Cortical-evoked potentials from deep brain stimulation
Hans O Lüders in Deep Brain Stimulation and Epilepsy, 2020
The neurostimulator equipment consists of the chronic stimulating electrode, of which one end is placed in the targeted region of the brain through a small burrhole while the opposite end is tunneled subcutaneously to a programmable, pacemaker-like device implanted in the infraclavicular region. The electrode that we use currently is Model 3387 (Meditronic, Inc, Minneapolis, MN, USA), a quadripolar lead consisting of four low-impedance (≈ 1 kohm), platinum-iridium contacts, each 1.27 mm in diameter, 1.5 mm in length, and separated from adjacent contacts by 1.5 mm. The four contacts are numbered 0 through 3, with 0 being the most distal contact. In the case of the STN, the approach that we use is to place the distal edge of the zero contact at the inferior border of STN. Placement is achieved using combined anatomical targeting and microelectrode-based physiological mapping of the target trajectory,12,13 with final placement and fixation per formed under the guidance of intra-operative fluoroscopy.
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.
Neuromodulation - Science and Practice in Epilepsy: Vagus Nerve Stimulation, Thalamic Deep Brain Stimulation, and Responsive NeuroStimulation
Published in Expert Review of Neurotherapeutics, 2019
Matthew S. Markert, Robert S. Fisher
Neurostimulation, or more accurately neuromodulation, is a relatively new therapy in the management of neurologic disease, although the concept of using electricity to treat brain diseases dates to antiquity [1]. The Roman Scribonius Largus (c.e. 1–50), physician to Emperors Tiberius and Claudius, described use of the electric ray torpedo occidentalis for curing pain from gout, and to arrest intractable headaches by placement against the skin[2]. Detailed use of fish bioelectrogenesis by physicians as an effective treatment for headaches, and possibly epilepsy, was described by the Persian author Ibn Sina in 1025 [3]. Vagus nerve stimulation (VNS) was approved in Europe in 1994 and in the United States in 1997, thalamic deep brain stimulation (DBS) for epilepsy in Europe in 2010 and the United States in 2018, and responsive neurostimulation (RNS) was approved in the United States in 2013. Several comparative and systematic reviews among these devices have been previously reported [4–11], but few focus discussion on the science underlying device use. No reviews have come out since approval of DBS in the United States, or discuss very recent documentation of the beneficial impact of neuromodulation in reducing risk for sudden unexpected death in epilepsy (SUDEP).
Neuromodulation with percutaneous electrical nerve field stimulation is associated with reduction in signs and symptoms of opioid withdrawal: a multisite, retrospective assessment
Published in The American Journal of Drug and Alcohol Abuse, 2018
To address the opioid epidemic, the US Congress passed the DRUG Addiction Treatment Act (55) to expand treatment options beyond specialized, addiction treatment centers.(56,57) This allows office-based physicians who complete training to obtain a waiver, allowing them to prescribe the opioid receptor agonist, buprenorphine to a limited number of subjects.(58) Unfortunately, a recent study suggests that only about 2.2% of American physicians have obtained a waiver and 90% of those were practicing in urban counties.(59) Some of the challenges reported by physicians include lack of time, inadequate staff support, concerns about DEA investigations, and paperwork requirements.(17) While it is beyond the scope of this study to compare outcomes of neurostimulation with the BRIDGE to those of commonly used pharmacotherapies, it seems logical that this type of therapy could play an important role as a therapeutic option since it could help overcome some of the current barriers encountered with pharmacotherapy.(60,61) The BRIDGE requires minimal training, can be used by physician extenders without limitations on the number of subjects treated, and can be implemented without the fear of inducing a precipitated withdrawal. At a cost of approximately $500 per device, which requires a one-time use, it is also likely to be cost effective and easily accessible. It is important to keep in mind that pharmacotherapy with opioid receptor agonists and/or antagonists plays an indispensable role not only in long-term maintenance therapy, but also during the induction phase in certain patients.
Current and future treatment management strategies for gastroparesis
Published in Expert Opinion on Orphan Drugs, 2019
Priyadarshini Loganathan, Mahesh Gajendran, Richard McCallum
The GP patients refractory to medical therapy are the candidates for GES [90–92]. The first gastric electrical stimulator placement in animal experiments can be traced back to 1963 [93]. The Food and Drug Administration (FDA) approved Gastric electrical stimulator (GES) in 2000 under the Humanitarian Device Exemption (HDE) program for treatment of chronic, intractable (drug‐refractory) nausea and vomiting secondary to GP of diabetic or ID etiology [94]. The GES apparatus is placed surgically; two electrical leads are placed in the muscularis of the anterior greater curvature of the stomach 1 cm apart and 10 cm proximal to pylorus. The pair of electrodes is connected to the neurostimulator generator positioned subcutaneously in the abdominal wall. The most commonly used GES is called as Enterra system (Medtronic Inc, Minneapolis, MN, USA), which utilizes the high frequency (14 Hz; 12 cpm) short pulse width (330 μs) and low‐energy stimulation.
Related Knowledge Centers
- Microelectrode
- Nervous System
- Neuromodulation
- Neuroprosthetics
- Prosthesis
- Transcranial Magnetic Stimulation
- Transcranial Direct-Current Stimulation
- Cranial Electrotherapy Stimulation
- Hearing Aid
- Brain–Computer Interface