scholarly journals Stim Salvage: Case Series Reporting on the Effectiveness of Spinal Cord Stimulation Salvage

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Patrick Paullus ◽  
Erika A Petersen
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
New Technologies ◽  
Case Series ◽  
Low Frequency ◽  
Low Frequency Stimulation ◽  
Trial Outcomes ◽  
Frequency Stimulation ◽  
New System

Abstract INTRODUCTION Spinal cord stimulation (SCS) has been successfully used to treat chronic pain with improved levels of pain, decreased use of narcotic medications, and increased level of function. Nevertheless, for patients SCS benefit wares over time and maximal reprogramming may not achieve improvement. However, advancing technologies, such as burst and high-frequency modulation, offer stimulation which differs from the traditional low-frequency stimulation. For those with SCS already placed, these new technologies offer a possible avenue with which to salvage SCS loss of efficacy. In patients with the an ineffective system, a salvage trial with a new system can be performed. In these cases, their current generators are externalized and then, utilizing their current epidural array, the leads are connected to a new trial system. These patients return to the OR in about 1 wk time for either permanent implantation or removal of the remainder of their old system. The results of these salvage trials are presented. METHODS We reviewed serially treated patients with previously placed SCS who were taken to the operating room for a salvage trial. All patient had their SCS leads externalized and connected to a different system. Changes in VAS, functional status, the trial outcomes led to permanent placement were collected retrospectively. RESULTS Results of 15 patient who underwent SCS externalization trial between 2016 and 2019 are summarized. Trial failure rate, salvage SCS response rate, changes in VAS, and patient satisfaction with the new system are reviewed. Successful salvage was accomplished in 93%. CONCLUSION New stimulation paradigms such as burst and high frequency offer a new avenue of effective treatment for those with an ineffective SCS systems. When a patient's device is unable to deliver these paradigms, an IPG-externalization trial may be a low risk option for salvaging therapy.

scholarly journals MONOSYNAPTIC REFLEX RESPONSE OF INDIVIDUAL MOTONEURONS AS A FUNCTION OF FREQUENCY

1957 ◽  
Vol 40 (3) ◽  
pp. 435-450 ◽  
Author(s):  
David P. C. Lloyd
Keyword(s):  
High Frequency ◽  
Temporal Summation ◽  
Low Frequency ◽  
Stimulation Frequency ◽  
Monosynaptic Reflex ◽  
Reflex Response ◽  
High Frequency Stimulation ◽  
Low Frequency Stimulation ◽  
Frequency Stimulation ◽  
Frequency Of Stimulation

An assemblage of individual motoneurons constituting a synthetic motoneuron pool has been studied from the standpoint of relating monosynaptic reflex responses to frequency of afferent stimulation. Intensity of low frequency depression is not a simple function of transmitter potentiality. As frequency of stimulation increases from 3 per minute to 10 per second, low frequency depression increases in magnitude. Between 10 and approximately 60 per second low frequency depression apparently diminishes and subnormality becomes a factor in causing depression. At frequencies above 60 per second temporal summation occurs, but subnormality limits the degree of response attainable by summation. At low stimulation frequencies rhythm is determined by stimulation frequency. Interruptions of rhythmic firing depend solely upon temporal fluctuation of excitability. At high frequency of stimulation rhythm is determined by subnormality rather than inherent rhythmicity, and excitability fluctuation leads to instability of response rhythm. In short, whatever the stimulation frequency, random excitability fluctuation is the factor disrupting rhythmic response. Monosynaptic reflex response latency is stable during high frequency stimulation as it is in low frequency stimulation provided a significant extrinsic source of random bombardment is not present. In the presence of powerful random bombardment discharge may become random with respect to monosynaptic afferent excitation provided the latter is feeble. When this occurs it does so equally at low frequency and high frequency. Thus temporal summation is not a necessary factor. There is, then, no remaining evidence to suggest that the agency for temporal summation in the monosynaptic system becomes a transmitting agency in its own right.

scholarly journals High-Frequency Spinal Cord Stimulation at T9/10 in Patients With Failed Back Surgery Syndrome

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Naoki Higashiyama ◽  
Takuro Endo ◽  
Taku Sugawara
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Low Frequency ◽  
The Elderly ◽  
Failed Back Surgery Syndrome ◽  
Leg Pain ◽  
Effective Treatment Option ◽  
Failed Back Surgery ◽  
Back Surgery

Abstract INTRODUCTION Spinal cord stimulation (SCS) is an effective treatment option for low back pain and radicular leg pain of failed back surgery syndrome (FBSS). In a recent study, high-frequency spinal cord stimulation (HFSCS) was found to be more effective in treating chronic pain than traditional paresthesia-based low-frequency SCS (paresthesia SCS). The purpose of this study is to evaluate the efficacy of paresthesia SCS and HFSCS in improving outcomes. METHODS We retrospectively reviewed the outcomes of patients who underwent paresthesia SCS or HFSCS between September 2016 and January 2019. Paresthesia SCS is generally characterized by programming stimulation parameters such that the patient experiences paresthesia, and the paresthesia topography overlaps the pain topography as much as possible. The patient in HFSCS had a placement of cylindrical lead at levels T9-10. Patients were programmed with the electrode overlying the inferior endplate of T9 (+) and the electrode overlying the superior endplate of T10 (–). RESULTS A total of 14 patients (4 males, 10 females) underwent paresthesia SCS implantation. Mean age was 77.2 ± 9.6 yr. A total of 5 patients (2 males, 3 females) underwent HFSCS implantation. Mean age was 78.2 ± 7.5 yr. Operative time was shorter for the HFSCS group compared to the paresthesia SCS group (53.4 ± 4.8 min vs 82.9 ± 20.3 min, respectively; P < .001). A total of 5 out of 5 patients in the HFSCS group (100%) and 10 out of 14 patients in the paresthesia SCS group (71.4%) achieved the outcome of 50% pain relief (P = .25) CONCLUSION To confirm paresthesia during the procedure in the elderly may be complicated by hearing/language difficulties or by sedative-related confusion. Compared to paresthesia SCS, HFSCS allows for lower operative times and a more efficient and accurate positioning of the electrodes.

Robust Changes of Afferent-Induced Excitation in the Rat Spinal Dorsal Horn After Conditioning High-Frequency Stimulation

2000 ◽  
Vol 83 (4) ◽  
pp. 2412-2420 ◽  
Author(s):  
Hiroshi Ikeda ◽  
Tatsuya Asai ◽  
Kazuyuki Murase
Keyword(s):  
Dorsal Horn ◽  
High Frequency ◽  
Low Frequency ◽  
Single Pulse ◽  
High Frequency Stimulation ◽  
Neuronal Excitation ◽  
Low Frequency Stimulation ◽  
Frequency Stimulation ◽  
Stimulation Of

We investigated the neuronal plasticity in the spinal dorsal horn and its relationship with spinal inhibitory networks using an optical-imaging method that detects neuronal excitation. High-intensity single-pulse stimulation of the dorsal root activating both A and C fibers evoked an optical response in the lamina II (the substantia gelatinosa) of the dorsal horn in transverse slices of 12- to 25-day-old rat spinal cords stained with a voltage-sensitive dye, RH-482. The optical response, reflecting the net neuronal excitation along the slice-depth, was depressed by 28% for more than 1 h after a high-frequency conditioning stimulation of A fibers in the dorsal root (3 tetani of 100 Hz for 1 s with an interval of 10 s). The depression was not induced in a perfusion solution containing an NMDA antagonist,dl-2-amino-5-phosphonovaleric acid (AP5; 30 μM). In a solution containing the inhibitory amino acid antagonists bicuculline (1 μM) and strychnine (3 μM), and also in a low Cl−solution, the excitation evoked by the single-pulse stimulation was enhanced after the high-frequency stimulation by 31 and 18%, respectively. The enhanced response after conditioning was depotentiated by a low-frequency stimulation of A fibers (0.2–1 Hz for 10 min). Furthermore, once the low-frequency stimulation was applied, the high-frequency conditioning could not potentiate the excitation. Inhibitory transmissions thus regulate the mode of synaptic plasticity in the lamina II most likely at afferent terminals. The high-frequency conditioning elicits a long-term depression (LTD) of synaptic efficacy under a greater activity of inhibitory amino acids, but it results in a long-term potentiation (LTP) when inhibition is reduced. The low-frequency preconditioning inhibits the potentiation induction and maintenance by the high-frequency conditioning. These mechanisms might underlie robust changes of nociception, such as hypersensitivity after injury or inflammation and pain relief after electrical or cutaneous stimulation.

Gnashing induced by electrical stimulation of rabbit brain cortex

1961 ◽  
Vol 200 (5) ◽  
pp. 916-918 ◽  
Author(s):  
Yojiro Kawamura ◽  
Shusaku Tsukamoto ◽  
Kiyokatsu Miyoshi
Keyword(s):  
Electrical Stimulation ◽  
High Frequency ◽  
Brain Cortex ◽  
Low Frequency ◽  
Rabbit Brain ◽  
Lower Jaw ◽  
Low Frequency Stimulation ◽  
Frequency Stimulation ◽  
Chewing Movement ◽  
Experimentally Induced

Gnashing was induced in rabbits by high-frequency cortical stimulation. The frequencies ranged from 60 to 1000 cycle/sec. Strictly circumscribed anteromedial cortical areas were responsive to stimulation. These loci are similar to those which induced chewing movements with low-frequency stimulation (30 cycle/ sec). Electrical stimulation within the above-described range induced gnashing of a constant rhythm of 3–4 cycle/sec that was almost independent of the stimulation frequency. The rate of experimentally induced gnashing is slower than the rate of experimentally induced chewing movements of 5–6 cycle/sec. Gnashing motion of the lower jaw consisted of the vertical and dominant lateral movements; the lateral deflection was more predominant than that of the chewing movement. Gnashing was readily induced with low-frequency stimulation after topical application of a 0.5% solution of strychnine nitrate on the cortical jaw motor area.

Tremor entrainment by patterned low-frequency stimulation

2008 ◽  
Vol 366 (1880) ◽  
pp. 3545-3573 ◽  
Author(s):  
Utako B Barnikol ◽  
Oleksandr V Popovych ◽  
Christian Hauptmann ◽  
Volker Sturm ◽  
Hans-Joachim Freund ◽  
...  
Keyword(s):  
General Anaesthesia ◽  
High Frequency ◽  
Standard Procedure ◽  
Low Frequency ◽  
Target Localization ◽  
Spinocerebellar Ataxia Type ◽  
Target Point ◽  
Low Frequency Stimulation ◽  
Tremor Suppression ◽  
Frequency Stimulation

High-frequency test stimulation for tremor suppression is a standard procedure for functional target localization during deep brain stimulation. This method does not work in cases where tremor vanishes intraoperatively, for example, due to general anaesthesia or due to an insertional effect. To overcome this difficulty, we developed a stimulation technique that effectively evokes tremor in a well-defined and quantifiable manner. For this, we used patterned low-frequency stimulation (PLFS), i.e. brief high-frequency pulse trains administered at pulse rates similar to neurons' preferred burst frequency. Unlike periodic single-pulse stimulation, PLFS enables one to convey effective and considerably greater integral charge densities without violation of safety requirements. In a computational investigation of an oscillatory neuronal network temporarily rendered inactive, we found that PLFS evokes synchronized activity, phase locked to the stimulus. While a stronger increase in the amount of synchrony in the neuronal population requires higher stimulus intensities, the portion of synchronously active neurons nevertheless becomes strongly phase locked to PLFS already at weak stimulus intensities. The phase entrainment effect of PLFS turned out to be robust against variations in the stimulation frequency, whereas enhancement of synchrony required precisely tuned stimulation frequencies. We applied PLFS to a patient with spinocerebellar ataxia type 2 (SCA2) with pronounced tremor that disappeared intraoperatively under general anaesthesia. In accordance with our computational results, PLFS evoked tremor, phase locked to the stimulus. In particular, weak PLFS caused low-amplitude, but strongly phase-locked tremor. PLFS test stimulations provided the only functional information about target localization. Optimal target point selection was confirmed by excellent post-operative tremor suppression.

Role of fascia in maintenance of muscle tension and pressure

1981 ◽  
Vol 51 (2) ◽  
pp. 317-320 ◽  
Author(s):  
S. R. Garfin ◽  
C. M. Tipton ◽  
S. J. Mubarak ◽  
S. L. Woo ◽  
A. R. Hargens ◽  
...  
Keyword(s):  
High Frequency ◽  
Muscle Tension ◽  
Fluid Pressure ◽  
Low Frequency ◽  
Testing Procedure ◽  
Force Transducer ◽  
High Frequency Stimulation ◽  
Low Frequency Stimulation ◽  
Frequency Stimulation

The effect of fasciotomy on muscle tension (measured by a force transducer attached to the tendon) and interstitial fluid pressure (measured by Wick catheters in the muscle belly) was studied in the anterolateral compartments of 13 dog hindlimbs. Muscle tension and pressure were monitored in the tibialis cranialis muscle after low- and high-frequency stimulation of the peroneal nerve to produce twitch- and tetanic-type contractions. Fasciotomy decreased muscle force during the low-frequency stimulation by 16% (35.3 +/- 4.9 to 28.4 +/- 3.9 N) and during the high-frequency stimulation by 10% (60.8 %/- 4.9 to 54.8 +/- 3.9 N). Muscle pressure decreased 50% after fasciotomy under both conditions, 15 +/- 2 to 6 +/- 1 mmHg and 84 +/- 17 to 41 +/- 8 mmHg), respectively. Repeated functional evaluations during the testing procedure indicated that muscle fatigue was not a major factor in these results. It was concluded that fascia is important in the development of muscle tension and changes in interstitial pressure. Furthermore, the results raised questions concerning the merits of performing a fasciotomy for athletes with a compartment syndrome.

A Retrospective Case Series of High-Frequency Spinal Cord Stimulation (HF10-SCS) in Neurogenic Bladder Incontinence

2018 ◽  
Vol 17 (1) ◽  
pp. 14-20 ◽  
Author(s):  
Simon Schieferdecker ◽  
Clemens Neudorfer ◽  
Faycal El Majdoub ◽  
Mohammad Maarouf
Keyword(s):  
Spinal Cord ◽  
Neurogenic Bladder ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series

scholarly journals Cholecystokinin release triggered by NMDA receptors produces LTP and sound–sound associative memory

2019 ◽  
Vol 116 (13) ◽  
pp. 6397-6406 ◽  
Author(s):  
Xi Chen ◽  
Xiao Li ◽  
Yin Ting Wong ◽  
Xuejiao Zheng ◽  
Haitao Wang ◽  
...  
Keyword(s):  
Associative Learning ◽  
Associative Memory ◽  
High Frequency ◽  
Low Frequency ◽  
Long Term Potentiation ◽  
High Frequency Stimulation ◽  
Low Frequency Stimulation ◽  
Term Potentiation ◽  
Frequency Stimulation

Memory is stored in neural networks via changes in synaptic strength mediated in part by NMDA receptor (NMDAR)-dependent long-term potentiation (LTP). Here we show that a cholecystokinin (CCK)-B receptor (CCKBR) antagonist blocks high-frequency stimulation-induced neocortical LTP, whereas local infusion of CCK induces LTP. CCK−/−mice lacked neocortical LTP and showed deficits in a cue–cue associative learning paradigm; and administration of CCK rescued associative learning deficits. High-frequency stimulation-induced neocortical LTP was completely blocked by either the NMDAR antagonist or the CCKBR antagonist, while application of either NMDA or CCK induced LTP after low-frequency stimulation. In the presence of CCK, LTP was still induced even after blockade of NMDARs. Local application of NMDA induced the release of CCK in the neocortex. These findings suggest that NMDARs control the release of CCK, which enables neocortical LTP and the formation of cue–cue associative memory.

Response of the diaphragm muscle to electrical stimulation of the phrenic nerve

1983 ◽  
Vol 58 (1) ◽  
pp. 92-100 ◽  
Author(s):  
Thomas E. Ciesielski ◽  
Yoshitaka Fukuda ◽  
William W. L. Glenn ◽  
Jack Gorfien ◽  
Kathryn Jeffery ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Phrenic Nerve ◽  
High Frequency ◽  
Low Frequency ◽  
Diaphragm Muscle ◽  
Diaphragm Pacing ◽  
Frequency Group ◽  
Low Frequency Stimulation ◽  
Frequency Stimulation

✓ The histological, histochemical, and ultrastructural features of canine diaphragms subjected to pacing by high-frequency electrical stimulation (27 to 33 Hz) of the phrenic nerve are compared with unstimulated diaphragms and with diaphragms subjected to pacing by low-frequency stimulation (11 to 13 Hz). The high-frequency group showed a reduced tidal volume (fatigue) after long-term stimulation, and myopathic changes which included enlarged internal and sarcolemmal nuclei, ring fibers, moth-eaten fibers with irregular histochemical staining, core/targetoid fibers, and smearing and aggregation of Z-band material with electron microscopy. The low-frequency group did not develop a significant degree of fatigue or pathological changes, and showed histochemical evidence of transformation to fast-twitch (type II) fibers. Possible pathogenic mechanisms and their similarity to those in certain human neuromuscular diseases are discussed. The application of the findings resulting from high- and low-frequency stimulation to long-term diaphragm pacing in humans with chronic ventilatory insufficiency is also discussed.

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