OT re neuro modulation ,maybe...maybe not....
What is neuro-modulation therapy?
Some bladder symptoms are due to problems of coordination or neuromuscular control. Neuro-modulation therapy is a specific type of therapy used when incontinence is due to such disturbances of neuromuscular control. In this type of therapy, a pacemaker, similar to the one used for heart, is implanted in the body to regulate the activity of nerves to the bladder and pelvic floor. This therapy is used to treat urge incontinence, symptoms of frequency and urgency, and also for problems of non-obstructed urinary retention or incomplete emptying. For details please visit: medtronic.com
and
analgesia.ch
(Pain management)
Hôpital de Morges
Neuromodulation refers to a series of techniques employing electrical stimulation or the administration of medication by means of devices implanted in the body. These techniques allow the treatment of a whole range of disorders including certain forms of
pain
spasticity
tremor
urinary problems (micturition disorders).
Generally, neuromodulation treatments are not recommended straight away. In fact, often the illnesses mentioned here can be treated satisfactorily with medication and/or surgery. It is only once conventional methods fail to achieve satisfactory results that neuromodulation techniques may be considered.
As a rule, the Pain management Service only treats patients suffering from pain. However, when neuromodulation is required for other disorders than pain, a close collaboration with the other specialists ensures an appropriate management and follow-up of each patient.
The types of pain which are treatable by means of neuromodulation can be extremely diverse. Only those most frequently encountered are mentioned here :
Low back pain and Sciatica
A large number of patients suffer from lumbago and sciatica. Often these pains are transitory and respond to conventional medicine and physiotherapy. Sometimes it is necessary to operate to treat an herniated vertebral disk or other spinal problems. Nevertheless, there are still some patients who despite the most enterprising measures still suffer from severe pain to the point of invalidity. In this case neuromodulation (by means of electrical stimulation of the spinal cord) can considerably reduce the pain.
Peripheral artery disease
When the arteries of the legs become obstructed, cramp-like pains can occur particularly when walking. Such patients should be operated on immediately (bypass) in order to re-establish normal circulation. Where such surgery is not possible or the risks are too great, a spinal cord stimulator can bring very effective relief.
Angina pectoris
Angina pectoris is a cramp-like pain felt in the chest and/or the left arm caused by the occlusion of the coronary arteries. Conventional management consists of prescribing medication and sometimes open heart surgery (bypass) is needed. When these treatments are ineffective or inappropriate the implantation of a spinal cord stimulator can achieve excellent results.
Spasticity
Certain neurological illnesses for example multiple sclerosis are accompanied by incapacitating spasms, particularly in the legs. Orally administered medicines are generally effective against spasticity, however, for some patients even high doses do not achieve a satisfactory result. In these cases the implantation of a pump for continuous administration of antispasmodic medications directly into the cerebro-spinal fluid (in other words directly where these substances work) allows very effective control of the spasm.
Tremor
Certain neurological illnesses, for example Parkinson's Disease, are associated with very severe shaking, dramatically affecting everyday life. Here again, medicines usually achieve satisfactory results. Sometimes the addition of stimulation of certain areas of the brain is recommended in the most severe cases producing excellent results.
Urinary problems (micturition disorders)
The treatment of urinary problems by means of neuromodulation techniques was not developed until recently. Depending on the situation and following very detailed functional tests it is possible to relieve a variety of disorders, including urine incontinence and retention.
How are theses treatments performed in practice?
Neuromodulation techniques consist of the surgical implantation of a small battery (a pacemaker) connected to a very fine electrode inserted either into the epidural space, or close to a peripheral nerve. At the end of the procedure, the pacemaker is programmed in order to achieve the desired effect without abnormal or unpleasant sensations or side effects. The alternative consists of implanting a pump equipped with a reservoir allowing for very precise continuous administration of medicine. Generally the catheter is introduced close to the spinal cord into the cerebro-spinal fluid.
In practise, all applications of neuromodulation require a test phase. During this trial period, which can last up to 3 weeks, the patient and his/her doctor can precisely judge the improvement that is obtained. During the test phase the patient is fitted with external equipment (pump or electrical stimulator) so that he/she can become accustomed to the equipment in day to day activities and can get a feel for what it would be like to have the final system implanted. It is only once the effect has been demonstrated that the final equipment is installed.
The surgical interventions required for neuromodulation treatment are minor and minimally invasive. In most patients these procedures are carried out under local anaesthesia although general anaesthesia is sometimes used. |
