A case of Neuromodulation is a medical device used to treat the chronic pain of neurological origin. An electric impulse generated by the machine causes a Paresthésie ( swarming ) which deteriorates the perception of the pain at the patient. A surgeon establishes it by means of a percutaneuse surgical operation or a Laminectomie close to the dorsal surface of the Spinal column. A generator of the electric impulses is then established in the abdomen or the buttocks, and a wire connects the case with the aforementioned generator.

History

The first case installation of of neuromodulation is made by Shealy in 1967. Since then, several studies showed the effectiveness of the case of neuromodulation by reducing the suffering of patients, whom they are reached of Algoneurodystrophie, of the Syndrome post-laminectomal, or Neuropathie périphérale.

Surgery

The complications generally related to this kind of intervention can include the migration of the wire connector in the organization, the infection, the Hématome extra-dural, the Paralysie, drilling of the Dura MATER, and in rare cases, death. The possibility of migration of the wire decreases with a laminectomy.

A phase of test is generally led before establishing the permanent device. An extra-dural temporary wire is used, connected to an external generator. This test lasts from 3 to 7 days. If the patient sees a reduction of the pain from at least 50%, he is candidate for the permanent device.

Precautions

The patients with cases of neuromodulation cannot be examined with the Imagerie by magnetic resonance (IRM) because of surchauffement of the electrodes established, which can thus damage the spinal column. Other intrusive means of examination non' can be used in its place, of which the Ultrason, the Tomodensitométrie (CT-scan) or the X-ray.

They must also avoid exposing to the places with electromagnetic Interférence strong, like the electric transformers, as well as electric dangerous work, like the Welding the arc.

Devices used

• the Conventional Implantable Pulsates Generator (IPG) consists of an electric pile and controls. When the pile is finished, it is replaced by means of an other surgical operation.

• the Plantable Rechargeable Pulsates Generator (IPG) consists of a rechargeable battery and electric controls. The pile is reloaded by means of an external device carried by the patient for at least a few hours both to three weeks.
• the device with Onde radio consists of an established receiver and another transmitting device (carried like a cellphone). The transmitter sends radio operator waves to the receiver, which in its turn stimulates the neurons. This device is generally used among patients requiring less stimulation neuromodulatrice.

One provides to the patient a remote control to light and extinguish the apparatus when it wishes it. Depending on the kind on device and the opinion on the doctor, the remote control can also change the desired level of stimulation a little. The doctor has a machine which can modify the configuration of the remote control.

Voltage

The cases of neuromodulation exist in versions with constant current, variable Voltage (Advanced Bionics or St Jude Medical), and in version with variable current, constant voltage (Medtronic). The producers of the apparatuses do not agree on the relative effectiveness their respective configurations.

Other uses

The cases of neuromodulation were used to treat patients reached of Migraine S strong and constant. The wire are established in the bilateral area suboccipitale.

Other

Among the famous patients established with cases of neuromodulation one finds Jerry Lewis (which is spokesperson of Medtronic), and Michael Roman, amputee of one leg following an infection and suffering of chronic pains, and which has revival its career of pilot of racecar after the establishment.

Appendices

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