Neuromodulation In Patients Research Articles

Comparison of Spinal Cord Stimulation, Dorsal Root Ganglion Stimulation, and Association of Both in Patients With Refractory Chronic Back and/or Lower Limb Neuropathic Pain: A Prospective, Randomized, Double-Blind, Cross-Over Trial (BOOST-DRG Study)

ObjectivesSpinal cord stimulation (SCS) and dorsal root ganglion stimulation (DRGS) have individually shown efficacy in relieving pain in patients with persistent spinal pain syndrome after spinal surgery (PSPS-T2). Combining SCS and DRGS simultaneously, along with Burst stimulation programming, may enhance the responder rate of patients with PSPS-T2. Material and MethodsThis study aimed to compare the pain relief (≥50%) responder rates in SCS, DRGS, and SCS+DGRS (DUAL) through a three-month randomized cross-over trial in patients with PSPS-T2. After the cross-over period, stimulation programming was switched to Burst. Secondary objectives included evaluating the clinical efficacy at three-, four-, six-, and 12-month follow-ups, assessing pain intensity, area of pain, area of paresthesia coverage, quality of life, functional disability, psychologic distress, medication intake, and the Multidimensional Clinical Response Index (MCRI). ResultsThe responder rate of pain relief was similar in SCS, DRGS, and DUAL (60%, p = 0.84) at the end of the cross-over period, increasing to 80% with the ability to switch between stimulation possibilities. Burst programming did not provide additional pain relief at the four-month follow-up (p = 0.99). Clinical outcomes significantly improved until 12-month follow-up compared with baseline. Considering a clinically significant increase of 1.05 of the MCRI, all patients were responders at three-, four-, and six- month follow-up, and 80% were responders at 12 months compared with baseline. ConclusionsThe full option to stimulate different neural structures, separately or simultaneously, led to improved responder rates, allowing patients to personalize treatment. A multidimensional assessment is essential to reveal the full potential benefits of neuromodulation in patients with chronic pain.

Efficacy and Safety of Sacral Neuromodulation in Patients with Lower Urinary Tract Dysfunction: A Five-Year Experience in North Cyprus

Efficacy and Safety of Sacral Neuromodulation in Patients with Lower Urinary Tract Dysfunction: A Five-Year Experience in North Cyprus

Effects of continuous theta burst stimulation on contralateral primary motor cortex: a concurrent TMS-EEG study.

Continuous theta burst stimulation (cTBS) is a noninvasive brain stimulation technique. cTBS modulation is an effective treatment for motor dysfunction rehabilitation in post-stroke patients. However, there's currently a lack of research on the effects of cTBS stimulation on the contralesional hemisphere. To better understand the role of cTBS in motor rehabilitation, we investigated the neuroregulatory mechanisms of cTBS in the contralateral cortex using transcranial magnetic stimulation-evoked electroencephalography (TMS-EEG). In this randomized, sham-controlled, single-blind study, 18 healthy subjects received two separate stimulation conditions: cTBS or sham stimulation applied to the left primary motor cortex (M1). TMS-EEG measurements were taken before and immediately after stimulation. We investigated the TMS-evoked potentials (TEPs), evoked oscillatory responses (EOR), and phase synchronization index (PSI) of TMS-EEG. The effects of cTBS were analyzed using two-way repeated-measures analysis of variance (RMANOVA). There was a significant "cTBS condition × time" interaction effect on the theta and gamma bands of EOR, and on interhemisphere PSI (inter-PSI) and global PSI in both cTBS stimulation conditions. (theta: F = 4.526, P = 0.041; gamma: F = 5.574, P = 0.024; inter-PSI: F = 5.028, P = 0.032; global PSI: F = 5.129, P = 0.030). After real cTBS modulation, the energy in the theta and gamma frequency bands was significantly higher than before (theta: F = 5.747, P = 0.022; gamma: F = 5.545, P = 0.024). The inter-PSI and global PSI significantly increased after real cTBS modulation (inter-PSI: F = 6.209, P = 0.018; global PSI: F = 6.530, P = 0.015). cTBS modulation significantly increased EOR and PSI in contralateral brain regions, thereby enhancing cortical excitability and cortical functional connectivity throughout the brain. This provides a theoretical basis for cTBS neuromodulation in patients with stroke.NEW & NOTEWORTHY In right-handed individuals, the left hemisphere exhibits higher excitability. According to hemispheric competition theory, applying continuous theta burst stimulation (cTBS) to inhibit excitability in the left hemisphere can reduce its inhibitory effect on the right, thereby promoting neural excitability. This study applied cTBS to the left M1 of healthy individuals and, for the first time, recorded transcranial magnetic stimulation-evoked electroencephalography (TMS-EEG) from the right M1 to analyze the effects of cTBS on cortical oscillations and network connectivity in the contralateral cortex.

Sacral neuromodulation for voiding dysfunction and urinary retention

Voiding dysfunction and non-obstructive urinary retention are common conditions with debilitating patient symptoms. Treatment of these conditions can be challenging with limited conservative options available. Sacral Neuromodulation is a minimally invasive treatment which has been demonstrated to deliver good success rates in this patient population. It provides patients with a trial period to establish the likelihood of treatment success prior to implantation of a full system and can be reversed should the need arise.This review looks at the potential mechanisms of action of Sacral Neuromodulation in patients with voiding dysfunction or non-obstructive urinary retention, along with the literature evaluating success rates both in the short and long term. It aims to examine any possible predictive factors that may play a role in guiding patient selection and improving patient counselling. It also addresses gaps in the literature and areas where further research is needed.

Effectiveness of neuromodulation in patients with drug-resistant epilepsy after failed surgical treatment

Effectiveness of neuromodulation in patients with drug-resistant epilepsy after failed surgical treatment

Search for approaches to transcranial neuromodulation in patients with post-stroke hemiparesis in real clinical practice

BACKGROUND: To increase the efficiency of motor recovery after a stroke in routine clinical practice, the search for selective biomarkers that determine the choice of the optimal strategy for noninvasive neuromodulation of the brain remains relevant. The study of interhemispheric interaction patterns can hypothetically help in determining the correct conceptual model of neuromodulation. AIM: To determine variants of interhemispheric interaction based on a correlation analysis of motor cortex excitability in patients with poststroke hemiparesis stratified by the degree of motor deficit. MATERIALS AND METHODS: This retrospective observational study involved 185 people (men, 56.2%; women, 43.8%) aged 19–88 years with verified poststroke hemiparesis and 40 healthy volunteers (men, 55.0%; women, 45.0%) aged 20–85 years. The patients underwent diagnostic transcranial magnetic stimulation in the projection of the cortical representation of m. abductor pollicis brevis and m. tibialis anterior of both brain hemispheres. The excitability level of the motor cortex and its interhemispheric asymmetry were recorded, and correlation analysis in subgroups stratified by the degree of paresis was performed. RESULTS: No interhemispheric correlation of resting motor thresholds (rMT) was found in patients with a level of muscle strength for the “hand” segment of 0–2 points (р 0.05). In the remaining subgroups, positive interhemispheric correlations of the rMT were noted (p 0.02). A positive correlation of the rMT of the damaged brain hemisphere and interhemispheric asymmetry of the motor cortex excitability for all degrees of paresis was observed when evaluating the cortical representation of the upper limb muscles. A negative correlation between the rMT of the unaffected brain hemisphere and interhemispheric asymmetry was detected for all degrees of motor deficit of the “foot” segment (p 0.02). CONCLUSION: The study did not confirm the concept of interhemispheric competition of the studied functional activity of the brain. Three authentic variants of interhemispheric interaction were identified: unidirectional hemispheric interaction with predominant reactivity of the affected hemisphere, unidirectional hemispheric interaction with predominant reactivity of the unaffected hemisphere, and functional interhemispheric dissociation. The results indicate the need to rethink some approaches to transcranial neuromodulation strategies in the analyzed cohort.

Feasibility of Sacral Neuromodulation in Patients With Underlying Neurologic Lower Urinary Tract Dysfunction and Fecal Incontinence

To evaluate the efficacy and safety of sacral neuromodulation (SNM) in patients with underlying neurologic conditions and compare outcomes to non-neurogenic patients. Between 2017-2022 patients undergoing 2-staged implantation of InterStim II were included in a single-center retrospective study. Patients were allocated into two groups: underlying neurologic conditions (group 1) or non-neurogenic (group 2). Efficacy and safety were evaluated by comparing patients' bladder/bowel logs pre- and post-operative. Patients' demographics, indications, preimplantation urodynamic study variables, surgery duration, number of postop visits, and time to revision/removal procedures were compared and included in the data analysis. Sixty-seven patients (64.2% female) with a mean age of 63.23±14.15years were included in the study - 16/67(23.9%) patients assigned to group 1. There is no statistically significant difference between the groups regarding the indication for the treatment. The most common indication was nonobstructing urinary retention (NOUR) in both study groups. The common neurologic pathologies were multiple sclerosis, disc disease, and spinal stenosis. Overall and subgroup (based on an indication for SNM implantation) analyses showed no significant difference in patients' demographics, the surgery duration, or the chances for clinical success with a similar follow-up period. During the follow-up, the device was removed in 4 (25.0%) and 10 (19.6%) of the patients in group 1 and group 2, respectively (P=.912). There was no significant difference between the groups in the time till InterStim II removal (P=.905). All NOUR patients with clinical success in group 1 had an improvement of at least 75% from the baseline compared to 69% of patients in group 2 (P=.42). Univariate analysis in NOUR patients demonstrated that maximal cystometric capacity below 430mL and the presence of detrusor contraction at voiding were statistically significant predictors of successful SNM. Overall, at the end of the follow-up period, 8 (50.0%) and 29 (56.9%) patients in groups 1 and 2, respectively, were defined as clinical success (P=.775).

Neuromodulation Techniques for Headache Management.

This narrative review aims to summarize evidence regarding the current utilization and future applications of neuromodulation in patients with headaches, with special attention paid to migraine and chronic cluster headache. A search was conducted in PubMed in August of 2023 to survey the current literature on neuromodulation for the treatment of headache. In total, the search yielded 1989 results, which were further filtered to include only systematic reviews published between 2022 to 2023 to capture the most up-to-date and comprehensive research on this topic. The citation lists of these articles were reviewed to find additional research on neuromodulation and supplement the results presented in this paper with primary literature. Research on the use of neuromodulation for the treatment of headache has predominantly focused on four neuromodulation techniques: peripheral nerve stimulation (PNS), transcranial magnetic stimulation (TMS), deep brain stimulation (DBS), and spinal cord stimulation (SCS). Outcome measures reported in this article include impact on migraine and headache frequency and/or pain intensity, adverse effects of the neuromodulation technique, and associated costs, when available. We found that neuromodulation has developed utility as an alternative treatment for both chronic cluster headaches and migraines, with a reduction in frequency and intensity of headache most elucidated from the articles mentioned in this review.

Modified sympathicotomy in patients with refractory ventricular tachycardia and structural heart disease: a single-center experience.

Modified cardiac sympathetic denervation (CSD) with stellate ganglion (SG) sparing is a novel technique for cardiac neuromodulation in patients with refractory ventricular tachycardia (VT). Our aim is to describe the mid- to long-term clinical outcome of the modified CSD with SG sparing in a series of patients with structural heart disease (SHD) and refractory VT. All consecutive patients with SHD and refractory VT undergoing modified CSD were enrolled. Baseline clinical characteristics and periprocedural data were collected for all patients. The primary outcome was any recurrence of sustained VT. We enrolled 15 patients (age: 69.2 ± 7.9years; male 100%) undergoing modified CSD. Left ventricular ejection fraction was 37 ± 11% and all patients had an implantable cardiac defibrillator (ICD); the underlying cardiomyopathy was non-ischemic in 73.3% of them. At least one previous ablation had been attempted in 66.6% of cases. The 73.3% of patients underwent bilateral CSD and the mean effective surgical time was 10.8 ± 2.4min per side; no major periprocedural complication occurred. After a median follow-up time of 15months (IQR: 8.5-24.5months), the primary outcome occurred in 47.6% of cases. All patients experienced a reduction of ICD shocks after CSD (3.1 ICD shocks/patient before vs. 0.3 ICD shocks/patient after CSD; p-value: 0.001). Bilateral CSD and a VT cycle length < 340ms were associated with better outcomes. A modified CSD approach with stellate ganglion sparing appears to be safe, fast, and effective in the treatment of patients with SHD and refractory VTs.

Sacral nerve modulation for patients with fecal incontinence: long-term outcome and effects on sexual function

Sacral nerve modulation has become an established treatment for fecal and urinary incontinence, and sexual disorders. The objective of this study was to evaluate the long-term outcome of sacral neuromodulation in patients with fecal or combined fecal and urinary incontinence (double incontinence), assessing its safety, efficacy, and impact on quality of life and sexual function. This was a multicentric, retrospective, cohort study including patients with fecal or double incontinence who received sacral neuromodulation at seven European centers between 2007 and 2017 and completed a 5-year follow-up. The main outcome measures included improvements of incontinence symptoms and quality of life compared with baseline, evaluated using validated tools and questionnaires at 1-, 6-, 12-, 36- and 60-month follow-up. 108 (102 women, mean age 62.4 ± 13.4 years) patients were recruited, of whom 88 (81.4%) underwent definitive implantation of the pacemaker. Patients’ baseline median Cleveland Clinic Incontinence Score was 15 (10–18); it decreased to 2 (1–4) and 1 (1–2) at the 12- and 36-month follow-up (p < 0.0001), remaining stable at the 5-year follow-up. Fecal incontinence quality of life score improved significantly. All patients with sexual dysfunction (n = 48) at baseline reported symptom resolution at the 5-year follow-up. The study was limited by the retrospective design and the relatively small patient sample. Sacral nerve modulation is an effective treatment for fecal and double incontinence, achieving satisfactory long-term success rates, with resolution of concomitant sexual dysfunction.

ID: 218213 Successful Spinal Cord Stimulator Trial in the Visually Impaired

A 72-year-old gentleman was referred to the chronic pain clinic after being deemed a non-surgical candidate for a multilevel lumbar fusion per orthopedic spine surgery. His past medical history is notable for coronary artery disease, diabetes mellitus, obstructive sleep apnea, and blindness in bilateral eyes. The patient has been suffering for years from lower back pain, without red flag symptoms, and had failed multiple treatment modalities, including bilateral sacroiliac joint injections, L3-4, L4-5, and L5-S1 facet blocks. Although he is capable of performing most of his activities of daily living, his blindness unfortunately has been a barrier to both surgical interventions and pain management therapy. After consultation with a chronic pain physician, he was offered a spinal cord stimulator trial. With direct communication between the patient and the spinal cord stimulator company representative, a remote-less algorithm was able to be programmed that allowed for successful mapping of target nerves generating 80% efficacy in pain therapy. A thorough literature review demonstrated a lack of research focus in neuromodulation for patients with disabilities. With tailored guidance this patient achieved adequate pain relief which significantly improved his quality of life during the trial phase. The patient is determined to undergo a permanent spinal cord stimulator placement soon. This case report outlines a successful neuromodulation trial in a visually impaired patient. Ultimately, there is still work to be done to ensure advancements in pain medicine are accessible to all patients regardless of disabilities.

Sacral neuromodulation in patients with neurogenic lower urinary tract dysfunction

Abstract Background Limited published data exist regarding the utility of sacral neuromodulation (SNM) for neurogenic lower urinary tract dysfunction (NLUTD), consisting of only small case series, and, to our knowledge, no Australian data have been published. The aim of this study was to evaluate the clinical outcomes of SNM for treatment of NLUTD in Australian patients. Methods A retrospective analysis was conducted of patients who received a permanent SNM implant between December 2014 and March 2021. Patients completed a urodynamic test preoperatively. They completed a 3-day bladder diary, uroflowmetry, and postvoid residual measurement preoperatively and at 6-month intervals postoperatively following SNM insertion. Urinary function, patient-reported outcome measures, and adverse events were assessed. Results A total of 36 patients received a permanent SNM implant. The mean duration of follow-up was 25 ± 20 months, with the majority (89%, n = 32) of patients reporting a &gt;50% improvement on bladder diary evaluation. There was a significant increase in void volume (p &lt; 0.001), decrease in postvoid residual (p &lt; 0.001), decrease in voiding frequency (p &lt; 0.001), decrease in incontinence episodes (p = 0.002), and decrease in pad number (p &lt; 0.001). There was no significant difference in peak flow (p = 0.21). There was no significant difference in SNM efficacy between patients with progressive or nonprogressive neurological conditions. Conclusions Sacral neuromodulation is a safe and effective therapy for NLUTD in the context of both progressive and nonprogressive neurological conditions. It should be offered more readily to patients with NLUTD as a minimally invasive treatment option with the potential to make clinically meaningful improvements in quality of life.

PO-05-036 PERCUTANEOUS STELLATE GANGLIA ABLATION IN THE MANAGEMENT OF VTSTORM

VT storm is a clinical emergency associated with high mortality. Neural modulation of the cardiac sympathetic chain, usually in the form of surgical sympathectomy, has shown to be effective in achieving reduction in appropriate ICD shocks and VT episodes. We hypothesised Percutaneous Stellate Ganglion Ablation (SGA) is a safe and effective alternative modality of neuromodulation in patients with VT storm. Patients with ES refractory to standard management, including sedation and mechanical ventilation, antiarrhythmic agents and beta-blockers, underwent bilateral percutaneous SGA. The ablation was performed at 2 levels - C7 and T1, bilaterally, under fluoroscopic guidance using a customized protocol. (Figure) At each site, 3 lesions were delivered sequentially at 50, 55 and 60 deg. C for 90 seconds using a COSMAN RF generator and RF needle electrode of 5cm length and 4mm active tip with ipsilateral Horner’s syndrome being the clinical end-point for successful ablation. Patients were followed up till discharge and as outpatients with periodic device interrogation There were 6 patients with refractory VT storm (4 male & 2 female) with a mean age of 56.5±5.2 years. The VT was monomorphic in 4 and polymorphic in the other 2 patients. The substrate was Ischaemic cardiomyopathy in 2, Non-ischaemic cardiomyopathy in 3 and Hypertrophic cardiomyopathy in 1 patient. The meean LVEF was 35 ± 20%. There were no periprocedural complications. Post-procedure, 2 out of the 6 patients had one episode of Non-sustained VT each in-hospital. All patients were discharged on Amiodarone and Metoprolol. The mean follow-up duration was 15± 3 months. At last follow-up all of them are alive and none of then received any shocks.. One patient had a VT at 42 days after procedUre which was terminated by device using ATP. SGA by RFA is a safe, effective, inexpensive, well-tolerated and minimally invasive procedure for neuromodulation and should be considered in drug refractory ES.

Effect duration of the initial course of peroneal electrical Transcutaneous NeuroModulation in patients with overactive bladder

The aim of this prospective 12-month follow-up study is to evaluate the persistence of the treatment effect achieved during the initial course of peroneal electrical Transcutaneous NeuroModulation (peroneal eTNM®) in patients with overactive bladder (OAB). This study enrolled 21 female patients who participated in two previous clinical studies designed to assess the efficacy and safety of peroneal eTNM®. The patients were left without subsequent OAB treatment and were invited to attend regular follow-up visits every 3months. The patient's request for additional treatment was considered an indicator of the withdrawal of the treatment effect of the initial course of peroneal eTNM®. The primary objective was the proportion of patients with persisting treatment effect at follow-up visit 12months after initial course of peroneal eTNM®. Descriptive statistics are presented using median, correlation analyses were computed using a nonparametric Spearman correlation. The proportion of patients with persistent therapeutic effect of the initial course of peroneal eTNM® was 76%, 76%, 62% and 48% at 3, 6, 9 and 12months, respectively. There was a significant correlation between patient reported outcomes and the number of severe urgency episodes with or without urgency incontinence as reported by patients at each follow-up visit (p = 0.0017). The treatment effect achieved during the initial phase of peroneal eTNM® persists for at least 12months in 48% of patients. It is likely that the duration of effects is dependent on the length of the initial therapy.

Neurosurgical interventions for cancer pain.

Half of all cancer patients will develop cancer-related pain, and a fifth of these patients will continue to experience pain refractory to maximal pharmacological therapy. This, together with the opioid crisis, has prompted a resurgence in neurosurgical treatments. Neuromodulatory or neuroablative procedures are largely used for various nonmalignant, chronic pain conditions, but there is growing evidence to support their use in cancer pain. This review aims to cover the main neurosurgical treatments that may prove useful in the changing sphere of cancer pain treatment. Neuromodulation techniques for pain have largely replaced neuroablation in neurosurgical practice due to the higher risk of inadvertent permanent neurological deficits from the latter. When compared to neuroablative approaches for severe treatment-refractory cancer pain, neuromodulation is more expensive (largely due to implant cost) and requires more follow-up, with greater engagement needed from the health service, the patient and their carers. Furthermore, neuroablation has a more rapid onset of effect. Neuromodulation techniques for pain have largely replaced neuroablation in neurosurgical practice due to the higher risk of inadvertent permanent neurological deficits from the latter. Whilst this approach is beneficial when treating nonmalignant pain, neuromodulation in patients with pain related to advanced cancer still has a limited role. Neuroablative procedures are less expensive, require less follow-up, and can have a lower burden on health services, patients and their carers.

SPinal coRd stimulatiOn coMpared with lumbar InStrumEntation for low back pain after previous lumbar decompression (PROMISE): a prospective multicentre RCT

IntroductionPersistent spine pain syndrome type 2 (PSPS2) represents a significant burden to the individual and society. Treatment options include revision surgery, stabilisation surgery of the spine, neuromodulation, analgesics and cognitive...

Narrative review of current neuromodulation modalities for spinal cord injury.

Neuromodulation is a developing field of medicine that includes a vast array of minimally invasive and non-invasive therapies including transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), peripheral nerve stimulation, and spinal cord stimulation (SCS). Although the current literature surrounding the use of neuromodulation in managing chronic pain is abundant, there is an insufficient amount of evidence specifically regarding neuromodulation in patients with spinal cord injury (SCI). Given the pain and functional deficits that these patients face, that are not amenable to other forms conservative therapy, the purpose of this narrative review is to examine and assess the use of various neuromodulation modalities to manage pain and restore function in the SCI population. Currently, high-frequency spinal cord stimulation (HF-SCS) and burst spinal cord stimulation (B-SCS) have been shown to have the most promising effect in improving pain intensity and frequency. Additionally, dorsal root ganglion stimulation (DRG-S) and TMS have been shown to effectively increase motor responses and improve limb strength. Although these modalities carry the potential to enhance overall functionality and improve a patient's degree of disability, there is a lack of long-term, randomized-controlled trials in the current space. Additional research is warranted to further support the clinical use of these emerging modalities to provide improved pain management, increased level of function, and ultimately an overall better quality of life in the SCI population.

Treating fibromyalgia with electrical neuromodulation: A systematic review and meta-analysis

ObjectiveSeveral types of electrical neuromodulation (such as transcranial direct current stimulation, tDCS; transcutaneous electrical nerve stimulation) have been applied in the treatment of fibromyalgia. These trials had different outcome measurements, such as subjective pain, pain threshold, depression, anxiety, and functioning. We intended to integrate data from different trials into a meta-analysis to clearly present the clinical value of electrical neuromodulation in fibromyalgia. MethodsA systematic review and meta-analysis of randomized controlled trials comparing the effect of all types of electrical neuromodulation in patients with fibromyalgia was conducted. The main outcome was subjective pain; the secondary outcomes included depression, anxiety, and functioning. ResultsTwenty-five studies and 1061 fibromyalgia patients were included in the quantitative analysis. Active electrical neuromodulation and active tDCS both showed significant effects on subjective pain, depression, and functioning. For different anode tDCS electrode positions, only F3-F4 revealed a significant effect on depression. Meta-regression tDCS effects on depression were significantly associated with age. ConclusionsElectrical neuromodulation is significantly effective in treating pain, depression, and functioning in patients with fibromyalgia. SignificanceThe results may help clinicians to arrange effective treatment plans for patients with fibromyalgia, especially in those patients who reveal limited response to pharmacotherapy and psychotherapy.

Brain Response Induced by Peroneal Electrical Transcutaneous Neuromodulation Invented for Overactive Bladder Treatment, as Detected by Functional Magnetic Resonance Imaging

ObjectivesIn this study, we aimed to investigate whether peroneal electrical Transcutaneous Neuromodulation invented for overactive bladder (OAB) treatment elicits activation in brain regions involved in neural regulation of the lower urinary tract. Materials and MethodsAmong 22 enrolled healthy female volunteers, 13 were eligible for the final analysis. Functional magnetic resonance imaging (fMRI) (Siemens VIDA 3T; Erlangen, Germany) was used to compare the brain region activation elicited by peroneal electrical Transcutaneous Neuromodulation with the activation elicited by sham stimulation. Each subject underwent brain fMRI recording during eight 30-second periods of rest, alternating with 30-second periods of passive feet movement using the sham device, mimicking the motor response to peroneal nerve stimulation. Subsequently, fMRI recording was performed during the analogic “off-on” stimulation paradigm using peroneal electrical transcutaneous neuromodulation. Magnetic resonance imaging data acquired during both paradigms were compared using individual and group statistics. ResultsDuring both peroneal electrical Transcutaneous Neuromodulation and sham feet movements, we observed activation of the primary motor cortex and supplementary motor area, corresponding to the cortical projection of lower limb movement. During peroneal electrical Transcutaneous Neuromodulation, we observed significant activations in the brain stem, cerebellum, cingulate gyrus, putamen, operculum, and anterior insula, which were not observed during the sham feet movement. ConclusionsOur study provides evidence that peroneal electrical Transcutaneous Neuromodulation elicits activation of brain structures that have been previously implicated in the perception of bladder fullness and that play a role in the ability to cope with urinary urgency. Our data suggest that neuromodulation at the level of supraspinal control of the lower urinary tract may contribute to the treatment effect of peroneal electrical Transcutaneous Neuromodulation in patients with OAB.

Неинвазивная нейромодуляция как метод обезболивания в комплексной терапии хронической боли в нижней части спины

Aim: To describe the Russian and foreign experience in the use of non-invasive neuromodulation for pain management in patients with chronic lower back pain (LBP); to present various neuromodulation techniques and other rehabilitation methods which can be used in combination with neuromodulation in patients with LBP; to describe neuromodulation parameters and programs for an optimal analgesic effect. Key points. LBP is a common (affecting 7.5 % of the world population) and socially significant condition (one of the leading causes of disability worldwide). The efficiency of drug pain management in chronic LBP is approximately 40 %, therefore, non-drug treatment options are required. The neuropathic component of chronic LBP is associated with reorganization in cortex brain structures Hence, neural stimulation is a most promising approach to chronic LBP management, while transcranial direct current electrotherapy stimulation (TEdC) and rhythmic transcranial magnetic stimulation (rTMS) are the most efficient and safest neural stimulation methods. rTMS is an efficient and safe approach to the management both of nociceptive and neuropathic pain, which is a common component of chronic conditions, in particular of LBP. The main area of exposure is motor cortex areas (М1). As compared to TEdC, rTMS is better tolerated by patients and demonstrates better pain management results. Conclusion. Pain syndrome is a significant limitation to rehabilitation in patients with LBP, and drug pain management is inefficient. We suggest that anaesthetic neuromodulation be included into a complex therapy of such patients. The most widely used and efficient neuromodulation techniques are TEdC and rTMS. Keywords: lower back pain, rehabilitation, transcranial magnetic stimulation, neuropathic pain.