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1.
Medicine (Baltimore) ; 99(3): e18633, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011443

RESUMO

Pain has a major impact on anxiety and depression levels. The aim of this study is to demonstrate how these symptoms (depression and anxiety) could positively influence the perception of pain after neurostimulation system implantation.We enrolled 100 patients and divided in 2 different groups, by using tests screening such as Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), Nursing Rating Scale (NRS): the group with spinal cord stimulation (SCS) and the group with pulsed spinal cord radiofrequency (RFP).We highlighted a significant decrease of scores (BDI, HAM-A, NRS) in each group between T0 (baseline) and T1. Moreover, the intra-group analysis showed a positive significant correlation between NRS and depressive and anxiety symptoms.We assert that the use of alternative methods (SCS and RFP) to the traditional pharmaceutical-surgical treatments, provide the reduction of the algic and anxiety-depressant symptoms, restoring also the perception of psychological well-being.


Assuntos
Ansiedade/psicologia , Dor Crônica/psicologia , Dor Crônica/terapia , Depressão/psicologia , Tratamento por Radiofrequência Pulsada/psicologia , Estimulação da Medula Espinal/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Escalas de Graduação Psiquiátrica , Tratamento por Radiofrequência Pulsada/métodos , Estimulação da Medula Espinal/métodos
2.
World Neurosurg ; 136: 44-48, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31917309

RESUMO

BACKGROUND: Spinal myoclonus (SM) is a rare hyperkinetic movement disorder that is either idiopathic or secondary to spinal cord lesions. The treatment is either symptomatic only or addresses the underlying etiology. We describe 2 patients with SM with compression myelopathy who were treated with spinal cord stimulation (SCS). CASE DESCRIPTION: The first patient was a 39-year-old man with cervicobrachial pain owing to compression myelopathy at level C5-6 underwent fusion. A year later, he developed neurologic deficits including left-limb dominant tetraparesis and involuntary movements of the right leg. Despite ventral fusion at C5-7 due to progressive myelopathy, the involuntary movements extended to both left extremities. A paddle electrode was placed at level C5-6. SM disappeared immediately under stimulation, and the effect continued even after 24 months. The second patient, a 57-year-old man, underwent fusion at level C5-6 in 1998. Since then, he experienced a persistent tremor in his left hand. After 20 years, he developed cervicobrachial pain of the right upper limb with paresis. Compression myelopathy at segment C6-7 was treated with fusion plating. Six months later, pain returned in both upper limbs, and the tremor extended discretely to his right side. A paddle electrode for SCS was placed at level C7-Th1. SM disappeared immediately under stimulation, and the effect persisted after 10 months. Both patients reported sustained pain reduction. CONCLUSIONS: SCS might offer a more selective medicament-free therapy option for SM. The activation of intraspinal networks and replacement of supraspinal descending influences are mechanisms of SCS in this disorder.


Assuntos
Vértebras Cervicais/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Mioclonia/terapia , Compressão da Medula Espinal/cirurgia , Estimulação da Medula Espinal/métodos , Adulto , Descompressão Cirúrgica , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mioclonia/etiologia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Fusão Vertebral
3.
World Neurosurg ; 133: e658-e665, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31574335

RESUMO

BACKGROUND: Recurrent and chronic low back pain, caused by degenerative lumbar spondylosis, commonly affects elderly patients, even those with no previous low back surgery. These patients, like those affected by failed back surgery syndrome (FBSS), may become unresponsive to medical conservative treatment and their quality of life could be easily compromised. Moreover, general comorbidities, obesity, and other typical conditions of the elderly may make surgery under general anesthesia riskier than the natural history of the disease. These patients could be considered affected by surgical back risk syndrome (SBRS). METHODS: In this article, we report our preliminary observational prospective study on the role of spinal cord stimulation (SCS) in 3 groups of patients: the FBSS group, the SBRS group, and the "other" group. Selection criteria, treatment modality, and outcomes for each patient group are described and discussed. Moreover, a potentially useful diagnostic and therapeutic flowchart on the management options for lumbar back diseases is discussed. RESULTS: The FBSS group included 25 patients, the SBRS group included 10 patients, and the other group included 3 patients. In 22/25 patients with FBSS (88% of the total), the implantation of a definitive neurostimulator was successful. In almost all patients in both the SBRS and the other groups, the implantation of a definitive neurostimulator was successful. CONCLUSIONS: In our opinion, SCS could be considered as a valid alternative treatment not only in selected patients affected by FBSS but also in selected patients affected by SBRS, in whom back surgery under general anesthesia may be challenging and overcome the potential benefit of the surgery itself. SBRS could be considered a new disease entity to be managed through SCS.


Assuntos
Dor Lombar/terapia , Estimulação da Medula Espinal/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Síndrome Pós-Laminectomia/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos
4.
PLoS One ; 14(12): e0227057, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31877192

RESUMO

Posterior root-muscle (PRM) reflexes are short-latency spinal reflexes evoked by epidural or transcutaneous spinal cord stimulation (SCS) in clinical and physiological studies. PRM reflexes share key physiological characteristics with the H reflex elicited by electrical stimulation of large-diameter muscle spindle afferents in the tibial nerve. Here, we compared the H reflex and the PRM reflex of soleus in response to transcutaneous stimulation by studying their recovery cycles in ten neurologically intact volunteers and ten individuals with traumatic, chronic spinal cord injury (SCI). The recovery cycles of the reflexes, i.e., the time course of their excitability changes, were assessed by paired pulses with conditioning-test intervals of 20-5000 ms. Between the subject groups, no statistical difference was found for the recovery cycles of the H reflexes, yet those of the PRM reflexes differed significantly, with a striking suppression in the intact group. When comparing the reflex types, they did not differ in the SCI group, while the PRM reflexes were more strongly depressed in the intact group for durations characteristic for presynaptic inhibition. These differences may arise from the concomitant stimulation of several posterior roots containing afferent fibers of various lower extremity nerves by transcutaneous SCS, producing multi-source heteronymous presynaptic inhibition, and the collective dysfunction of inhibitory mechanisms after SCI contributing to spasticity. PRM-reflex recovery cycles additionally obtained for bilateral rectus femoris, biceps femoris, tibialis anterior, and soleus all demonstrated a stronger suppression in the intact group. Within both subject groups, the thigh muscles showed a stronger recovery than the lower leg muscles, which may reflect a characteristic difference in motor control of diverse muscles. Based on the substantial difference between intact and SCI individuals, PRM-reflex depression tested with paired pulses could become a sensitive measure for spasticity and motor recovery.


Assuntos
Reflexo H , Músculo Esquelético/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/terapia , Estimulação da Medula Espinal , Adulto , Feminino , Humanos , Masculino , Músculo Esquelético/fisiologia , Reflexo , Medula Espinal/fisiologia , Medula Espinal/fisiopatologia , Estimulação da Medula Espinal/métodos , Adulto Jovem
5.
Artigo em Russo | MEDLINE | ID: mdl-31626155

RESUMO

BACKGROUND: Spinal cord injury causes significant impairments of both motor and pelvic organ functions. Latest studies have shown impressive potentials for using transcutaneous spinal cord electrical stimulation (TcSCES) in the late period of injury to restore motor functions. All results were obtained in a limited number of patients in the specific conditions of a physiological experiment. It remains unclear how effective a TcSCES cycle is in restoring motor activity in patients after spinal cord injury in real clinical conditions. AIM: The main objective of this investigation was to study the effectiveness of TcSCES in combination with the standard rehabilitation of patients after a spinal cord injury. An additional objective was to evaluate the effect of TcSCES to excretory functions in patients with spinal cord injury. SUBJECTS AND METHODS: The studies were conducted at Saint Petersburg City Hospital Forty, which included 15 patients with thoracic spinal injury at 2.4±2.06 years after injury; the severity of the latter was American Spinal Injury Association (ASIA) Grades B and C. All the patients underwent a 2-week standard cycle of rehabilitation treatment; of them 7 patients (a study group) received additionally TcSCES. Standard scales were used to assess neurological status and muscle strength and sensitivity. The patients filled out a urinary diary; residual urine volume was monitored using bladder catheterization or ultrasound. RESULTS: An increase in muscle strength was recorded in 6 patients of the study group and in 1 patient of the control one. The end of the treatment cycle was marked by a 1-score spasticity increase in 1 patient of the study group and in 2 patients in the control one. In the study group, the level of anesthesia decreased per segment in 1 patient; an improvement in deep and proprioceptive sensitivity was recorded in 2 patients; no change in sensitivity was observed in the control group. In the study group, 2 patients showed a reduction in the severity of injury from ASIA Grade B to ASIA Grade C. In three patients of the study group, the residual urine volume decreased and control and a sensation of urgency to urinate appeared; in the control group, these parameters remained unchanged after the treatment cycle. DISCUSSION: The main result of the study is evidence for the efficiency of using TcSCES in the complex therapy of motor neurorehabilitation. The performed cycle of TcSCES in patients was noted to result in better motor and excretory functions. CONCLUSION: The use of a short-term TcSCES cycle in the motor rehabilitation program for patients with spinal cord injury contributes to recovery of severe motor disorders and is accompanied by an improvement in urinary functions.


Assuntos
Traumatismos da Medula Espinal/reabilitação , Estimulação da Medula Espinal/métodos , Humanos , Espasticidade Muscular/fisiopatologia , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/fisiopatologia , Resultado do Tratamento
6.
Neurosciences (Riyadh) ; 24(3): 221-224, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31380822

RESUMO

In the present article, we described a case of treating intractable pain from failed back surgery syndrome (FBSS) and multiple sclerosis (MS) after implantation of spinal cord stimulation (SCS) in a patient. We are reporting a case where SCS has been used for treating a patient with both FBSS and MS.


Assuntos
Síndrome Pós-Laminectomia/terapia , Esclerose Múltipla/terapia , Estimulação da Medula Espinal/métodos , Síndrome Pós-Laminectomia/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Esclerose Múltipla/complicações
7.
World Neurosurg ; 131: 264-274.e3, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31369885

RESUMO

In the United States, chronic low back pain affects up to 37% of adults and is a multibillion dollar health care expenditure. Spinal cord simulation (SCS) has been established as an effective treatment alternative for chronic neuropathic low back and leg pain, especially for patients with failed back surgery syndrome or chronic regional pain syndrome. The field of SCS has rapidly advanced such that analgesia can now be achieved through numerous different waveforms, each claiming to offer improved outcomes. These waveforms include traditional paresthesia-based SCS (<100 Hz), paresthesia-free high-frequency SCS (5-10 kHz), burst SCS, and subperception SCS (1-5 kHz). Level 1 evidence critically evaluating the efficacy of these different waveforms is lacking. We conducted a systematic review of the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify all randomized controlled trials of SCS in the treatment of chronic neuropathic low back and leg pain, failed back surgery syndrome, or chronic regional pain syndrome. Of 38 eligible studies reviewed, 13 randomized controlled trials were finally included in our systematic review. We reviewed evidence from randomized controlled trials in the field of SCS that have established paresthesia-based SCS, paresthesia-free high-frequency SCS, burst SCS, and subperception SCS as viable treatment options for chronic neuropathic low back and leg pain. We critically evaluated evidence that claims to support the use of one waveform over another and reviewed the literature on patient preference for different waveforms.


Assuntos
Síndromes da Dor Regional Complexa/terapia , Síndrome Pós-Laminectomia/terapia , Dor Lombar/terapia , Estimulação da Medula Espinal/métodos , Dor Crônica/terapia , Humanos , Perna (Membro) , Preferência do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
Pain Res Manag ; 2019: 1236430, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31281554

RESUMO

Background: Spinal cord stimulation is an established treatment option for certain chronic pain conditions which have been previously unresponsive to conservative therapies or potentially for a subset of patients who have not improved following spine surgery. Prior to permanent lead implantation, stimulator lead trials are performed to ensure adequate patient benefit. During these trials, one of the most common complications and reasons for failure is the displacement and migration of the trial leads, resulting in lost therapeutic coverage. Other complications include infection and dislodged bulky dressings. There is a paucity of literature describing an adequate procedural method to prevent these common complications. Objective: This study utilizes a series of 19 patients to evaluate a new technique for securing percutaneous spinal cord simulator trial leads, which may minimize dislodgement and migration complications and improve the rate of trial success. Study Design: Retrospective case series. Setting: New Jersey Medical School, Department of Anesthesiology, Pain Management Division. Methods: A retrospective chart review was conducted on 19 consecutive patients undergoing placement of the percutaneous thoracic spinal cord stimulator trial leads for pain associated with lumbar spine pathology over a two-year period (2010-2012). Results: Of the 19 patients in our cohort, there was one trial lead displacement, no lead migrations, and no site infections. Thirteen patients went on to permanent lead implantation. This improved trial lead placement technique had a high success rate with a low number of complications. Limitations: Small sample size, retrospective case series, and no control group for comparison. Conclusion: This case series was able to demonstrate that our described novel spinal cord stimulator trial lead placement and dressing technique can decrease the incidence of lead displacement and migration, thus improving trial success.


Assuntos
Eletrodos Implantados/efeitos adversos , Migração de Corpo Estranho/prevenção & controle , Procedimentos Neurocirúrgicos/métodos , Estimulação da Medula Espinal/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Estudos Retrospectivos
11.
J Clin Neurosci ; 67: 255-257, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31221583

RESUMO

We describe a case of a 70-year old man with sensorimotor chronic inflammatory demyelinating polyneuropathy (CIDP) with small-fibre involvement resulting in severe diffuse neuropathic pain which was refractory to immunotherapy and anti-neuropathic medication. His pain was successfully treated with implantation of a spinal cord stimulation (SCS) system comprising bilateral cervical and lumbar epidural leads. Following SCS programming, he experienced a 50% reduction in average pain severity with substantial improvement in quality of life, persisting at 18 months after surgery. SCS has been employed to treat a variety of neuropathic pain syndromes. However, this is the first report to our knowledge of SCS utilised effectively for pain in CIDP. This therapy should be considered in painful CIDP for neuropathic pain refractory to medical management, though further studies are required to evaluate its efficacy.


Assuntos
Neuralgia/terapia , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/terapia , Estimulação da Medula Espinal/métodos , Idoso , Humanos , Masculino , Neuralgia/etiologia , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/complicações , Qualidade de Vida
12.
Int J Neurosci ; 129(10): 1013-1023, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31092102

RESUMO

The effective treatment of many diseases requires the use of multiple treatment strategies among which neuromodulation is playing an increasingly important role. Neuromodulation devices that act to normalize or modulate nerve activity through the targeted delivery of electrical stimuli will be the focus of this review. These devices encompass deep brain stimulators, vagus nerve stimulators, spinal cord simulators and sacral nerve stimulators. Already neuromodulation has proven successful in the treatment of a broad range of conditions from Parkinson's disease to chronic pain and urinary incontinence. Many of these approaches seek to exploit the activities of the autonomic nervous system, which influences organ function through the release of neurotransmitters and associated signalling cascades. This review will outline existing and emerging applications for each of these neuromodulation devices, proposed mechanisms of action and clinical studies evaluating both their safety and therapeutic efficacy.


Assuntos
Terapia por Estimulação Elétrica/métodos , Terapia por Estimulação Elétrica/tendências , Estimulação Elétrica Nervosa Transcutânea/métodos , Estimulação Elétrica Nervosa Transcutânea/tendências , Ensaios Clínicos como Assunto/métodos , Estimulação Encefálica Profunda/métodos , Estimulação Encefálica Profunda/tendências , Epilepsia/fisiopatologia , Epilepsia/terapia , Humanos , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Estimulação da Medula Espinal/métodos , Estimulação da Medula Espinal/tendências , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Resultado do Tratamento , Estimulação do Nervo Vago/métodos , Estimulação do Nervo Vago/tendências
13.
Exp Brain Res ; 237(7): 1793-1803, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31053895

RESUMO

Transcutaneous spinal cord stimulation (tSCS) is a useful technique for the clinical assessment of neurological disorders. However, the characteristics of the spinal cord circuits activated by tSCS are not yet fully understood. In this study, we examined whether remote muscle contraction enhances the spinal reflexes evoked by tSCS in multiple lower-limb muscles. Eight healthy men participated in the current experiment, which required them to grip a dynamometer as fast as possible after the presentation of an auditory cue. Spinal reflexes were evoked in multiple lower-limb muscles with different time intervals (50-400 ms) after the auditory signals. The amplitudes of the spinal reflexes in all the recorded leg muscles significantly increased at 50-250 ms after remote muscle activation onset. This suggests that remote muscle contraction simultaneously facilitates the spinal reflexes in multiple lower-limb muscles. In addition, eight healthy men performed five different tasks (i.e., rest, hand grip, pinch grip, elbow flexion, and shoulder flexion). Compared to control values recorded just before each task, the spinal reflexes evoked at 250 ms after the auditory signals were significantly enhanced by the above tasks except for the rest task. This indicates that such facilitatory effects are also induced by remote muscle contractions in different upper-limb areas. The present results demonstrate the existence of a neural interaction between remote upper-limb muscles and spinal reflex circuits activated by tSCS in multiple lower-limb muscles. The combination of tSCS and remote muscle contraction may be useful for the neurological examination of spinal cord circuits.


Assuntos
Retroalimentação Sensorial/fisiologia , Extremidade Inferior/fisiologia , Contração Muscular/fisiologia , Músculo Esquelético/fisiologia , Reflexo/fisiologia , Estimulação da Medula Espinal/métodos , Adulto , Humanos , Extremidade Inferior/inervação , Masculino , Adulto Jovem
14.
Curr Pain Headache Rep ; 23(6): 39, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31044337

RESUMO

PURPOSE OF REVIEW: Spinal cord stimulation (SCS), based on the gate theory of nociception, has been shown to be effective in the management of chronic pain conditions. While early-generation technology offered many patients improvement in their pain and symptoms, limitations including paresthesia, dependence on mapping, decreased chronological efficacy, and inadequate coverage left many patients with persistent pain and overt therapeutic failure. RECENT FINDINGS: New advances in neuromodulation technology circumvent many of these previous limitations and offer patients improved pain relief and quality of life. In this review, an update on recent technological developments in the field of SCS and peripheral neuromodulation is presented with discussion on differentiating characteristics which may help guide applicability to individual patient needs.


Assuntos
Dor Crônica/terapia , Manejo da Dor/métodos , Medição da Dor/métodos , Estimulação da Medula Espinal/métodos , Dor Crônica/diagnóstico , Gânglios Espinais/patologia , Humanos , Manejo da Dor/tendências , Medição da Dor/tendências , Estimulação da Medula Espinal/tendências , Tecnologia sem Fio/tendências
15.
Exp Brain Res ; 237(7): 1841-1852, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079235

RESUMO

Noninvasive transspinal stimulation of the thoracolumbar region, where leg motor circuits reside, produces prominent plasticity of brain and spinal cord circuits. However, reorganization of cortical and corticospinal excitability after multiple sessions (i.e. repeated) remains elusive. In this study, we investigated changes in intracortical inhibition, intracortical facilitation, and corticospinal excitability after 10 sessions of cathodal transcutaneous delivery of pulse or direct current stimulation, termed here transspinal (tsPCS, tsDCS), in resting healthy humans. tsPCS was delivered at sub- and supra-threshold intensities, while intensity for tsDCS ranged from 2.24 to 2.34 mA within a session. Intracortical inhibition and facilitation were assessed based on the tibialis anterior (TA) motor evoked potential (MEP) amplitude following subthreshold transcranial magnetic stimulation (TMS) at the conditioning-test (C-T) intervals of 1, 2, 3, 10, 15, 20, 25, and 30 ms. The TA MEP recruitment input-output curves were also assembled to establish changes in corticospinal excitability. For both transspinal stimulation protocols, the active cathodal electrode was placed over the T10 spinal process. Results indicated that repeated tsPCS did not alter intracortical inhibition or intracortical facilitation but decreased corticospinal excitability for the right M1 and increased corticospinal excitability for the left M1. tsDCS decreased intracortical inhibition, increased intracortical facilitation, did not affect the maximal MEP amplitude but increased the slope of the right TA MEP input-output curve. Neurophysiological changes may be attributed to neural mechanisms involved in learning and memory. These results support that noninvasive transspinal stimulation alters both cortical and corticospinal neural excitability in resting healthy humans.


Assuntos
Potencial Evocado Motor/fisiologia , Córtex Motor/fisiologia , Tratos Piramidais/fisiologia , Estimulação da Medula Espinal/métodos , Estimulação Magnética Transcraniana/métodos , Adulto , Eletrodos , Feminino , Humanos , Masculino , Adulto Jovem
16.
Stereotact Funct Neurosurg ; 97(1): 55-65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30995653

RESUMO

BACKGROUND/AIMS: Postherpetic neuralgia (PHN) can be refractory to both medical and minimally invasive treatments. Its complex pathophysiology explains the numerous neurosurgical procedures that have been implemented through the years. Our objective was to summarize all available neurosurgical strategies for the management of resistant PHN and evaluate their respective safety and efficacy outcomes. METHODS: A comprehensive systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: A total of 38 studies comprising 811 patients with refractory PHN were included. The safety and efficacy of the following procedures were investigated: spinal cord stimulation (SCS), dorsal root entry zone (DREZ) lesioning, intrathecal drug delivery, caudalis DREZ lesioning, dorsal root ganglion (DRG) radiofrequency lesioning, peripheral nerve stimulation, gamma knife surgery, deep brain stimulation, cordotomy, percutaneous radiofrequency rhizotomy and Gasserian ganglion stimulation. CONCLUSIONS: There are several available neurosurgical approaches for recalcitrant PHN including neuromodulatory and ablative procedures. It is suggested that patients with resistant PHN undergo minimally invasive procedures first, including SCS, peripheral nerve stimulation or DRG radiofrequency lesioning. More invasive procedures should be reserved for refractory cases. Comparative studies are needed in order to construct a PHN neurosurgical management algorithm.


Assuntos
Neuralgia Pós-Herpética/cirurgia , Neurocirurgiões/tendências , Procedimentos Neurocirúrgicos/tendências , Cordotomia/métodos , Cordotomia/tendências , Humanos , Neuralgia Pós-Herpética/diagnóstico por imagem , Procedimentos Neurocirúrgicos/métodos , Rizotomia/métodos , Rizotomia/tendências , Estimulação da Medula Espinal/métodos , Estimulação da Medula Espinal/tendências
17.
Phys Med Rehabil Clin N Am ; 30(2): 337-354, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30954151

RESUMO

Spinal cord epidural stimulation (scES) combined with activity-based training can promote lower limb motor function recovery in chronic, motor complete spinal cord-injured individuals. Task- and individual-specific scES parameters modulate the excitability of human spinal circuitry so that sensory information and residual descending input can serve as sources of control for generating motor patterns appropriate for standing, stepping, and volitionally moving the lower limb. Task-specific activity-based training with scES is crucial for promoting neural plasticity and motor function improvement. Future studies with more individuals and advanced stimulation technology are needed to better understand the recovery potential in this population.


Assuntos
Reabilitação Neurológica , Traumatismos da Medula Espinal/reabilitação , Estimulação da Medula Espinal , Humanos , Extremidade Inferior/fisiopatologia , Reabilitação Neurológica/métodos , Traumatismos da Medula Espinal/fisiopatologia , Estimulação da Medula Espinal/métodos
18.
Stereotact Funct Neurosurg ; 97(1): 31-36, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947223

RESUMO

BACKGROUND: Spinal cord stimulation (SCS) is a well-established therapy for chronic pain syndromes, with growing applicability to other conditions. Restless legs syndrome (RLS) is a widespread, chronic movement disorder managed primarily and incompletely by medication, and its etiology can be classified as idiopathic or secondary. METHODS: Three patients underwent SCS implantation for chronic back and/or leg pain with concomitant targeting of RLS: (1) a 34-year-old man with sporadic RLS symptoms that strongly intensified after military-related spinal fractures, (2) a 54-year-old man with RLS likely secondary to meralgia paresthetica, and (3) a 42-year-old man with low back and right lower extremity pain after a military motor vehicle accident. RESULTS: Continuing through 40-month, 2-month, and 28-month follow-ups, respectively, the patients experienced exemplary relief of their RLS symptoms. Notably in the case of patient 1, this benefit appears separate from his pain relief, as during the 5-month period directly after surgery but before adjusted targeting, he only experienced pain alleviation. CONCLUSIONS: To our knowledge, this is the first reported case of using SCS as a potentially long-lasting, safe, and highly effective therapy for RLS of mixed etiology. Additionally, 2 patients with RLS possibly secondary to chronic pain also benefited from the therapy. This success may be due to increased inhibition from hypothalamic cells controlling dopaminergic input to the spine.


Assuntos
Dor Crônica/diagnóstico por imagem , Dor Crônica/terapia , Síndrome das Pernas Inquietas/diagnóstico por imagem , Síndrome das Pernas Inquietas/terapia , Estimulação da Medula Espinal/métodos , Adulto , Dor Crônica/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Síndrome das Pernas Inquietas/complicações
19.
PLoS One ; 14(4): e0214818, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947310

RESUMO

Transcutaneous electrical stimulation is a relatively new technique to evoke spinal reflexes in lower limb muscles. The advantage of this technique is that the spinal reflex responses can be obtained from multiple lower limb muscles simultaneously. However, repeatability of spinal reflexes evoked by transcutaneous spinal cord stimulation between days has not been evaluated. We aimed to examine repeatability of recruitment properties of the spinal reflexes evoked by transcutaneous spinal cord stimulation. Recruitment curves of the spinal reflexes evoked by transcutaneous spinal cord stimulation of 8 lower limb muscles (i.e., foot, lower leg, and thigh muscles) of 20 males were measured on two consecutive days. To confirm that responses were caused by activation of the sensory fiber, a double-pulse stimulation with 50 ms inter-pulse interval was delivered. Peak-to-peak amplitude of the first response was calculated for each muscle when no response was observed in the second response owing to post-activation depression. For comparison with the spinal reflexes evoked by transcutaneous spinal cord stimulation, the recruitment curves of the H-reflex amplitude of the soleus of 9 males were measured. Threshold intensity and maximal slope of the recruitment curves were calculated, and inter-day repeatability of the properties was quantified using intraclass correlation coefficients. For the spinal reflexes evoked by transcutaneous spinal cord stimulation, the intraclass correlation coefficient values of threshold intensity and maximal slope for each muscle ranged from 0.487 to 0.874 and from 0.471 to 0.964, respectively. Regarding the soleus H-reflex, the intraclass correlation coefficients of threshold intensity and maximal slope were 0.936 and 0.751, respectively. The present data showed that repeatability of the recruitment properties of the spinal reflexes evoked by transcutaneous spinal cord stimulation in the lower limb was moderate to high. Measurement of the spinal reflexes evoked by transcutaneous spinal cord stimulation would be useful for longitudinal neurophysiological studies.


Assuntos
Reflexo H/fisiologia , Estimulação da Medula Espinal/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Humanos , Extremidade Inferior , Vértebras Lombares , Masculino , Músculo Esquelético/inervação , Músculo Esquelético/fisiologia , Recrutamento Neurofisiológico , Reprodutibilidade dos Testes , Adulto Jovem
20.
Neuromodulation ; 22(3): 244-252, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30840354

RESUMO

BACKGROUND: Traumatic spinal cord injury (SCI) disrupts signaling pathways between the brain and spinal networks below the level of injury. In cases of severe SCI, permanent loss of sensorimotor and autonomic function can occur. The standard of care for severe SCI uses compensation strategies to maximize independence during activities of daily living while living with chronic SCI-related dysfunctions. Over the past several years, the research field of spinal neuromodulation has generated promising results that hold potential to enable recovery of functions via epidural electrical stimulation (EES). METHODS: This review provides a historical account of the translational research efforts that led to the emergence of EES of the spinal cord to enable intentional control of motor functions that were lost after SCI. We also highlight the major limitations associated with EES after SCI and propose future directions of spinal neuromodulation research. RESULTS: Multiple, independent studies have demonstrated return of motor function via EES in individuals with chronic SCI. These enabled motor functions include intentional, controlled movement of previously paralyzed extremities, independent standing and stepping, and increased grip strength. In addition, improvements in cardiovascular health, respiratory function, body composition, and urologic function have been reported. CONCLUSIONS: EES holds promise to enable functions thought to be permanently lost due to SCI. However, EES is currently restricted to scientific investigation in humans with SCI and requires further validation of factors such as safety and efficacy before clinical translation.


Assuntos
Espaço Epidural/fisiologia , Rede Nervosa/fisiologia , Desempenho Psicomotor/fisiologia , Recuperação de Função Fisiológica/fisiologia , Traumatismos da Medula Espinal/terapia , Estimulação da Medula Espinal/tendências , Humanos , Córtex Sensório-Motor/fisiologia , Medula Espinal/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Estimulação da Medula Espinal/métodos
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