Vagus Nerve Stimulation for Major Depressive Episodes.
Authors: Eljamel S
Abstract
Stimulation of the left vagus nerve is a novel antidepressive therapy that relies upon the vagal projections to the brain stem to modulate brain circuits involved in mood regulation. There is cumulative evidence from prospective and long-term studies that has demonstrated tolerability and effectiveness of vagus nerve stimulation (VNS) in major depressive episodes (MDE). VNS in MDE has the following advantages: symptomatic response (defined as at least a 50% improvement in MDE severity) occurs in at least 15-17% of patients after 10 weeks of VNS treatment and in at least 22-37% o...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Peripheral Neuromodulation to Treat Postamputation Pain.
Authors: Soin A, Fang ZP, Velasco J
Abstract
Some of the more common peripherally mediated pain disorders are postamputation stump pain and phantom pain. These disabling conditions have proven difficult to treat. Here we aim to illustrate an option to treat postamputation pain using peripheral neurostimulation techniques. Traditional peripheral neuromodulation techniques use standard stimulation parameters and work by stimulation of nerve tissues which are then felt by the patient as a tingling sensation or paresthesia. Recently introduced high-frequency (10 kHz) electrical nerve block [HFAC (high-frequenc...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Phrenic Nerve Stimulation: Technology and Clinical Applications.
Authors: Abdunnur SV, Kim DH
Abstract
Phrenic nerve stimulation is a technique used to reanimate the diaphragm of patients with central nervous system etiologies of respiratory insufficiency. Current clinical indications include congenital central hypoventilation syndrome, spinal cord injury above C4, brain stem injury, and idiopathic severe sleep apnea. Presurgical evaluation ensures proper patient selection by validating the intact circuit from the phrenic nerve through alveolar oxygenation. The procedure involves placing leads around the phrenic nerves bilaterally and attaching these leads to radio rece...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Peripheral Neurostimulation with a Microsize Wireless Stimulator.
Authors: Yearwood TL, Perryman LT
Abstract
Implementation of wireless technology enables tremendous reduction in the size of implantable neurostimulator devices. Without the need for tethering to an implantable pulse generator, a multitude of clinical applications can be envisioned, utilizing safe, rapidly implanted, economical, and culturally sensitive methods. External pulse generators providing power to implanted microsize wireless leads and/or contact pairs can be incorporated into belts, fabric, jewelry, and other suitable and convenient accoutrements. Microsized wireless neurostimulator lead placemen...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Trigeminal Ganglion Stimulation.
Authors: Van Buyten JP
Abstract
Facial pain in the distribution of the trigeminal nerve, commonly identified as trigeminal neuralgia, should not be confused with trigeminal neuropathic pain. The latter is caused by an accidental and nonintentional nerve lesion. When the first-line pharmacological treatment fails to provide satisfactory pain relief, surgical treatment, such as microvascular decompression and neurodestructive interventions (radiofrequency or cryotherapy), is not indicated. The logical choice of technique becomes neuromodulation, but it may be challenging to perform in the facial area. Althou...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Sacral Neuromodulation for Genitourinary Problems.
Authors: Banakhar M, Hassouna M
Abstract
Sacral neuromodulation (SNM) is a minimally invasive therapeutic option for many voiding dysfunction conditions. It is approved by the US FDA for refractory overactive bladder with and without incontinence and nonobstructive retention. Since SNM has shown a favorable response for these approved indications, other therapeutic applications have been proposed for various conditions such as painful bladder syndrome, chronic pelvic pain and neurological voiding dysfunction in both adult and pediatric age groups. SNM therapy with the most commonly used dedicated SNM devic...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Carotid Sinus/Nerve Stimulation for Treatment of Resistant Hypertension and Heart Failure.
Authors: Yin D, Slavin KV
Abstract
Hypertension and cardiovascular disease are leading causes of morbidity and mortality worldwide. The prevalence of resistant hypertension remains high and is expected to increase. Moreover, there are limitations to therapeutic interventions aimed at treating resistant hypertension and heart failure despite the wide availability of therapeutic agents and dietary and lifestyle modification. Device-based therapy by baroreflex activation via carotid sinus/nerve stimulation is currently undergoing investigation, and promising findings from clinical trials have been published. ...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Sacral Nerve Stimulation in the Treatment of Bowel Disorders.
Authors: Nordenstam J, Boller AM, Mellgren A
Abstract
Defecation problems occur in patients of all ages, but are more prevalent in the elderly, postpartum women, and patients with chronic and debilitating medical conditions. Most of the time, these problems respond to medical therapy and nonsurgical options, but it is not uncommon for patients to require surgical intervention. Sacral nerve stimulation (SNS) presents an alternative for patients with bowel dysfunction combining proven therapeutic benefits and limited surgical risks. Here we describe the common indications for SNS, patient selection, technica...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea.
Authors: Mwenge GB, Rombaux P, Lengele B, Rodenstein D
Abstract
Obstructive sleep apnea (OSA) is a very frequent affliction that affects about 1-5% of the adult population in its severe form. Continuous positive airway pressure (CPAP) is the most commonly used treatment and is highly effective, but its use is limited by low long-term adherence rates and overall poor acceptance among the patients. Therefore, there is a need for developing alternative approaches to OSA treatment, including a more 'natural' concept of maintaining an open airway through neuromodulation. Here we review the concept, scientific r...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Stimulation of the Dorsal Root Ganglion.
Authors: Liem L
Abstract
Dorsal root ganglion (DRG) stimulation has recently emerged as a new neuromodulation modality that stays on the intersection of the peripheral and central nervous system. With DRG location within the spinal column and with electrodes for DRG stimulation placed through the intraspinal epidural space, it may make more sense to group DRG stimulation together with more commonly used spinal cord stimulation (SCS) rather than peripheral nerve stimulation (PNS), particularly if one agrees that the stimulation delivered to DRG partly works downstream at the spinal cord level. Based on curr...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Sphenopalatine Ganglion Stimulation in Neurovascular Headaches.
Authors: Schoenen J
Abstract
The interest for the sphenopalatine ganglion (SPG) in neurovascular headaches dates back to 1908 when Sluder presented his work on the role of the SPG in 'nasal headaches', which are now part of the trigeminal autonomic cephalalgias and cluster headache (ICHD-III-beta). Since then various interventions with blocking or lesional properties have targeted the SPG (transnasal injection of lidocaine and other agents, alcohol or steroid injections, radiofrequency lesions, or even ganglionectomy); success rates vary, but benefit is usually transient. Here we briefly review some anatom...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Regulation of Peripheral Nerve Stimulation Technology.
Authors: Birk DM, Yin D, Slavin KV
Abstract
The number of peripheral nerve stimulation (PNS) indications, targets, and devices is expanding, yet the development of the technology has been slow because many devices used for PNS do not have formal regulatory approval. Manufacturers have not sought Food and Drug Administration (FDA) approval for PNS devices because of a perceived lack of interest amongst practitioners and patients. Without FDA approval, companies cannot invest in marketing to educate the implanters and the patients about the benefits of PNS in the treatment of chronic pain. Violation of this ...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Technology for Peripheral Nerve Stimulation.
Authors: Parker JL, Cameron T
Abstract
Peripheral nerve stimulation (PNS) has been in use for over 50 years to treat patients suffering from chronic pain who have failed conservative treatments. Despite this long history, the devices being used have changed very little. In fact, current PNS technology was developed specifically for spinal cord stimulation. The use of technology developed for other applications in PNS has led to an unnecessary number of device complications and the limited adoption of this promising therapy. The following chapter provides an overview of PNS technology throughout the years, ...
Source: Progress in Neurological Surgery - November 20, 2015 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
