Spinal Anesthesia and Minimal Invasive Laminotomy for Paddle Electrode Placement in Spinal Cord Stimulation: Technical Report and Clinical Results at Long-Term Followup

Object. We arranged a mini-invasive surgical approach for implantation of paddle electrodes for SCS under spinal anesthesia obtaining the best paddle electrode placement and minimizing patients' discomfort. We describe our technique supported by neurophysiological intraoperative monitoring and clinical results. Methods. 16 patients, affected by neuropathic pain underwent the implantation of paddle electrodes for spinal cord stimulation in lateral decubitus under spinal anesthesia. The paddle was introduced after flavectomy and each patient confirmed the correct distribution of paresthesias induced by intraoperative test stimulation. VAS and patients' satisfaction rate were recorded during the followup and compared to preoperative values. Results. No patients reported discomfort during the procedure. In all cases, paresthesias coverage of the total painful region was achieved, allowing the best final electrode positioning. At the last followup (mean 36.7 months), 87.5% of the implanted patients had a good rate of satisfaction with a mean VAS score improvement of 70.5%. Conclusions. Spinal cord stimulation under spinal anesthesia allows an optimal positioning of the paddle electrodes without any discomfort for patients or neurosurgeons. The best intraoperative positioning allows a better postoperative control of pain, avoiding the risk of blind placements of the paddle or further surgery for their replacement

Using meteorological measurements from different sources to evaluate the human comfort in urban area

Climate change affects the thermal and human comfort in urban areas. This is more evident in equatorial towns that have experienced, in the last decades, of an increase of air temperature which, acting together with the increasing of the rain rate, generates a strong deterioration of the human comfort. The characterization of the urban heat island is one of the most important points in the agenda of the Research Centers, as well as of the Weather Services of the Nations located in the equatorial area. The Escuela Superior Politecnica del Litoral (Ecuador), jointly with the Instituto Nacional de Meteorologia e Hidrologia (INAMHI - Ecuador) and with the Politecnico di Torino and the Università di Torino (Italy), started a project devoted to the analysis of the thermal comfort in the Guayaquil urban area. The research is funded by the Secretaria de Educacion Superior, Ciencia, Tecnologia e Innovacion (SENESCYT – Ecuador) in the context of the PROMETEO project. The preliminary results of this research show us how, to better describe the thermal comfort in the urban area, it is important to have available the meteorological parameters measured by a meso-network of Automatic Weather Stations. The elaboration of these measures with the Universal Thermal Climate Indices, like the PMV and the PET, provide a detailed analysis of the thermal comfort and of the related human comfort in the urban area. The results of this analysis are to be evaluated jointly with the aerological measurements and with the remote sensing images to characterize correctly the urban heat island

Using meteorological measurements from different sources to evaluate the human comfort in urban area

Climate change affects the thermal and human comfort in urban areas. This is more evident in equatorial towns that have experienced, in the last decades, of an increase of air temperature which, acting together with the increasing of the rain rate, generates a strong deterioration of the human comfort. The characterization of the urban heat island is one of the most important points in the agenda of the Research Centers, as well as of the Weather Services of the Nations located in the equatorial area. The Escuela Superior Politecnica del Litoral (Ecuador), jointly with the Instituto Nacional de Meteorologia e Hidrologia (INAMHI - Ecuador) and with the Politecnico di Torino and the Università di Torino (Italy), started a project devoted to the analysis of the thermal comfort in the Guayaquil urban area. The research is funded by the Secretaria de Educacion Superior, Ciencia, Tecnologia e Innovacion (SENESCYT – Ecuador) in the context of the PROMETEO project. The preliminary results of this research show us how, to better describe the thermal comfort in the urban area, it is important to have available the meteorological parameters measured by a meso-network of Automatic Weather Stations. The elaboration of these measures with the Universal Thermal Climate Indices, like the PMV and the PET, provide a detailed analysis of the thermal comfort and of the related human comfort in the urban area. The results of this analysis are to be evaluated jointly with the aerological measurements and with the remote sensing images to characterize correctly the urban heat island

The cientificWorldJOURNAL Clinical Study Spinal Anesthesia and Minimal Invasive Laminotomy for Paddle Electrode Placement in Spinal Cord Stimulation: Technical Report and Clinical Results at Long-Term Followup

Object. We arranged a mini-invasive surgical approach for implantation of paddle electrodes for SCS under spinal anesthesia obtaining the best paddle electrode placement and minimizing patients' discomfort. We describe our technique supported by neurophysiological intraoperative monitoring and clinical results. Methods. 16 patients, affected by neuropathic pain underwent the implantation of paddle electrodes for spinal cord stimulation in lateral decubitus under spinal anesthesia. The paddle was introduced after flavectomy and each patient confirmed the correct distribution of paresthesias induced by intraoperative test stimulation. VAS and patients' satisfaction rate were recorded during the followup and compared to preoperative values. Results. No patients reported discomfort during the procedure. In all cases, paresthesias coverage of the total painful region was achieved, allowing the best final electrode positioning. At the last followup (mean 36.7 months), 87.5% of the implanted patients had a good rate of satisfaction with a mean VAS score improvement of 70.5%. Conclusions. Spinal cord stimulation under spinal anesthesia allows an optimal positioning of the paddle electrodes without any discomfort for patients or neurosurgeons. The best intraoperative positioning allows a better postoperative control of pain, avoiding the risk of blind placements of the paddle or further surgery for their replacement

Recommendations of the International Society of Intraoperative Neurophysiology for intraoperative somatosensory evoked potentials

Intraoperative somatosensory evoked potentials (SEPs) provide dorsal somatosensory system functional and localizing information, and complement motor evoked potentials. Correct application and interpretation require in-depth knowledge of relevant anatomy, electrophysiology, and techniques. It is advisable to facilitate cortical SEPs with total intravenous propofol-opioid or similarly favorable anesthesia. Moreover, SEP optimization is recommended to enhance surgical feedback speed and accuracy by maximizing signal-to-noise ratio (SNR); it consists of selecting highest-SNR peripheral and cortical derivations while omitting low-SNR channels. Confounding factors causing non-surgical SEP reduction should be excluded before issuing a warning. It is advisable to facilitate their identification with peripheral SEP controls and cortical SEP systemic controls whenever possible. Warning criteria should adjust for baseline drift and reproducibility. The recommended adaptive warning criterion is visually obvious amplitude reduction from recent pre-change values and clearly exceeding trial-to-trial variability, particularly when abrupt and focal. Acquisition and interpretation should be done by qualified technical and professional level personnel. Indications for SEP monitoring include intracranial, posterior fossa, and spinal neurosurgery, as well as orthopedic spine, cerebrovascular, and descending aortic surgery. Indications for SEP mapping include sensorimotor cortex and dorsal column midline identification. Future advances could modify current recommendations

Impact of supporting people with advanced Parkinson’s disease on carer’s quality of life and burden

Purpose: The aim of this study was to assess the burden and the quality of life (QoL) perceived by caregivers assisting advanced Parkinson’s disease (PD) patients. Patients and Methods: Consecutive advanced PD patients treated with levodopa/carbidopa intestinal gel (LCIG) or continuous subcutaneous apomorphine infusion (CSAI) or care as usual (CU) and their care partners were recruited during routine visits according to a cross-sectional design. Caregiver’s distress was assessed by Zarit Burden Interview (ZBI) and a QoL survey to evaluate and understand the burden experienced by care partners during family and working activities. Results: A total of 126 patients (53 LCIG, 19 CSAI and 54 CU) and their care partners were enrolled. The ZBI score boxplot showed that LCIG and CU populations have a similar distribution (ZBI inter-quartile range [IQR] values respectively 18–42 for LCIG and 19–43 for CU group), while the CSAI group has a wider score range (IQR 16–52). Caregivers assisting patients in treatment with LCIG have more time to perform family or household duties (p=0.0022), or to engage in leisure activities (p=0.0073) compared to CU, while no difference was found when compared to CSAI group. Approximately 50% of the care partners showed mood changes in the last 6 months and LCIG and CSAI had less impact on caregiver’s mood compared to CU. Patients treated with LCIG were more independent in taking a bath or shower without assistance and were more able to move and walk without assistance. Conclusion: Care partners of advanced PD patients treated with device-aided therapies have more time for their own life and a better perception of their QoL with a tendency to an improvement of mood compared with those of patients treated with CU

The Italian multiple sclerosis register

The past decade has seen extraordinary increase in worldwide availability of and access to several large multiple sclerosis (MS) databases and registries. MS registries represent powerful tools to provide meaningful information on the burden, natural history, and long-term safety and effectiveness of treatments. Moreover, patients, physicians, industry, and policy makers have an active interest in real-world observational studies based on register data, as they have the potential to answer the questions that are most relevant to daily treatment decision-making. In 2014, the Italian MS Foundation, in collaboration with the Italian MS clinical centers, promoted and funded the creation of the Italian MS Register, a project in continuity with the existing Italian MS Database Network set up from 2001. Main objective of the Italian MS Register is to create an organized multicenter structure to collect data of all MS patients for better defining the disease epidemiology, improving quality of care, and promoting research projects in high-priority areas. The aim of this article is to present the current framework and network of the Italian MS register, including the methodology used to improve the quality of data collection and to facilitate the exchange of data and the collaboration among national and international groups

The Italian multiple sclerosis register

The past decade has seen extraordinary increase in worldwide availability of and access to several large multiple sclerosis (MS) databases and registries. MS registries represent powerful tools to provide meaningful information on the burden, natural history, and long-term safety and effectiveness of treatments. Moreover, patients, physicians, industry, and policy makers have an active interest in real-world observational studies based on register data, as they have the potential to answer the questions that are most relevant to daily treatment decision-making. In 2014, the Italian MS Foundation, in collaboration with the Italian MS clinical centers, promoted and funded the creation of the Italian MS Register, a project in continuity with the existing Italian MS Database Network set up from 2001. Main objective of the Italian MS Register is to create an organized multicenter structure to collect data of all MS patients for better defining the disease epidemiology, improving quality of care, and promoting research projects in high-priority areas. The aim of this article is to present the current framework and network of the Italian MS register, including the methodology used to improve the quality of data collection and to facilitate the exchange of data and the collaboration among national and international groups