천수신경조절술에 대한 반응도로 본 영향인자의 단기적 분석

전계민,윤하나 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.2

Purpose: Sacral neuromodulation has become an effective option for controlling intractable symptoms of overactive bladder: urgency and urge incontinence. However, it has its limitations in that an intermittent pulse generator (IPG) is insertable only in patients with symptom improvement of at least 50%. In this study, we aimed to investigate the parameters that predict surgical outcomes. Materials and Methods: Data from 31 candidates for sacral neuromodulation were retrospectively analyzed. Twenty patients out of 31 candidates had satisfactory symptom improvement after tinned lead test implantation, which resulted in IPG implantation. Data and neural stimulation parameters were compared and analyzed between successful IPG implants (group 1) and test failures (group 2). Results: The percentage of female patients was higher in the IPG implant group (group 1: 95%, group 2: 64%). There was a significant difference in symptom duration, between the two groups (group 1: 40.5 months, group 2: 91 months). There was a significant difference in the number of episodes of urgency between the two groups (group 1: 6.83/day, group 2: 9.66/day, p=0.012), and severity of urgency showed significant difference between two groups (group 1<group 2, p=0.027). Conclusions: In females, the severity and duration of symptoms may be factors predicting poor response to neuromodulation. Although there is a need for further data analysis, this study suggests that the proper selection of surgical time is important in controlling patients’ lower urinary tract symptoms by neuromodulation. Purpose: Sacral neuromodulation has become an effective option for controlling intractable symptoms of overactive bladder: urgency and urge incontinence. However, it has its limitations in that an intermittent pulse generator (IPG) is insertable only in patients with symptom improvement of at least 50%. In this study, we aimed to investigate the parameters that predict surgical outcomes. Materials and Methods: Data from 31 candidates for sacral neuromodulation were retrospectively analyzed. Twenty patients out of 31 candidates had satisfactory symptom improvement after tinned lead test implantation, which resulted in IPG implantation. Data and neural stimulation parameters were compared and analyzed between successful IPG implants (group 1) and test failures (group 2). Results: The percentage of female patients was higher in the IPG implant group (group 1: 95%, group 2: 64%). There was a significant difference in symptom duration, between the two groups (group 1: 40.5 months, group 2: 91 months). There was a significant difference in the number of episodes of urgency between the two groups (group 1: 6.83/day, group 2: 9.66/day, p=0.012), and severity of urgency showed significant difference between two groups (group 1<group 2, p=0.027). Conclusions: In females, the severity and duration of symptoms may be factors predicting poor response to neuromodulation. Although there is a need for further data analysis, this study suggests that the proper selection of surgical time is important in controlling patients’ lower urinary tract symptoms by neuromodulation.

Nanomaterials-assisted thermally induced neuromodulation

Congqi Yang,Seongjun Park 대한의용생체공학회 2021 Biomedical Engineering Letters (BMEL) Vol.11 No.3

Neuromodulation, as a fast-growing technique in neuroscience, has been a great tool in investigation of the neural pathwaysand treatments for various neurological disorders. However, the limitations such as constricted penetration depth, low temporalresolution and low spatial resolution hindered the development and clinical application of this technique. Nanotechnology,which refers to the technology that deals with dimension under 100 nm, has greatly infl uenced the direction of scientifi cresearches within recent years. With the recent advancements in nanotechnology, much attention is being given at applyingnanomaterials to address the limitations of the current available techniques in the fi eld of biomedical science includingneuromodulation. This mini-review aims to introduce the current state-of-the-art stimuli-responsive nanomaterials used forassisting thermally induced neuromodulation.

128-Channel Recording, 32-Channel Stimulation, Digitally Interfaced Optogenetic Neuromodulation System-on-Chip

송상민,김민재,김준규,박현태,박영훈,엄경식,박성윤 한국과학기술원 반도체설계교육센터 2022 IDEC Journal of Integrated Circuits and Systems Vol.8 No.2

This paper presents a digitally interfaced a 128-channel recording, 32-channel stimulation optogenetic neuromodulation system on chip (SoC) that has been developed for long-term optogenetics neuroscience research. The low-power 128-channel neural recording frontend offers low-noise multichannel recording, on-chip 16-bit data digitization, and electrode impedance measurement. The 32-channel optogenetic stimulator provides high-resolution, accurate optical stimulation. The chip communicates through two control signal shared SPI interfaces for simultaneous recording and stimulation with independent on-the-fly control command and data transfer, resulting in only 6 external wires. The developed system constitutes a fully digital, bidirectional 128/32-channel SoC suitable for in-vivo neuromodulation.

Function of Selective Neuromodulatory Projections in the Mammalian Cerebral Cortex: Comparison Between Cholinergic and Noradrenergic Systems

Rho, Hee-Jun,Kim, Jae-Hyun,Lee, Seung-Hee Frontiers Media S.A. 2018 Frontiers in neural circuits Vol.12 No.-

<P>Cortical processing is dynamically modulated by different neuromodulators. Neuromodulation of the cerebral cortex is crucial for maintaining cognitive brain functions such as perception, attention and learning. However, we do not fully understand how neuromodulatory projections are organized in the cerebral cortex to exert various functions. The basal forebrain (BF) cholinergic projection and the locus coeruleus (LC) noradrenergic projection are well-known neuromodulatory projections to the cortex. Decades of studies have identified anatomical and physiological characteristics of these circuits. While both cholinergic and noradrenergic neurons widely project to the cortex, they exhibit different levels of selectivity. Here, we summarize their anatomical and physiological features, highlighting selectivity and specificity of these circuits to different cortical regions. We discuss the importance of selective modulation by comparing their functions in the cortex. We highlight key features in the input-output circuits and target selectivity of these neuromodulatory projections and their roles in controlling four major brain functions: attention, reinforcement, learning and memory, sleep and wakefulness.</P>

Transcutaneous Electrical Stimulation of the Abdomen, Ear, and Tibial Nerve Modulates Bladder Contraction in a Rat Detrusor Overactivity Model: A Pilot Study

Rosa L. Coolen,Dennis Frings,Els van Asselt,Jeroen R. Scheepe,Bertil F. M. Blok 대한배뇨장애요실금학회 2023 International Neurourology Journal Vol.27 No.3

Purpose: The global prevalence of overactive bladder (OAB) is estimated at 11.8%. Despite existing treatment options such as sacral neuromodulation, a substantial number of patients remain untreated. One potential alternative is noninvasive transcutaneous electrical stimulation. This form of stimulation does not necessitate the implantation of an electrode, thereby eliminating the need for highly skilled surgeons, expensive implantable devices, or regular hospital visits. We hypothesized that alternative neural pathways can impact bladder contraction. Methods: In this pilot study, we conducted transcutaneous electrical stimulation of the abdominal wall (T6-L1), the ear (vagus nerve), and the ankle (tibial nerve) of 3 anesthetized female Sprague-Dawley rats. Stimulation was administered within a range of 20 Hz to 20 kHz, and its impact on intravesical pressure was measured. We focused on 3 primary outcomes related to intravesical pressure: (1) the pressure change from the onset of a contraction to its peak, (2) the average duration of contraction, and (3) the number of contractions within a specified timeframe. These measurements were taken while the bladder was filled with either saline or acetic acid (serving as a model for OAB). Results: Transcutaneous stimulation of the abdominal wall, ear, and ankle at a frequency of 20 Hz decreased the number of bladder contractions during infusion with acetic acid. As revealed by a comparison of various stimulation frequencies of the tibial nerve during bladder infusion with acetic acid, the duration of contraction was significantly shorter during stimulation at 1 kHz and 3 kHz relative to stimulation at 20 Hz (P=0.025 and P=0.044, respectively). Conclusions: The application of transcutaneous electrical stimulation to the abdominal wall, ear, and tibial nerve could provide less invasive and more cost-effective treatment options for OAB relative to percutaneous tibial nerve stimulation and sacral neuromodulation. A follow-up study involving a larger sample size is recommended.

Percutaneous Nerve Evaluation Test Versus Staged Test Trials for Sacral Neuromodulation: Sensitivity, Specificity, and Predictive Values of Each Technique

Mai Banakhar,Magdy Hassouna 대한배뇨장애요실금학회 2016 International Neurourology Journal Vol.20 No.3

Purpose: InterStim device is an U.S. Food and Drug Administration approved minimal invasive therapy for sacral neuromodulation for lower urinary tract dysfunction. Before InterStim implantation, a trial with the appropriate screening tests is required to determine patient therapy eligibility. There are two different techniques for patient screening: percutaneous nerve evaluation (PNE) test and staged test. Few studies have reported success and failure rates for each technique. However, test sensitivity and predictive values of either test have not been studied. The aim of our study was to determine the sensitivity and specificity of each test and to establish a decision algorithm for the most appropriate testing method to be used as a screening test. Methods: This cross-sectional study was conducted from August 2009 to February 2012 and included patients with lower urinary tract dysfunction who participated in the stimulation test trial. Patients underwent PNE as the first stimulation test, while those who encountered technical difficulty during PNE or electrode migration underwent staged testing. Results: A total of 213 patients, including 172 female and 41 male subjects, underwent PNE. The patients’ diagnoses included refractory overactive bladder (47.9%), nonobstructive urinary retention (29.6%), and frequency urgency syndrome (22.1%). A total of 202 patients were screened with PNE and 10 patients with staged testing. Overall sensitivity of PNE was 87.3%, and it was 90% for staged test. PNE specificity was 98.5% as compared to 92.9% for staged test. Positive and negative predictive values for PNE were 99% and 82.1% and for staged test were 90% and 92.9%, respectively. Conclusions: PNE test has high specificity and positive predictive value. We recommend PNE, a simple office-based, less expensive procedure as the first option for screening.

Pulsed Radiofrequency Neuromodulation for the Treatment of Saphenous Neuralgia

Han, Bo Ram,Choi, Hyuk Jai,Kim, Min Ki,Cho, Yong-Jun The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.54 No.2

A 65-year-old male presented with pain in his right medial calf. An imaging study revealed no acute lesions, and a diagnosis of saphenous neuralgia was made by a nerve conduction study. He received temporary pain relief with saphenous nerve blocks twice in a one-week interval. Pulsed radiofrequency neuromodulation reduced pain to 10% of the maximal pain intensity. At 6 months after the procedure, the pain intensity was not aggravated even without medication. Pulsed radiofrequency neuromodulation of the saphenous nerve may offer an effective and minimally invasive treatment for patients with saphenous neuralgia who are refractory to conservative management.

Needle Placement: A Guide to Predictable Sensory and Motor Responses Based on Variations in Needle Placement During Sacral Neuromodulation Procedures

Melanie Crites-Bachert,Casey Clark 대한배뇨장애요실금학회 2019 International Neurourology Journal Vol.23 No.4

Purpose: Providing practitioners with an adjunctive guide that will aid implanters in the ability to predict and, immediately recognize, what suboptimal needle placement looks like (based on visualization of needle/lead placement and the patient’s sensory and motor responses), allow cultivation of a more complete and comprehensive level of understanding of the sacral neuromodulation procedure as a whole, and inversely provide a guide for what true optimal needle/lead placement should currently demonstrate (based on current International Continence Society guidelines). Methods: More than 400 patients underwent sacral neuromodulation procedures from 2011–2018 by a practitioner who is in the top 5% of implanting physicians in the United States. Common stimulation patterns with motor and sensory responses were observed in patients with suboptimal needle placement intraoperatively. Results: Reproducible stimulation patterns were observed with common suboptimal needle placement intraoperatively. This allowed the implanting practitioner to immediately identify and correct the needle placement intraoperatively to achieve optimal needle placement and optimal motor and sensory responses for the patients. Conclusions: By considering the 3-dimensional spatial trajectory of the S3 nerve, and following this presented guide, the most optimal lead placement with consistently reproducible outcomes that include S3 motor and sensory response on all 4 leads at less than, or equal to, 2 volts can be achieved and can potentially maximize the life of the device while potentially affording patients a more successful outcome.

Sacral Neuromodulation in Patients With a Cardiac Pacemaker

Abdullah A. Gahzi,Dean S. Elterman,Magdy Hassouna 대한배뇨장애요실금학회 2016 International Neurourology Journal Vol.20 No.3

The objective of this study was to describe our experience using sacral neuromodulation to treat urinary urgency, frequency, urge incontinence, and chronic urinary retention in patients with cardiac pacemakers. With the increasingly widespread use of InterStim for bladder function restoration, we are seeing more complex patients with multiple comorbidities, including cardiac conditions. Herein, we report 3 cases of individuals with cardiac pacemakers who underwent InterStim implantation to treat urinary conditions. This study is a case series of 3 patients with cardiac pacemakers who underwent sacral neuromodulation to treat refractory voiding dysfunction. The initial patient screening for InterStim therapy involved percutaneous nerve evaluation (PNE), in which a temporary untined lead wire was placed through the S3 foramen. Patients who did not respond to PNE proceeded to a staged implant. All patients in this study had a greater than 50% improvement of their urinary symptoms during the initial trial and underwent placement of the InterStim implantable pulse generator (IPG). Postoperative programming was done under electrocardiogram monitoring by a cardiologist. No interference was observed between the Inter- Stim IPG and the cardiac pacemaker. In this group of patients, sacral neuromodulation in the presence of a cardiac pacemaker appears to have been safe.

Pulsed Radiofrequency Application for the Treatment of Pain Secondary to Sacroiliac Joint Metastases

이유리,이나래,권영숙,장지수,임소영 대한통증학회 2016 The Korean Journal of Pain Vol.29 No.1

Sacroiliac (SI) joint pain can result from degeneration, infection, malignancy, and trauma. Patients with metastatic bone pain who do not respond to conventional treatment may need more aggressive neuroinvasive approaches. Recently, pulsed radiofrequency (PRF) neuromodulation has emerged as a promising treatment alternative for refractory cases of SI joint pain. Nevertheless, there is no report on the treatment of pain arising from SI joint metastases with PRF. We are reporting about a 63-year-old woman suffering from buttock pain due to breast cancer metastases in the SI joint. We treated this patient with PRF neuromodulation of the L4-S3 primary dorsal rami and lateral branches using a rotating curved needle technique. The patient tolerated the procedures well, without any complications. She experienced about 70% reduction in pain, and pain relief was sustained for 10 months. This result suggests that PRF neuromodulation is a safe, effective treatment for pain from SI joint metastases. (Korean J Pain 2016; 29: 53-56)