Advanced Optical Imaging in the Study of Acute and Chronic Response to Implanted Neural Interfaces
Yu Chen, Babak Kateb in Neurophotonics and Brain Mapping, 2017
Implanted medical devices that interface with the nervous system are currently used to diagnose and treat a wide variety of neurological and psychiatric disorders and impairments. The acceptance of these devices is likely to grow over the next decade to the extent that they are demonstrated to provide benefit to patients who are resistant to treatment by pharmaceutical or other interventions. Neurostimulation devices treat medical conditions such as chronic pain, Parkinson’s disease, essential tremor, epilepsy, hearing loss, and urinary incontinence, among others. There are an estimated 800,000 implanted neurostimulation devices in patients worldwide, and the market share is expected to grow (Medtech Insight 2013). Neural recording devices, which detect neural signals, are currently marketed for epilepsy monitoring and brain mapping. Several medical devices recently approved by the U.S. Food and Drug Administration (FDA) include both stimulation and recording elements. These include a closed-loop system, the NeuroPace Responsive Neurostimulation System for epilepsy, which detects brain electrical signals and provides stimulation to interrupt seizures. Similarly, the Inspire Upper Airway stimulation system to treat sleep apnea detects ventilatory effort and responds with stimulation of the hypoglossal nerve to open the airway. The closed-loop detection/therapy combination of neural sensing and stimulation in a single device platform has the potential to increase the therapeutic potency of future devices.
Spinal Cord Stimulation
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
There is substantial scientific evidence on the efficacy of SCS for treatment of low back and lower extremity pain of neuropathic nature. Clinical studies have revealed from 50 to 70% success rates with certain methods of SCS.23,49–51 Those studies have shown decreased pain intensity scores, functional improvement, and decreased medication use with SCS treatment. The main drawback of neurostimulation is a decrease in its effectiveness over time, as seen in 20 to 40% of patients. It seems that this “tolerance” to treatment is due to reorganization of CNS (CNS plasticity) that takes place in neuropathic pain states. Anecdotal evidence suggests that not using the SCS continuously (e.g., shutting it off overnight) may decrease the development of tolerance.
Brain stimulation: new directions
Alan Weiss in The Electroconvulsive Therapy Workbook, 2018
Results from tDCS clinical trials are encouraging highlighting the potential benefits of evidencebased, low-cost, safe neurostimulation treatments that can be accessed by a large number of patients who may not respond to conventional treatments, who may be ineligible for ECT or who may lack sufficient medical resources in their local area. These treatment approaches will develop to a point where they will become first-line before ECT is considered. However, owing to their simplicity and low cost they are open to a dangerous and misinformed "do it yourself" approach to treatment, with information on how to build your own device or alternatively other models, like the Neurogadget, readily available for purchase on the Internet (Neurogadget, 2017).
Current and future pharmacotherapy options for drug-resistant epilepsy
Published in Expert Opinion on Pharmacotherapy, 2022
Are any of these drugs going to change the treatment of epilepsy? This is difficult to tell. ASMs still represent the main treatment for epilepsy, but they are not the only option. Surgical techniques are advancing as well as research into neurostimulation. This will reinforce the need to identify good outcome measures. In terms of seizure-based outcomes, the definition of drug-resistance proposed by the ILAE introduced a few important points such as the duration of the observation and the relapsing remitting nature of some epilepsy syndromes. It goes without saying that the short follow-up provided by regulatory trials is insufficient to gain any information on the usefulness of specific compounds in the long term. In this regard, phase IV trials will be needed but will need to adopt the same criteria in terms of seizure freedom and comparable outcome measures. In addition to seizure-based outcomes, it is important to recognize that that several factors beyond seizure frequency are relevant for patients with drug-resistant epilepsy and these include comorbidities, especially cognitive and psychiatric ones. Potentially, this could lead to the development of new compounds targeting specific comorbidities in addition to seizures, but none of the drugs currently under development appear to address this issue.
Can we use the dynamic and complex interplay between pain and sleep to quantify neuromodulation responsiveness for chronic pain?
Published in Expert Review of Neurotherapeutics, 2021
Thomas Kinfe, Michael Buchfelder, Andreas Stadlbauer
To date, robustly designed (randomized-controlled) human studies are increasingly evaluating noninvasive and invasive neurostimulation therapies (e.g. deep brain stimulation, motor cortex stimulation, transcranial magnetic stimulation, transcranial direct current stimulation, transcranial alternating stimulation, cervical noninvasive vagus nerve stimulation, different spinal cord stimulation waveforms and dorsal root ganglion stimulation) for refractory chronic pain disorders, such as primary headache disorders, lower back pain, neuropathic leg pain and complex regional pain syndrome [7–13]. These studies have underscored the usefulness of neurostimulation as an adjunctive treatment strategy for use with pharmacological-behavioral therapies. However, none of these studies have incorporated objective sleep measures, such as polysomnography, actinography, electromyography or electroencephalography [7–13].
Neuromodulation for the treatment of primary headache syndromes
Published in Expert Review of Neurotherapeutics, 2019
The sphenopalatine ganglion (SPG) stimulation (Pulsante®) was developed initially for the acute treatment of cluster headache. In this neurostimulation technique, a small electrode is implanted through the oral cavity into the close vicinity of the SPG. After the surgical intervention and a recovery period of four weeks, patients receive a handheld device to perform an on-demand activation of the electrode [14]. To do so patients have to hold the device during an attack onto their cheek to activate the electrode and induce pain relief. The main advantage of this induction-based approach is that the battery is located in the handheld device and not in the electrode so that no surgical revisions are required for the exchange of batteries. The downside of this method is that patients have to hold the device onto their cheek during the entire stimulation period (15–20 min) which is not always easy given the excruciating severity of the headache.
Related Knowledge Centers
- Microelectrode
- Nervous System
- Neuromodulation
- Neuroprosthetics
- Prosthesis
- Transcranial Magnetic Stimulation
- Transcranial Direct-Current Stimulation
- Cranial Electrotherapy Stimulation
- Hearing Aid
- Brain–Computer Interface