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BACKGROUND: Dystonia is uncommon in Tourette's syndrome, and occipital neuralgia secondary to Tourette's dystonia is more rare, affecting quality of life. Occipital peripheral nerve stimulation (PNS) is an excellent alternative by being adjustable and minimally invasive. Our case demonstrates occipital PNS as an effective option for refractory Tourette's dystonia. CASE PRESENTATION: A thirty-four-year-old male with poorly controlled Tourette's cervical dystonia presented with severe occipital neuralgia. Various medications were prescribed including propranolol and amitriptyline, and bilateral third-occipital nerve rhizotomies and occipital nerve blocks were trialed. Distal nerve blocks at the occipital protuberance were most effective. Therefore, an occipital PNS trial was done, and a PNS was implanted with no complications. Upon follow-up, the patient reported drastic pain reduction. CONCLUSION: Our case illustrates neuromodulation benefits for a rare presentation of refractory occipital neuralgia secondary to Tourette's-related dystonia. Occipital PNS should be considered for refractory cases because it is safe, easy to implant, and effective.
FUNDAMENTO: A distonia é incomum na síndrome de Tourette, e a neuralgia occipital secundária à distonia de Tourette é mais rara, afetando a qualidade de vida. A estimulação do nervo periférico occipital (SNP) é uma excelente alternativa por ser ajustável e minimamente invasiva. Nosso caso demonstra o SNP occipital como uma opção eficaz para a distonia de Tourette refratária. APRESENTAÇÃO DO CASO: Um homem de 34 anos com distonia cervical de Tourette mal controlada apresentou neuralgia occipital grave. Vários medicamentos foram prescritos, incluindo propranolol e amitriptilina, e foram testadas rizotomias bilaterais do nervo terceiro-occipital e bloqueios do nervo occipital. Os bloqueios dos nervos distais na protuberância occipital foram mais eficazes. Portanto, foi feito um ensaio de PNS occipital e um PNS foi implantado sem complicações. Após o acompanhamento, o paciente relatou redução drástica da dor. CONCLUSÃO: Nosso caso ilustra os benefícios da neuromodulação para uma apresentação rara de neuralgia occipital refratária secundária à distonia relacionada a Tourette. O PNS occipital deve ser considerado para casos refratários porque é seguro, fácil de implantar e eficaz.
Subject(s)
Humans , Male , Female , Patients/classification , Tourette Syndrome/complications , Peripheral Nerves/abnormalitiesABSTRACT
Objective To observe the effect of paired associative stimulation ( PAS) on the recovery of sensorimotor function and to explore the mechanism in terms of neural plasticity. Methods Ninety male adult Sprague-Dawley rats were randomly divided into a sham operation group (Sham group), a model group (Model group) and a paired associative stimulation group ( PAS group) , each of 30. Each group was then subdivided into 7-, 14-and 28-day subgroups with 10 rats in each. A model of focal cerebral ischemia and reperfusion was estab-lished using the Longa suture method in the Model and PAS groups. The rats in the Sham group underwent the same surgical procedure except for the occlusion of the middle cerebral artery. The rats received 30 minutes of paired pe-ripheral nerve stimulation and transcranial magnetic stimulation comprising 90 pairs at 0.05 Hz beginning 24 h after the occlusion. The impulse wave width of the peripheral nerve stimulation was 200 μs and the intensity was 6 mA. The intensity of the transcranial magnetic stimulation was 120％ of the resting motor threshold. The other two groups weren't given any intervention. Neurological function was tested using Garcia scores on the 1st, 7th, 14th and 28th day after surgery. The rats were then sacrificed and the expression of MAP-2 and GAP-43 in the ischemic penumbra were detected using western blotting and immunohistochemistry. Results No neurological dysfunction was ob-served in the Sham group at any time. Compared with the Sham group at the same time points, the average Garcia scores of the Model and PAS groups were significantly lower (P≤0.05). However, the average Garcia scores on the 7th, 14th and 28th day were significantly higher in the PAS group compared with the Model group at the same time points ( P≤0.05) . The average Garcia scores of the Model and PAS groups on the 28th day after surgery were significantly higher than those on the 1st day (P≤0.05), but only the PAS group's average Garcia score on the 28th day was significantly higher than that on the 7th day. Compared with the Sham group at the same time points, the expression of MAP-2 and GAP-43 protein in the Model and PAS groups was significantly higher, but with that of the Model group significantly lower than that of the PAS group ( all P≤0.05) . The protein expression of MAP-2 and GAP-43 protein in the PAS group on the 14th day was significantly higher than on the 7th and 28th day ( P≤0.05 for both) . Conclusions PAS can promote the recovery of sensorimotor function after cerebral thrombosis, at least in rats. That may be due to its promoting the expression of the neuroplasticity-associated proteins MAP-2 and GAP-43 in the ischemic penumbra.
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Objective To compare the effects of transforaminal peripheral nerve stimulation(PNS) and spinal cord stimulation(SCS) in treatment of postherpetic neuralgia.Methods A total of 64 patients with postherpetic neuralgia in our hospital from January 2015 to January 2016 were divided into PNS group and SCS group according to random number table.Both two groups were treated with PNS or SCS for 14 days,respectively.Visual analogue scale(VAS) and piasburgh sleep quality index(PSQI) were adapted to assess the effects at the different time of preoperation, postoperation 1 day,1 week,1 month,2 months.Results At the preoperation and 2 months postoperation,in PNS group,the VAS were (8.4±1.6) and (1.4±1.0),the PSQI were (16.1±2.1) and (5.8±1.3),respectively;meanwhile in the SCS group,the VAS were (8.6±1.8) and (2.9±1.2),the PSQI were (15.6±2.3),(7.5±1.5),respectively.Obviously,the VAS and PQSI at different follow-up stages were improved after transforaminal PNS or SCS treatment, the differences were signicant(P<0.05).Moreover,the PNS group had lower VAS and higher PQSI compared with the SCS group at different follow-up stages,the differences were signicant(P<0.05).Conclusion The transforaminal PNS achieved satisfying outcomes on pain relief and quality of sleep improvements for the postherpetic neuralgia patients,which was superior to that of the SCS.
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@#Objective To investigate the effects of local injection of Botulinum toxin A (BTX-A) on hemifacial spasm guided by periph-eral nerve stimulation. Methods 57 patients with hemifacial spasm from January, 2012 to June, 2015 received local multi-point injection of BTX-A guided by peripheral nerve stimulation. The grades of facial spasm were evaluated before, 72 hours and 6 months after treatment. They were followed up for 3-9 months. Results The spasm reduced in the patients both 72 hours and 6 months after treatment (χ2=4.946, P<0.05). The incidence was 98.25% of satisfaction and 92.99% of very well 72 hours after treatment, while it was 91.23% and 78.95% 6 months after treatment. The relief of spasm was maintained for (23.1 ± 2.3) weeks. Conclusion Injection of BTX-A guided by peripheral nerve stimulation is effective on hemifacial spasm for a long time.
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JUSTIFICATIVA E OBJETIVOS: O uso da estimulação elétrica de nervos periféricos para o tratamento da dor crônica constitui um armamentário neurocirúrgico utilizado há bastante tempo, sendo uma modalidade indicada no tratamento das síndromes dolorosas de caráter neuropático, juntamente com outras formas de neuroestimulação: estimulação elétrica da coluna dorsal e a estimulação cerebral profunda. O objetivo deste estudo foi analisar a relevância da estimulação nervosa periférica no tratamento das síndromes dolorosas crônicas. CONTEÚDO: A principal indicação é a dor neuropática crônica, intensa, refratária ao tratamento conservador. Apresenta, contudo, necessidade de a área acometida ter uma distribuição anatômica definida e relacionada ao nervo periférico no qual se deseja realizar a estimulação. Deve-se perceber também sinais de comprometimentoobjetivo do nervo. É necessária a realização de teste de neuroestimulação entre 7 e 10 dias previamente ao implante definitivo e deve-se obter melhora de pelo menos 50% da dor em escalas de avaliação específicas. Existem duas formas de implante de eletrodo em nervos periféricos: abordagem cirúrgica direta e técnica percutânea. Após o teste ser completado, é realizado o implante do sistema de gerador permanente. CONCLUSÃO: O uso da estimulação de nervos periféricos no tratamento das síndromes dolorosas crônicas tem mostrado resultados promissores. O desenvolvimento de novos materiais é extremamente necessário para a evolução da técnica e o tratamento dessas síndromes dolorosas crônicas. Nesse sentido, novas próteses estão sendo desenvolvidas e uma das características de implante mais viável para uso no sistema nervoso periférico seria uma prótese de baixo perfil, com bateria já implantada com os eletrodos e recarregável.
BACKGROUND AND OBJECTIVES: Peripheral nerve stimulation to treat chronic pain is a neurosurgical armamentarium used for a long time, being indicated to treat neuropathic painful syndromes together with other types of nerve stimulation: dorsal column electric stimulation and deep cerebral stimulation. This study aimed at analyzing the relevance of peripheral nerve stimulation to treat chronic painful syndromes. CONTENTS: Primary indication is severe chronic neuropathic pain refractory to conservative treatment. However, the affected area needs to have a defined anatomic distribution and related to the peripheral nerve to be stimulated. One should also notice signs of objective involvement of the nerve. A nerve stimulation test shall be performed from 7 to 10 days prior to the final implant and pain must improve at least 50% according to specific evaluation scales. There are two methods to implant electrodes in peripheral nerves: direct surgical approach and percutaneous technique. After the test, the implant with permanent generator is performed. CONCLUSION: Peripheral nerve stimulation to treat chronic painful syndromes has shown promising results. The development of new materials is extremely necessary for the technical evolution and treatment of chronic painful syndromes. In this sense, new prostheses are being developed and one feature of a more feasible implant to be used in the peripheral nervous system would be low profile prosthesis with already implanted and rechargeable battery.
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Objective To investigate the effects of local injection of Botulinum toxin type A (BTX-A) on spastic cerebral palsy guided by peripheral nerve stimulation. Methods 30 children with spastic cerebral palsy received local multi-point injection of BTX-A guided by peripheral nerve stimulation. They were assessed with modified Ashworth scale (MAS) and Gross Motor Function Assessment Scale (GM-FM-88) before and 1 week, 3 months and 6 months after treatment. Results The scores of MAS decreased significantly 1 week, 3 months and 6 months after treatment (P<0.001). The scores of GMFM-88 increased 3 months and 6 months after treatment (P<0.001). Conclusion Injection of BTX-A guided by peripheral nerve stimulation is effective on spastic cerebral palsy.
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Occipital nerve stimulation (ONS) is a form of peripheral nerve stimulation used to treat refractory headaches. The trial of ONS was carried with the midline incision C1-2 level, inserted electrical lead subcutaneously to oblique and cephalad direction followed by trajectory of blunt dissection. We used 8 pole electrical lead to cover lesser occipital nerve, greater occipital nerve, third occipital nerve and great auricular nerve. We anchored the lead at the midline insertion site after confirming the stimulation of the patient. And then we looped and tightened the lead loosely, connected the lead and the extension under right supraspinatus muscle region. After 1 week trial period, we performed the permanent implantation of occipital nerve stimulator. We inserted internal pulse generator under a pocket located at right infraclavicular region. The VAS score dropped from 8/10 to 1-2/10. No serious complications were detected during 1 month follow-up.
Subject(s)
Humans , Follow-Up Studies , Headache , Muscles , Peripheral NervesABSTRACT
A 54-year-old man experienced injury to the second finger of his left hand due to damage from a paintball gun shot 8 years prior, and the metacarpo-phalangeal joint was amputated. He gradually developed mechanical allodynia and burning pain, and there were trophic changes of the thenar muscle and he reported coldness on his left hand and forearm. A neuroma was found on the left second common digital nerve and was removed, but his symptoms continued despite various conservative treatments including a morphine infusion pump on his left arm. We therefore attempted median nerve stimulation to treat the chronic pain. The procedure was performed in two stages. The first procedure involved exposure of the median nerve on the mid-humerus level and placing of the electrode. The trial stimulation lasted for 7 days and the patient's symptoms improved. The second procedure involved implantation of a pulse generator on the left subclavian area. The mechanical allodynia and pain relief score, based on the visual analogue scale, decreased from 9 before surgery to 4 after surgery. The patient's activity improved markedly, but trophic changes and vasomotor symptom recovered only moderately. In conclusion, median nerve stimulation can improve chronic pain from complex regional pain syndrome type II.
Subject(s)
Humans , Middle Aged , Arm , Burns , Causalgia , Chronic Pain , Cold Temperature , Electrodes , Fingers , Forearm , Hand , Hyperalgesia , Infusion Pumps , Joints , Median Nerve , Morphine , Muscles , NeuromaABSTRACT
Transcutaneous electrical nerve stimulation(TENS), acupuncture-needling, and electroacupuncture are useful non-ablative methods in medical practice for relief of pain. These procedures appear to work by causing an increased discharge in afferent nerve fibers which in turn modifies the transmission of impulses in pain pathways. It is known that the mechanism of analagesic effect via these maneuvers are variable depending on the stimulating parameters. For example, the endogenous opioid system is profoundly related to the mechanism when a peripheral nerve stimulation is applied with parameters of low frequency and high intensity. However, when stimulated with parameters of high frequency and high intensity, the reduced activity of dorsal horn neurons is only slightly reversed by a systemic administration of naloxone, a specific opiate antagonist. Thus, the present study was performed to investigate the neurotransmitter that concerns the mechanism of peripheral nerve stimulation with parameters of high frequency and high intensity. We used an iontophoretic application of antagonists of possible related neurotransmitters. The dorsal horn neuron activity which was evoked by squeezing the peripheral cutaneous receptive field, was recorded as an index of pain with a microelectrode at the lumbo-sacral spinal cord. Naloxone, picrotoxin and strychnine were applied at 200nA during a period of conditioning nerve stimulation. We observed the effects of these drugs on the change of dorsal horn neuron activities. The main results of the experiment can be summarized as follows. The spontaneous activity of dorsal horn neurons increased in the presence of glutamate and decreased with GABA. It did not change with naloxone, picrotoxin or strychnine. When naloxone was applied iontophoretically during peripheral nerve stimulation, there was no statistically significant analgesic effect compared with that of the control group. When picrotoxin was applied iontophoretically during peripheral nerve stimulation, the analgesic effect was reduced. When strychnine was applied, the analgesic effect was reduced but did not show a statistically significant difference with the control group. These results suggested that the GABAergic system may have been partially related in the analgesic action of peripheral nerve stimulation with parameters of high frequency and high intensity.
Subject(s)
Cats , Female , Male , Animals , Conditioning, Psychological , Iontophoresis , Naloxone/pharmacology , Neurons/drug effects , Picrotoxin/pharmacology , Spinal Cord/cytology , Strychnine/pharmacology , Transcutaneous Electric Nerve StimulationABSTRACT
There are some reports showing that an experience of long-enduring pain causes a change in the pain transmission system, suggesting a plastic nature of the nociceptive system. However, most of the studies concerning the analgesic effect of peripheral nerve stimulation dealt with normal animal or human subjects. So, the present study was undertaken to investigate the effect of peripheral nerve stimulation on the dorsal horn cell activity using a tonic pain model, which was made by producing a cutaneous inflammation. The main results are summarized as follows. 1) The evoked activity by electrical or natural stimulation as well as spontaneous activity was enhanced, and the receptive field size was also expanded by the inflammation. 2) Peripheral nerve conditioning stimulation reduced the C-response of the dorsal horn cell in the normal and inflamed group, and the degree of inhibition between the two groups showed no significant difference. 3) Inhibition of the C-response of the dorsal horn cells by peripheral conditioning stimulation was completely reversed by naloxone in the inflamed group whereas there was a partial block in the normal group.