As described, neuromodulation consists of a wide variety of therapies utilized across a wide variety of different medical specialties. Most frequently, neuromodulation is associated with stimulation. Analogous to the use of a pace-maker, stimulation refers to stimulating a nerve or set of nerves using controlled electrical impulses to try and improve their overall functionality and restore movement or alleviate pain.
Targets for stimulation usually include the brain and spinal cord, but can also include the peripheral and autonomic nerves as well. Examples include spinal cord stimulation, vagal nerve stimulation, deep brain stimulation, and peripheral nerve stimulation. Please see below for additional information on each of these therapies.
Spinal cord stimulation (SCS) delivers low level electrical stimulation to the spinal cord for the management of neuropathic pain and is an adjustable, non-destructive, neuromodulatory procedure. Pain is masked by changing the sensation from painful to a gentler, more soothing tingling sensation which masks the pain. The most common indications include post-laminectomy syndrome, complex regional pain syndrome (CRPS), chronic cervical and lumbar radiculopathy. Physicians have also used SCS for ischemic limb pain, angina. the treatment of intractable pain due to other causes including visceral/abdominal pain, cervical neuritis, spinal cord injury, post-herpetic neuralgia, and neurogenic pain secondary to thoracic outlet syndrome. Most studies indicate that, in carefully selected patients, SCS can produce at least 50% pain relief in at least 50%.
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Spinal Cord Stimulation for Patients
Spinal Cord Stimulation for Practitioners
Deep brain stimulation (DBS) delivers electrical current to the deep structures of the brain. It has come to replace the once more common ablative procedures such as pallidotomy and thalamotomy to be an adjustable, neuromodulative procedure. It is used to treat a number of movement disorders including Parkinson’s disease, tremor, and dystonia. Targets include the subthalamic nucleus, globus pallidus, and thalamus. Many research studies have looked at DBS for the treatment of depression, obsessive compulsive disorder, anorexia, obesity, multiple sclerosis, and pain syndromes. Most recently, DBS has been at the forefront for the treatment of epilepsy.
Cortical stimulation has been used to treat pain patients for various syndromes from post stroke pain to neuropathic pain. It has become most widely used in the treatment of epilepsy. Investigative reports are looking at cortical stimulation for the treatment of movement disorders, depression, and stroke.
Peripheral nerve stimulation (PNS) has been used for the treatment of a variety of neuropathic pain conditions. Occipital nerve stimulation has been used for the treatment of various headache conditions and peripheral nerve stimulation for neuropathic pain from nerve injuries outside of the central nervous system. It is recognized for its use in epilepsy through stimulation of the vagus nerve (vagal nerve stimulation – VNS). Sacral Nerve Stimulation (SNS) has been used for the treatment of neurogenic bladder, overactive bladder (OAB), interstitial cystitis, and other disorders of the pelvic region. Peripheral field stimulation has also been used in those patients with a variable pain pattern or non- discrete neurpathic pain.
Neuroprosthetics have been used for deafness with cochlear implants, as well as for blindness via retinal stimulation. Investigations have looked into artificial limbs and as an adjunct for rehab, as well as the involvement of what has been known as the brain-machine interface.
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Drug Delivery Devices are surgically implanted pumps that deliver medication directly to a desired target, most often the spinal cord or brain. This method of medication delivery directly into the central nervous system, enables a ,much lower dosage to be administered and decreases, if not eliminates many side effects seen with oral or other systemic administration. Implanted pumps are used in the treatment of pain syndromes such as chronic low back pain following surgery (failed back syndrome) or cancer pain, as well as for the treatment of spasticity seen with multiple sclerosis, stroke and spinal cord injury
Reference for Practitioners
Reference for Patients
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The mission of the North American Neuromodulation Society (NANS) Foundation is to support multidisciplinary collaboration among patients, clinicians, scientists, engineers, and others to advance neuromodulation through research and education.
American Academy of Neurology
Advancing Neurology. Advancing you.
Date: April 22-28, 2017
Location: Boston, Massachusetts
International Neuromodulation Society 13th World Congress
Date: May 27, 2017 - June 1, 2017
Location: Edinburgh, Scotland