scholarly journals Modelling Studies of Non-invasive Electric and Magnetic Stimulation of the Spinal Cord

2020 ◽  
pp. 139-165
Author(s):  
Sofia Rita Fernandes ◽  
Ricardo Salvador ◽  
Mamede de Carvalho ◽  
Pedro Cavaleiro Miranda
Keyword(s):  
Spinal Cord ◽  
Clinical Practice ◽  
Direct Current ◽  
Magnetic Stimulation ◽  
Experimental Studies ◽  
Functional Rehabilitation ◽  
Motor Pathways ◽  
Non Invasive ◽  
Individualized Dosing ◽  
Modelling Studies

AbstractExperimental studies on transcutaneous spinal cord direct current and magnetic stimulation (tsDCS and tsMS, respectively) show promising results in the neuromodulation of spinal sensory and motor pathways, with possible clinical application in spinal functional rehabilitation. Modelling studies on the electric field (EF) distribution during tsDCS and tsMS can be powerful tools to understand the underlying biophysics and to guide stimulation protocols for a specific clinical target. In this chapter, we review modelling studies of tsDCS and report on our own modelling findings on tsDCS and tsMS. We discuss the main differences between the EF induced by these two stimulation techniques and the implications for clinical practice, addressing the relevance of modelling studies for more personalized target protocols and individualized dosing.

Treatment and management

2020 ◽  
pp. 165-174
Author(s):  
Delphine Magis
Keyword(s):  
Clinical Practice ◽  
Transcranial Magnetic Stimulation ◽  
Adverse Events ◽  
Direct Current ◽  
Magnetic Stimulation ◽  
Significant Proportion ◽  
Herbal Medicines ◽  
Multidisciplinary Care ◽  
Non Invasive ◽  
Behavioural Therapies

A significant proportion of migraine patients appears reluctant to take migraine preventive drugs, or do not sufficiently improve when on available medications. The concept of non-pharmacological migraine approaches includes a large diversity of treatments: oral therapies (nutraceuticals or herbal medicines); exercise, behavioural therapies, and multidisciplinary care; acupuncture; peripheral invasive or non-invasive nerve stimulation; and, finally, brain neuromodulation (transcranial magnetic stimulation and transcranial direct current stimulation). The majority of these treatments have few adverse events and their efficacy often seems within the range of usual migraine preventive drugs. However, large placebo-controlled studies are often lacking. Thus, keeping these alternatives in mind when taking care of migraine patients in daily clinical practice is worthwhile.

History of spinal cord stereotaxy

1996 ◽  
Vol 85 (4) ◽  
pp. 725-731 ◽  
Author(s):  
Eric M. Gabriel ◽  
Blaine S. Nashold
Keyword(s):  
Spinal Cord ◽  
Clinical Practice ◽  
Spinal Fusion ◽  
Spinal Surgery ◽  
Experimental Studies ◽  
Functional Neurosurgery ◽  
Content Type ◽  
Anatomy And Physiology ◽  
History Of ◽  
Fine Print

✓ Stereotactic and functional neurosurgery has experienced a remarkable degree of development during the last 50 years, from the plaster of Paris frame of Spiegel and Wycis to the technology of frameless stereotaxis. Although predominantly used for intracranial procedures, stereotaxy has its roots in experimental studies of the spinal cord. The field of spinal cord stereotaxy has not received the same amount of attention as supratentorial surgery, but there have been significant contributions to the field that have helped to further our understanding of spinal cord anatomy and physiology. Now that frameless stereotaxis has reached clinical practice, there may be further developments in the field of spinal surgery: this technique may prove useful for spinal fusion operations and, possibly, intramedullary operations as well.

Transcranialis egyenáram-stimuláció a kognitív idegtudományban – buktatók és megoldások

2021 ◽  
Vol 74 (5-6) ◽  
pp. 171-182
Author(s):  
Orsolya Pesthy ◽  
Karolina Janacsek ◽  
Dezső Németh
Keyword(s):  
Clinical Practice ◽  
Individual Differences ◽  
Mechanism Of Action ◽  
Direct Current ◽  
Brain Stimulation ◽  
Brain Activity ◽  
Noisy Data ◽  
Full Understanding ◽  
Non Invasive ◽  
Potential Problems

Transcranial direct current stimulation (tDCS) is a promising brain stimulation tool which is non-invasive, easy to use and relatively cheap. Since it can change brain activity in a temporal manner, it can contribute to both clinical practice and neuroscientific research. However, the effectiveness of tDCS has been questioned considering the lack of full understanding of its mechanism of action and the seemingly contradictory results. In this review, we aim to provide a summary of potential problems and possible solutions. Our main focus is on the inter-individual differences in the effect of tDCS which can explain the noisy data, thus, controlling for them is important in order to show reliable results. This review is hoped to contribute to maximizing the potential of tDCS by helping future researchers to design replicable studies.

scholarly journals Non-invasive Brain and Spinal Stimulation for Pain and Related Symptoms in Multiple Sclerosis: A Systematic Review

2020 ◽  
Vol 14 ◽  
Author(s):  
Chiara Zucchella ◽  
Elisa Mantovani ◽  
Roberto De Icco ◽  
Cristina Tassorelli ◽  
Giorgio Sandrini ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Systematic Review ◽  
Spinal Cord ◽  
Direct Current ◽  
Primary Motor Cortex ◽  
Random Noise ◽  
Direct Current Stimulation ◽  
Non Invasive

Background: Neuropathic and nociceptive pain frequently affect patients with multiple sclerosis (MS), with a prevalence close to 90% and significant impact on general health and quality of life. Pharmacological strategies are widely used to treat pain in MS, but their effectiveness and side-effects are controversial. Among non-pharmacological treatments for pain, non-invasive brain and spinal stimulation (NIBSS) has shown promising preliminary results in MS.Objective: Systematic review to investigate the effect of NIBSS for the management of pain in MS.Methods: A literature search using Pubmed, Science Direct and Web of Science was conducted from databases inception to February 21, 2020 for studies assessing the analgesic effect of NIBSS on pain in MS.Results: A total of 279 records were title- and abstract-screened, nine were assessed for full text and included. The NIBSS techniques explored were transcranial direct current stimulation (N = 5), transcranial magnetic stimulation (N = 2), transcranial random noise stimulation (N =1), transcutaneous spinal direct current stimulation (N = 1). The targets were the primary motor cortex (M1; N = 4), the left dorsolateral pre-frontal cortex (DLPFC; N = 3), the spinal cord (N = 1), unspecified brain target (N = 1). The study designs were randomized (N = 7), open label (N = 1), single case report (N = 1). Despite the differences in study design, target and NIBSS technique that impeded a meta-analysis, all the studies converge in showing a significant improvement of pain after active NIBSS with less consistent effects on other symptoms of the pain-related cluster (depression, fatigue, cognition) and quality of life.Conclusions: Excitatory NIBSS over M1, left DLPFC and spinal cord appear to be the most effective protocols for pain in MS. Open questions include the use of neurophysiological or neuroimaging surrogate outcome measures, the stratification of patients according to the clinical profiles and underlying pathogenetic mechanisms and the combination of NIBSS to pharmacological treatment, neurorehabilitation, or psychotherapy to improve the clinical effect. The duration of the effect to NIBSS and the feasibility and efficacy of telemedicine NIBSS protocols are other open key questions.

scholarly journals Case Report: Initial Evidence of Safety and Efficacy of High Definition-Transcranial Direct Current Stimulation in a Patient With Neuropathic Pain and Implanted Spinal Cord Stimulator

2021 ◽  
Vol 2 ◽  
Author(s):  
Choi Deblieck ◽  
Steven Smeijers ◽  
Bart Morlion ◽  
Abhishek Datta ◽  
Chris Thomas ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Motor Cortex ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Spinal Cord Stimulation ◽  
High Definition ◽  
Predictive Tool ◽  
Direct Current Stimulation ◽  
Non Invasive

Neuropathic pain (NP), often treatment-refractory, is one of the most debilitating conditions contributing to suffering and disability worldwide. Recently, non-invasive neuromodulation techniques, particularly repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) have emerged as potential therapeutic alternatives due to their ability to alter cortical excitability of neural circuits. However, the magnetic field induced in rTMS may be unsafe for patients with an implanted electrode in the head or neck area while tDCS poses no theoretical risk of injury to these patients. High definition (HD)-tDCS is a novel, more focal technique of tDCS and may be safer to the patient compared to the more diffuse stimulation of conventional tDCS. To our knowledge, no study has ever demonstrated the safety and/or feasibility of HD-tDCS in patients with spinal cord stimulation (SCS) devices using computational modeling of induced electrical fields. Furthermore, this study highlights the potential use of (HD-)tDCS as predictive tool for a positive response in chronic epidural motor cortex stimulation (MCS), especially in patients with an implanted device not suitable for rTMS. In a 54-year-old woman with an implanted spinal cord stimulation (SCS) system for another pain syndrome, HD-tDCS was initiated for refractory post-surgical inferior alveolar nerve neuropathy. She was submitted to 7 days of anodal HD-tDCS over the left motor cortex at 1.5 mA for 30 min. A notable decrease in pain perception was observed, lasting for approximately 5–6 h (Numeric Rating Score decreased from 8 to 4.34). No adverse events were reported. The stimulation parameters and clinical efficacy of the SCS system remained unchanged. Additionally, computational analysis indicated no meaningful alteration of current flow when considering a model with a SCS implant with respect to a model without implant. Regarding the positive therapeutic effect of HD-tDCS, the patient was selected for an epidural MCS trial and subsequent implantation, which showed short-term pain relief of 50–75%. Although one case does not demonstrate efficacy, tolerability, or safety to the novel intervention, it paves the way for better diagnosis and treatment for patients who are otherwise excluded from other non-invasive neuromodulation techniques, such as rTMS. A positive tDCS effect could be a potential biomarker for positive epidural MCS response in patients with an implanted stimulation device non-compatible with rTMS.

scholarly journals Neurostimulation Methods in the Treatment of Chronic Pain

2012 ◽  
pp. S23-S31 ◽  
Author(s):  
R. ROKYTA ◽  
J. FRICOVÁ
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Deep Brain Stimulation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Motor Cortex Stimulation ◽  
Positive Effects ◽  
Non Invasive ◽  
Different Types ◽  
Deep Brain

The main neuromodulatory methods using neurostimulation principles are described. It concerns peripheral nerve stimulation (PNS), spinal cord stimulation (SCS), deep brain stimulation (DBS), motor cortex stimulation (MSC), and repetitive transcranial magnetic stimulation (rTMS). For each method the history, pathophysiology, the principles for use and the associated diagnoses are mentioned. Special attention is focused on the most common neuromodulatory invasive methods like SCS and MCS and non-invasive methods such as rTMS. In addition to the positive effects, side effects and complications are described and discussed in detail. In conclusion, neuromodulatory (neurostimulatory) techniques are highly recommended for the treatment of different types of pharmacoresistant pain.

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