Influence of spinal cord stimulation on evoked potentials by cutaneous electrical stimulation

In the past, limited research has been done to investigate the influence of spinal cord stimulation (SCS) for treatment of chronic pain on evoked potentials (EP). Further insight into the mechanism of SCS may provide explanations for unsatisfactory results with this therapy in certain subpopulations. It also might predict effectiveness of SCS. In previous research MEG responses were measured on median and tibial nerve stimulations in chronic pain patients with and without SCS (1). However, this stimulation method preferentially activates large myelinated proprioceptive fibres, leaving painrelated small fibres unrelated. We expect that the observation of pain processing is impaired by large amounts of non-painrelated activity

A new and innovative therapy for restoration of dropped-foot with a 2-channel electrical stimulation implant: description and outcome in twenty patients

Dropped foot is a condition often found in several patient groups, including Multiple Sclerosis, incomplete spinal cord lesion and most notably, stroke. a dropped foot occurs when the muscles of the lower leg are not able to voluntary lift the foot during the swing phase of walking because they are no longer under control of the central nervous system. as a result, the patient's gait pattern is inefficient, unstable and uncoordinated. This results in a higher chance of stumbling and falling, a low walking speed, and pain in the joints and muscles around the hip

Cardiac responses of vagus nerve stimulation: Intraoperative bradycardia and subsequent chronic stimulation

OBJECTIVES: Few adverse events on heart rate have been reported with vagus nerve stimulation (VNS) for refractory epilepsy. We describe three cases with intraoperative bradycardia during device testing. PATIENTS AND METHODS: At our hospital 111 patients have received a VNS system. Intraoperative device testing is performed under ECG-monitoring. We reviewed the patients and their VNS-therapy follow-up outcome who experienced a change in heart rate, during device testing (Lead Test). RESULTS: Three patients with medically refractory epilepsy showed a bradycardia during intraoperative Lead Test. Postoperative the VNS-therapy started under ECG-monitoring. No change in cardiac rhythm occurred. Subsequent chronic stimulation is uneventful. All three have reduced seizure frequency. Two already have had their second implant, without the occurrence of bradycardia. CONCLUSION: In case of intraoperative bradycardia VNS-therapy onset should be done under ECG-monitoring. Subsequent chronic stimulation is safe in respect to heart rate. Bradycardia during intraoperative device testing is no reason to abort the operation

Vagus nerve stimulation for medically refractory epilepsy: A long-term follow-up study

Introduction Vagus nerve stimulation (VNS) is thought to have a cumulative effect in time on seizure frequency reduction. There also might be other variables than reduction of seizure frequency in order to determine VNS efficacy. In this study we describe the long-term outcome of the first group of vagus nerve stimulation patients with pharmacoresistant epilepsy at the Medisch Spectrum Twente, The Netherlands. Methods This long-term descriptive prospective study included 19 patients, 11 males and 8 females, aged 17–46 years with pharmacoresistant epilepsy. They had received 3–16 (mean 9) different anti-epileptic drugs and were not eligible for surgical resection of an epileptic focus. A vagus nerve stimulator was implanted in the period April 1999–October 2001. Follow-up ranges from 2 to 6 years (mean 4 years). Efficacy was measured as the percentage change in seizure rate during 1 year and then after each year follow-up of VNS compared to 5 months baseline before implantation. Results Mean seizure reduction at 1–6 years was, respectively, 14% (n = 19), 25% (n = 19), 29% (n = 16), 29% (n = 15), 43% (n = 9) and 50% (n = 7). Because of VNS two patients were able to start living without supervision. One patient died after 2 years of follow-up possibly as a result of SUDEP. Four patients had no apparent reduction in seizure frequency. Two of them had their stimulator removed. The other two patients however had significantly reduced post-ictal periods and seizure time and received a new pulse generator when the battery was depleted. One stimulator was switched off due to adverse effects, even though there was a positive effect on his seizure reduction. In six patients the medication regimen was changed during VNS by adding one anti-epileptic drug, however without significant change in seizure reduction. Adverse effects were hoarseness and coughing during stimulation. One patient had a temporary paralysis of his left vocal cord. Conclusion We think that VNS is an effective treatment for pharmacoresistant epilepsy and its positive effect persists during the years of follow-up. Our results suggest that seizure reduction should not be considered as the only variable of importance to describe the outcome of VNS on epilepsy and it is worthwhile to look at other outcome measures