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Burst spinal stimulator

Ariel Morales, R Jason Yong, Alan D Kaye, Richard D Urman
PURPOSE OF REVIEW: The purpose of the present investigation is to summarize supporting evidence for novel sub-perception spinal cord stimulation (SCS) therapy over traditional paresthesia inducing low-frequency waveforms for the treatment of chronic pain. The focus of this review is to summarize key studies comparing traditional low-frequency tonic waveforms to modern high frequency and burst stimulation for the treatment of patients with chronic intractable low back pain and/or leg pain...
March 14, 2019: Current Pain and Headache Reports
Viviana Versace, Stefania Campostrini, Luca Sebastianelli, Leopold Saltuari, Markus Kofler
The cutaneous silent period (CSP) to noxious finger stimulation constitutes a robust spinal inhibitory reflex that protects the hand from injury. In certain conditions spinal inhibition is interrupted by a brief burst-like electromyographic activity, dividing the CSP in two inhibitory phases (I1 and I2). This excitatory component is termed long-loop reflex (LLR) and is presumed to be transcortical in origin. Efficient defense from environmental threats requires sensorimotor integration between multimodal sensory afferents and planning of defensive movements...
February 27, 2019: Journal of Neurophysiology
L Delange Segura, M Rodríguez Padilla, M T Palomino Jiménez, M Fernández Baena, J F Rodríguez Staff
Pain associated with chronic pancreatitis is often difficult to treat. On many occasions, interventional techniques may be necessary. In recent years, spinal cord stimulation techniques have been used successfully in the management of these patients. However, only the use of traditional tonic stimulation based on paresthesias has been published for this purpose. Spinal cord burst stimulation (SCBS) has been shown to be more effective than tonic stimulation, especially in failed back surgery syndrome (FBSS)...
February 5, 2019: Pain Practice: the Official Journal of World Institute of Pain
Ankit Maheshwari, Jason E Pope, Timothy R Deer, Steven Falowski
Spinal cord stimulation has emerged as a state-of-the-art evidence-based treatment for chronic neuropathic pain and mixed nociceptive-neuropathic pain. In recent years, several newer devices and treatment algorithms have provided unique and effective ways of treating chronic pain by spinal cord stimulation. In a previous review, the authors commented on the 5-year forecast for high frequency and Burst waveforms, as the only two paresthesia independent SCS strategies. Over the last 5 years, there has been considerable addition to the outcome data related to these modalities...
February 2019: Expert Review of Medical Devices
Genni Duse, Claudio Reverberi, Alessandro Dario
OBJECTIVES: We present the results of a prospective, randomized, crossover, single-blind, study in which each patient is in control of himself. The aim was to evaluate subperception-based (SP-SCS) waveforms in previously implanted spinal cord stimulation (SCS) patients with leg and/or back pain due to failed back surgery syndrome, who experienced only paresthesia-based stimulation (PB-SCS). Patients with PB-SCS experience in SCS was 4.7 years (SD 2.9). MATERIALS AND METHODS: We enrolled 28 consecutive patients...
December 11, 2018: Neuromodulation: Journal of the International Neuromodulation Society
Jan Vesper, Philipp Slotty, Stefan Schu, Katja Poeggel-Kraemer, Heike Littges, Pieter Van Looy, Filippo Agnesi, Lalit Venkatesan, Tony Van Havenbergh
INTRODUCTION: The burst waveform, a recent innovation in spinal cord stimulation (SCS), can achieve better outcomes than conventional tonic SCS, both for de novo implants and as a salvage therapy. Burst stimulation delivers more energy per second than tonic stimulation, which is a consideration for battery consumption. The clinical effectiveness of an energy-conserving strategy was investigated. METHODS: Subjects were experienced users of BurstDR SCS for back and leg pain...
November 19, 2018: Neuromodulation: Journal of the International Neuromodulation Society
Beatrice Barra, Camille Roux, Melanie Kaeser, Giuseppe Schiavone, Stephanie P Lacour, Jocelyne Bloch, Gregoire Courtine, Eric M Rouiller, Eric Schmidlin, Marco Capogrosso
Recovery of reaching and grasping ability is the priority for people with cervical spinal cord injury (SCI). Epidural electrical stimulation (EES) has shown promising results in improving motor control after SCI in various animal models and in humans. Notably, the application of stimulation bursts with spatiotemporal sequences that reproduce the natural activation of motoneurons restored skilled leg movements in rodent and nonhuman primate models of SCI. Here, we studied whether this conceptual framework could be transferred to the design of cervical EES protocols for the recovery of reaching and grasping in nonhuman primates...
July 2018: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Emanuele Formento, Karen Minassian, Fabien Wagner, Jean Baptiste Mignardot, Camille G Le Goff-Mignardot, Andreas Rowald, Jocelyne Bloch, Silvestro Micera, Marco Capogrosso, Gregoire Courtine
Epidural electrical stimulation (EES) of the spinal cord restores locomotion in animal models of spinal cord injury but is less effective in humans. Here we hypothesized that this interspecies discrepancy is due to interference between EES and proprioceptive information in humans. Computational simulations and preclinical and clinical experiments reveal that EES blocks a significant amount of proprioceptive input in humans, but not in rats. This transient deafferentation prevents modulation of reciprocal inhibitory networks involved in locomotion and reduces or abolishes the conscious perception of leg position...
December 2018: Nature Neuroscience
Jeffri Retamal, Andrea Reyes, Paulina Ramirez, David Bravo, Alejandro Hernandez, Teresa Pelissier, Luis Villanueva, Luis Constandil
Intrathecal administration of brain derived neurotrophic factor (BDNF) induces long-term potentiation (LTP) and generates long-lasting central sensitization in spinal cord thus mimicking chronic pain, but the relevance of these observations to chronic pain mechanisms is uncertain. Since C-fiber activation by a high-frequency subcutaneous electrical stimulation (SES) protocol causes spinal release of BDNF and induces spinal cord LTP, we propose that application of such protocol would be a sufficient condition for generating long-lasting BDNF-mediated central sensitization...
2018: Frontiers in Pharmacology
Gary L Schmidt
Chronic pain causes a tremendous burden on the society in terms of economic factors and social costs. Rates of spinal surgery, especially spinal fusion, have increased exponentially over the past decade. The opioid epidemic in the United States has been one response to the management of pain, but it has been fraught with numerous catastrophic-related adverse effects. Clinically, spinal cord stimulation (SCS)/neuromodulation has been used in the management of chronic pain (especially spine-related pain) for more than two decades...
October 24, 2018: Journal of the American Academy of Orthopaedic Surgeons
Laura Demartini, Gaetano Terranova, Massimo A Innamorato, Alessandro Dario, Michele Sofia, Carlo Angelini, Genni Duse, Amedeo Costantini, Matteo L G Leoni
BACKGROUND: Spinal cord stimulation (SCS) is a well-known treatment in patients with failed back surgery syndrome (FBSS). Burst stimulation is a recently developed stimulation modality that seems to be superior to tonic stimulation. METHODS: This observational multicenter study compared tonic and burst stimulation during a trial period in patients with FBSS or radiculopathy. All the patients enrolled underwent two weeks of tonic stimulation followed by another two weeks of BurstDR stimulation, without randomization...
October 17, 2018: Neuromodulation: Journal of the International Neuromodulation Society
Marco Capogrosso, Fabien B Wagner, Jerome Gandar, Eduardo Martin Moraud, Nikolaus Wenger, Tomislav Milekovic, Polina Shkorbatova, Natalia Pavlova, Pavel Musienko, Erwan Bezard, Jocelyne Bloch, Grégoire Courtine
Epidural electrical stimulation (EES) of the spinal cord and real-time processing of gait kinematics are powerful methods for the study of locomotion and the improvement of motor control after injury or in neurological disorders. Here, we describe equipment and surgical procedures that can be used to acquire chronic electromyographic (EMG) recordings from leg muscles and to implant targeted spinal cord stimulation systems that remain stable up to several months after implantation in rats and nonhuman primates...
September 2018: Nature Protocols
Jason A Keller, Jingyi Chen, Sierra Simpson, Eric Hou-Jen Wang, Varoth Lilascharoen, Olivier George, Byung Kook Lim, Lisa Stowers
Voluntary urination ensures that waste is eliminated when safe and socially appropriate, even without a pressing urge. Uncontrolled urination, or incontinence, is a common problem with few treatment options. Normal urine release requires a small region in the brainstem known as Barrington's nucleus (Bar), but specific neurons that relax the urethral sphincter and enable urine flow are unknown. Here we identify a small subset of Bar neurons that control the urethral sphincter in mice. These excitatory neurons express estrogen receptor 1 (BarESR1 ), project to sphincter-relaxing interneurons in the spinal cord and are active during natural urination...
September 2018: Nature Neuroscience
Tomofumi Yamaguchi, Toshiyuki Fujiwara, Su-Chuan Lin, Yoko Takahashi, Kozo Hatori, Meigen Liu, Ying-Zu Huang
This study explored the effect of corticospinal activity on spinal plasticity by examining the interactions between intermittent theta burst transcranial magnetic stimulation (iTBS) of the motor cortex and peripheral patterned electrical stimulation (PES) of the common peroneal nerve (CPN). Healthy volunteers ( n = 10) received iTBS to the tibialis anterior (TA) muscle zone of the motor cortex and PES of the CPN in three separate sessions: (1) iTBS-before-PES, (2) iTBS-after-PES, and (3) sham iTBS-before-PES...
2018: Frontiers in Neuroscience
Ivano Dones, Vincenzo Levi
The origin and the neural pathways involved in chronic neuropathic pain are still not extensively understood. For this reason, despite the wide variety of pain medications available on the market, neuropathic pain is challenging to treat. The present therapeutic alternative considered as the gold standard for many kinds of chronic neuropathic pain is epidural spinal cord stimulation (SCS). Despite its proved efficacy, the favourable cost-effectiveness when compared to the long-term use of poorly effective drugs and the expanding array of indications and technical improvements, SCS is still worldwide largely neglected by general practitioners, neurologists, neurosurgeons and pain therapists, often bringing to a large delay in considering as a therapeutic option for patients affected by neuropathic chronic pain...
July 24, 2018: Brain Sciences
Natalie Mrachacz-Kersting, Sabata Gervasio, Veronique Marchand-Pauvert
In humans, an ipsilateral tibial nerve (iTN) stimulation elicits short-latency-crossed-responses (SLCR) comprised of two bursts in the contralateral gastrocnemius lateralis (cGL) muscle. The average onset latency has been reported to be 57-69 ms with a duration of 30.4 ± 6.6 ms. The aim of this study was to elucidate if a transcortical pathway contributes to the SLCR. In Experiment 1 ( n = 9), single pulse supra-threshold transcranial magnetic stimulation (supraTMS) was applied alone or in combination with iTN stimulation (85% of the maximum M-wave) while participants walked on a treadmill (delay between the SLCR and the motor evoked potentials (MEP) varied between -30 and 200 ms)...
2018: Frontiers in Human Neuroscience
Aref-Ali Gharooni, Krishnan Padmakumari Sivaraman Nair, Debby Hawkins, Ian Scivill, Daniel Hind, Ram Hariharan
STUDY DESIGN: Single-blind, sham-controlled, crossover randomized feasibility study OBJECTIVES: (1) Assess the feasibility of a full-scale trial of intermittent theta-burst stimulation (iTBS) for upper-limb sensorimotor dysfunction following spinal cord injury (SCI). (2) Determine the safety and tolerability of iTBS over primary motor cortex on upper-limb function in people with spinal cord injury (SCI). SETTING: Large Tertiary Spinal Injuries Centre METHODS: Participants with incomplete SCI, suffering with upper-limb spasticity were recruited and randomized to receive active/sham iTBS over the hand representation of the primary motor cortex...
August 2018: Spinal Cord
Mitchell D Reed, Kimberly E Iceman, Michael B Harris, Barbara E Taylor
The development of amphibian breathing provides insight into vertebrate respiratory control mechanisms. Neural oscillators in the rostral and caudal medulla drive ventilation in amphibians, and previous reports describe ventilatory oscillators and CO2 sensitive regions arise during different stages of amphibian metamorphosis. However, inconsistent findings have been enigmatic, and make comparisons to potential mammalian counterparts challenging. In the current study we assessed amphibian central CO2 responsiveness and respiratory rhythm generation during two different developmental stages...
November 2018: Comparative Biochemistry and Physiology. Part A, Molecular & Integrative Physiology
David Acton, Matthew J Broadhead, Gareth B Miles
Astrocytes modulate many neuronal networks, including spinal networks responsible for the generation of locomotor behavior. Astrocytic modulation of spinal motor circuits involves release of ATP from astrocytes, hydrolysis of ATP to adenosine, and subsequent activation of neuronal A1 adenosine receptors (A1 Rs). The net effect of this pathway is a reduction in the frequency of locomotor-related activity. Recently, it was proposed that A1 Rs modulate burst frequency by blocking the D1 -like dopamine receptor (D1 LR) signaling pathway; however, adenosine also modulates ventral horn circuits by dopamine-independent pathways...
September 1, 2018: Journal of Neurophysiology
Steven M Falowski
INTRODUCTION: Intraoperative neuromonitoring for spinal cord stimulation uses electromyography (EMG) responses to determine myotomal coverage as a marker for dermatomal coverage. These responses are utilized to determine the orientation of the electrode. Somatosensory evoked potential (SSEP) collision testing can also be used in which sensory signals are decreased and/or eliminated when stimulation is activated. METHODS: Fifteen patients were observed in the study...
April 29, 2018: Neuromodulation: Journal of the International Neuromodulation Society
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