhão ao longo dos próximos 5 anos. RECOMENDAÇÃO PRELIMINAR: De acordo com o exposto, a CONITEC em sua 60ª reunião, nos dias 04 e 05 de outubro de 2017, recomendou preliminarmente a não incorporação no SUS da estimulação do nervo vago com dispositivo implantável para tratamento de pacientes com epilepsia focal ou generalizada refratária a pelo menos dois esquemas de medicamentos anticonvulsivantes e não candidatos ao tratamento cirúrgico. A matéria foi disponibilizada em consulta pública. CONSULTA PÚBLICA: Foram recebidas 12 contribuições técnico-científicas e 40 contribuições de experiência ou opinião, sendo 100% discordantes ou parcialmente discordantes da recomendação preliminar da CONITEC em ambos os formulários. Os argumentos foram convergentes e se basearam principalmente na necessidade de tratamento para pacientes refratários a dois ou mais medicamentos, ou inelegíveis à cirurgia ressectiva. A maioria das contribuições técnico-científicas foram realizadas por profissionais de saúde. As contribuições de experiência ou opinião foram realizadas principalmente por profissionais de saúde, familiares, amigos ou cuidadores e por pacientes que relataram experiência com a ENV e descreveram a redução na frequência das crises epilépticas como efeito positivo. As contribuições relataram também experiência com os FAEs utilizados para o tratamento da doença, cujos eventos adversos foram apontados como efeitos negativos, apesar também terem sido apontados alguns efeitos positivos dos mesmos. A CONITEC solicitou ao grupo elaborador do PCDT de epilepsia os critérios de elegibilidade para uso de tratamento por estimulação do nervo vago em pacientes com epilepsia refratária, que foram apresentados na 64ª reunião em 07/03/2018. O plenário da CONITEC entendeu que houve argumentação suficiente para alterar sua recomendação inicial e recomendou a incorporação da estimulação do nervo vago para o tratamento da epilepsia refratária aos medicamentos e com contraindicação à cirurgia, em centros habilitados em neurocirurgia, devendo o procedimento incluir-se na relação CNRAC. Foi assinado o Registro de Deliberação nº 337/2018. RECOMENDAÇÃO FINAL: A estimulação elétrica do nervo vago também esteve em avaliação devido à solicitação por incorporação pela empresa fabricante do dispositivo gerador de pulso, para terapia adjuvante em pacientes pediátricos com epilepsia resistente a medicamentos, sem indicação para cirurgia ressectiva de epilepsia. A deliberação final da solicitação feita pela empresa ocorreu na 66ª reunião ordinária em 10 de maio de 2018, onde os membros da CONITEC deliberaram por unanimidade recomendar a criação de um procedimento para estimulação elétrica do nervo vago para terapia adjuvante em pacientes com epilepsia resistente a medicamentos, sem indicação para cirurgia ressectiva de epilepsia, em Centros e Unidades Habilitados conforme Protocolo de Uso. DECISÃO: Incorporar o procedimento para estimulação elétrica do nervo vago para terapia adjuvante em pacientes com epilepsia resistente a medicamentos, sem indicação para cirurgia ressectiva de epilepsia no âmbito do Sistema Único de Saúde ­ SUS, dada pela Portaria nº 24 de 11 de setembro de 2018, publicada no DOU de 12/09/2018. A portaria de incorporação contemplou as duas indicações solicitadas.


Assuntos
Humanos , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Epilepsias Parciais/reabilitação , Epilepsia Resistente a Medicamentos/reabilitação , Avaliação da Tecnologia Biomédica , Avaliação em Saúde/economia , Sistema Único de Saúde , Brasil , Análise Custo-Benefício/economia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA