Efficacy Of Neuromodulation Research Articles

Neuromodulation for treatment for neurogenic bowel dysfunction

To explore the efficacy of neuromodulation (including sacral neuromodulation and dorsal penile/clitoral nerve neuromodulation) for the treatment to neurogenic bowel dysfunction due to spinal cord injury. From January 2006 to April 2008, 9 patients with neurogenic constipation after spinal cord injury underwent the therapy of neuromodulation, 1 patient underwent the therapy of sacral neuromodulation, 8 patients underwent the therapy of dorsal penile/clitoral nerve neuromodulation. The therapeutic efficacy was evaluated and followed up by means of Wexner constipation score. One patient received permanent electrode and neurostimulator implantation and constipation were improved continuously. A significant improvement in the Wexner constipation score was observed compared with the preoperative baseline level (preoperative baseline: median 22; after implantation: median 9). Four patients were effective after the therapy of dorsal penile/clitoral nerve neuromodulation. Wexner constipation score decrease from 19 to 11 after 12 weeks dorsal penile/clitoral nerve neuromodulation. Patients also showed a significant improvement in their symptoms and quality of life during follow up. Sacral neuromodulation and dorsal penile/clitoral nerve neuromodulation may be effective for some neurogenic constipation. However there are no methods successfully identify the candidate who will be beneficial before the procedure. Good quality research data are needed to evaluate the effects of sacral neuromodulation and dorsal penile/clitoral nerve neuromodulation for these conditions.

Electrical neuromodulatory therapy in female voiding dysfunction

Female voiding dysfunction such as urge-frequency syndrome, urge incontinence and unobstructive urinary retention are often refractory to conservative management. Electrical neuromodulation with surface electrodes or with implantable systems has become a valuable addition to the therapeutic options in the last two decades. Interstitial cystitis is an emerging indication. The application of these techniques in non-neurogenic patients is reviewed. The techniques using unimplantable electrodes, anogenital electrical stimulation with plug electrodes, transcutaneous electrical nerve stimulation with surface electrodes, and posterior tibial nerve stimulation using needle electrodes are addressed. Several techniques using implantable systems are discussed, e.g. sacral nerve neuromodulation (Interstim device), pudendal nerve stimulation (Interstim and Bion device) and paraurethral neuromodulation (Miniaturo device). The long-term efficacy of neuromodulation for the established indications is more than half, but 20-50% of the patients initially tested do not respond to a test procedure. The disadvantage is the high surgical revision rate and the high cost of treatment. Technical advances will hopefully be able to address these aspects.

Sacral neuromodulation for treatment of lower urinary tract dysfunction

Despite initial reservations, sacral neuromodulation has begun to develop as a new therapeutic tool for the treatment of lower urinary tract dysfunction. It bridges the gap between conservative treatment options and highly invasive procedures, such as urinary diversion. At present, there are no clinical variables that can reliably predict the efficacy of neuromodulation in an individual patient. All patients, regardless of indication, must therefore undergo a test stimulation before they can be offered chronic sacral neuromodulation with an implanted system. Evaluations in various clinical trials have confirmed that sacral neuromodulation, based on unilateral sacral foramen electrode implantation, has statistically significant therapeutic effects compared to controls, in patients with urge syndromes and failure to empty. The patients most likely to benefit from this treatment are those with detrusor hyperactivity or detrusor hypo-activity. Those with pain syndromes are less likely to respond and to benefit from treatment. Acute and subchronic sacral neuromodulation are associated with very low rates of complications. Complications of chronic sacral neuromodulation are caused either by surgery-related morbidity or hardware problems. Conservative treatment options should be exhausted before neuromodulation is considered. This rule has two purposes: First, it postpones surgery, with its potential morbidity, for as long as possible; second, the long-term efficacy of neuromodulation is still unclear and may be limited in some patients. A fully exploited conservative therapy, in combination with subsequent sacral neuromodulation, may therefore be the optimum way to pursue therapeutic options of relatively low invasiveness.