Effects of iontophoretically applied naloxone, picrotoxin and strychnine on dorsal horn neuron activities treated with high frequency conditioning stimulation in cats

Jeong, Yong,Baik, Eun-Joo,Nam, Taick-Sang,Paik, Kwang-Se Yonsei University, College of Medicine 1995 Yonsei medical journal Vol.36 No.4

Occipital nerve stimulation in a patient with an intractable chronic headache -A case report-

( Jae Hyuck Shin ),( Yong Chul Kim ),( In Ki Jang ),( Jae Hun Kim ),( Soo Young Park ),( Sang Chul Lee ) 대한마취과학회 2011 Korean Journal of Anesthesiology Vol.60 No.4

Occipital nerve stimulation (ONS) is a form of peripheral nerve stimulation used to treat refractory headaches. The trial of ONS was carried with the midline incision C1-2 level, inserted electrical lead subcutaneously to oblique and cephalad direction followed by trajectory of blunt dissection. We used 8 pole electrical lead to cover lesser occipital nerve, greater occipital nerve, third occipital nerve and great auricular nerve. We anchored the lead at the midline insertion site after confirming the stimulation of the patient. And then we looped and tightened the lead loosely, connected the lead and the extension under right supraspinatus muscle region. After 1 week trial period, we performed the permanent implantation of occipital nerve stimulator. We inserted internal pulse generator under a pocket located at right infraclavicular region. The VAS score dropped from 8/10 to 1-2/10. No serious complications were detected during 1 month follow-up. (Korean J Anesthesiol 2011; 60: 298-301)

Lead fracture of peripheral nerve stimulator for brachial plexopathy -a case report-

최서정,채지선,김윤진,전진영,문호식 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.5

Peripheral nerve stimulation (PNS) is a useful treatment for chronic pain, but it can cause damage depending on its application site. Here, we describe the case of a 54-year-old man who underwent PNS for brachial plexopathy in 2015. One lead was implanted on the left medial cord to stimulate the medial antebrachial cutaneous nerve, and the other was implanted on the radial nerve to stimulate the posterior antebrachial cutaneous nerve. Both leads were inserted near the shoulder joint but did not cross it. Before PNS, the patient did not move his shoulder and elbow because of severe pain, but the treatment greatly alleviated this pain. Twenty months after the operation, both leads were fractured, and the severe pain returned. Repetitive motion near the joint was closely related to the lead fractures. In conclusion, large joints as the insertion sites of PNS leads should be avoided to prevent lead fractures.

Central and Peripheral Motor Conduction Studies by Single-Pulse Magnetic Stimulation

Hideyuki Matsumoto,Yoshikazu Ugawa 대한신경과학회 2024 Journal of Clinical Neurology Vol.20 No.3

Single-pulse magnetic stimulation is the simplest type of transcranial magnetic stimulation (TMS). Muscle action potentials induced by applying TMS over the primary motor cortex are recorded with surface electromyography electrodes, and they are called motor-evoked potentials (MEPs). The amplitude and latency of MEPs are used for various analyses in clinical practice and research. The most commonly used parameter is the central motor conduction time (CMCT), which is measured using motor cortical and spinal nerve stimulation. In addition, stimulation at the foramen magnum or the conus medullaris can be combined with conventional CMCT measurements to evaluate various conduction parameters in the corticospinal tract more precisely, including the cortical–brainstem conduction time, brainstem–root conduction time, cortical–conus motor conduction time, and cauda equina conduction time. The cortical silent period is also a useful parameter for evaluating cortical excitability. Single-pulse magnetic stimulation is further used to analyze not only the central nervous system but also the peripheral nervous system, such as for detecting lesions in the proximal parts of peripheral nerves. In this review article we introduce four types of single-pulse magnetic stimulation—of the motor cortex, spinal nerve, foramen magnum, and conus medullaris—that are useful for the diagnosis, elucidation of pathophysiology, and evaluation of clinical conditions and therapeutic effects. Single-pulse magnetic stimulation is a clinically useful technique that all neurologists should learn.

Comparing neuromodulation modalities involving the suprascapular nerve in chronic refractory shoulder pain: retrospective case series and literature review

Saugat Dey 대한견주관절의학회 2021 대한견주관절의학회지 Vol.24 No.1

Chronic shoulder pain not relieved by either conservative or surgical management is referred to as chronic refractory shoulder pain. This is a retrospective case series where chronic refractory shoulder pain patients were treated either with peripheral nerve stimulation (PNS) or with pulsed radiofrequency (p-RF) therapy to the suprascapular nerve. Both patients receiving PNS reported 100% pain relief for the first month. At the 3- and 6-month follow-ups, one patient continued to experience 100% relief while the other reported 90% relief. One patient undergoing p-RF experienced about 90% pain relief at both 1- and 3-month intervals and 0% relief at the 6-month interval. The other patient with p-RF experienced 33% relief at 1-month and 0% relief thereafter. No patient reported any complications. The results of previous randomized controlled trials evaluating the efficacy of p-RF administered to the suprascapular nerve were mixed, and there is a lack of published studies on PNS effects. Neuromodulation of the suprascapular nerve can be effective for chronic refractory shoulder pain patients. Larger scale randomized controlled trials comparing PNS and p-RF are needed to better understand their respective therapeutic capacity.

Identification of Safe Zone with Intraoperative Neurophysiological Monitoring during Surgical Removal of Peripheral Nerve Tumor

Dong-hun Kim,Choi Jin-gyu,Son Byung Chul 대한말초신경학회 2016 The Nerve Vol.2 No.2

During resection of peripheral nerve tumor, it is essential to identify and protect the neighboring neural elements to the tumor itself prior to attempting direct resection. The authors present the techniques of intraoperative electrophysiologic monitoring and nerve stimulation during resection of schwannoma of the peripheral nerve tumor in the upper extremity. After performing a longitudinal epineurotomy in a ‘bare area’ of the tumor (devoid of fascicular structure), an intraoperative bipolar nerve stimulation was given (0.5-1msec, 1mA) to identify safe zones to assist to determine functioning and nonfunctioning fascicles, and therefore facilitate resection. With the aid of microscopic dissection and intraoperative nerve stimulation, the schwannoma could be removed by opening the epineurium at a ‘bare area’ and separating the uninvolved fascicles until the single feeding fascicle was identified. Intraoperative neurophysiology and nerve stimulation is a helpful technique to facilitate complete removal of peripheral nerve tumor unassociated with neurologic deficit.

Median Nerve Stimulation in a Patient with Complex Regional Pain Syndrome Type II

Jeon, Ik-Chan,Kim, Min-Su,Kim, Seong-Ho The Korean Neurosurgical Society 2009 Journal of Korean neurosurgical society Vol.46 No.3

A 54-year-old man experienced injury to the second finger of his left hand due to damage from a paintball gun shot 8 years prior, and the metacarpo-phalangeal joint was amputated. He gradually developed mechanical allodynia and burning pain, and there were trophic changes of the thenar muscle and he reported coldness on his left hand and forearm. A neuroma was found on the left second common digital nerve and was removed, but his symptoms continued despite various conservative treatments including a morphine infusion pump on his left arm. We therefore attempted median nerve stimulation to treat the chronic pain. The procedure was performed in two stages. The first procedure involved exposure of the median nerve on the mid-humerus level and placing of the electrode. The trial stimulation lasted for 7 days and the patient's symptoms improved. The second procedure involved implantation of a pulse generator on the left subclavian area. The mechanical allodynia and pain relief score, based on the visual analogue scale, decreased from 9 before surgery to 4 after surgery. The patient's activity improved markedly, but trophic changes and vasomotor symptom recovered only moderately. In conclusion, median nerve stimulation can improve chronic pain from complex regional pain syndrome type II.

신경자극기를 이용한 액와부 상박신경총 차단의 효과

한종인 梨花女子大學校 醫科大學 醫科學硏究所 1996 EMJ (Ewha medical journal) Vol.19 No.4

말초신경자극기를 이용한 액와부 상박신경총 차단법이 시행된 30명의 환자에서 저자들은 다음과 같은 결론을 얻었다. 말초신경자극기를 사용하는 경우에도 완전 성공률이 73.3%로 성공률의 향상을 가져오지는 않았으나 숙련도가 낮은 초심자의 경우에도 합병증의 유발없이차단을 가능케 하므로 유용하고, 특히 전박의 내피신경, 척골신경, 상박의 내피신경과 정중신경 지배영역 시 유용하리라 생각된다. Objectives : Axillary block is a common anesthetic technique for operation on the hand and forearm. Many variations of the axillary approach have been described. Therefore we studied the results obtained when the axillary approach to brachial plexus blockade is attempted utilizing peripheral nerve stimulation(PNS). Methods : Axillary brachial plexus block with PNS(0.5mA, 2Hz) was used in 30 adult patients undergoing hand and forearm surgery. 20ml of 1.5% lidocaine and 20ml of 0.375% bupivacaine solution was injected. A pin prick test was performed at 5, 10, 15 20, 25 and 30 min. and quality of the clock in the distribution of 7 peripheral nerve of the brachial plexs was evaluated. Results : Block were 28 cases(93.3%) including 6 cases(20%) of incomplete block and total failure were 2 cases. Average number of blocked peripheral nerve of upper extrmity was 4.4±1.7. The order of rate of block was medial cutaneous n. of forearm, ulnar n., medial cutaneous n. of arm, median n., radial n., musculocutaneous n. and axillary n.. Conclusion : We found that a PNS can be utilized to establish blockade of the upper extrimity, but the success rate is not different than other methods, But it is appropriate for blocks established by beginner without complication.

뇌졸중 환자의 상지기능 개선을 위한 말초감각신경자극과 과제 지향적 훈련의 동시 적용 효과 : 단일 맹검 무작위대조군실험

김선호(Kim, Sun-Ho),원경아(Won, Kyung-A),정은화(Jung, Eun-Hwa) 대한신경계작업치료학회 2020 재활치료과학 Vol.9 No.4

목적 : 본 연구는 뇌졸중 환자들의 상지기능 개선을 위해 말초신경감각자극과 과제지향적 훈련의 동시적용하여 효과를 알아보는 것이다. 연구방법 : 본 연구는 29명의 편마비 환자를 대상으로 수행하였다. 말초신경감각자극과 과제지향적 훈련을 동시에 적용한 실험군은 14명, 과제지향적 훈련만 실시한 대조군은 15명으로 주5회, 회기당 30분씩, 총 4주간 진행하였다. 결과측정은 손목과 어깨근육의 자발적 근수축 비율과 상자와 나무토막 검사, 잡기와 쥐기의 근력, Action Research Arm Test를 사용하여 중재 전·후로 측정하였다. 결과 : 4주간의 중재 후 짧은노쪽손목폄근, 노쪽손목굽힘근의 근 활성도와 잡기 근력, Action Research Arm Test에서 실험군은 대조군 보다 유의한 개선을 나타냈다. 결론 : 말초신경감각자극과 과제지향적 훈련의 동시적용은 과제지향적훈련만 하는 것보다 뇌졸중 환자의 상지기능 개선에 보다 효과적이었다. Objective : This study aimed to investigate the effect of simultaneous application of peripheral nerve sensory stimulation and task-oriented training on the improvement of upper extremity motor function after stroke. Methods : This study included 29 patients with hemiplegia. The 14 subjects were in the peripheral nerve sensory stimulation and task-oriented training group for 4 weeks (30 min/d, 5 d/wk), while the 15 control group subjects underwent only task-oriented training for the same duration. The outcome measures were the percentage of voluntary baseline muscle contractions of the wrist and shoulder and Box and Block Test, grip and pinch strength, and Action Research Arm Test. Results : After 4 weeks, muscle activity of extensor carpi radialis, flexor carpi radialis and grip strength and Action Research Arm Test were significantly higher in the experimental group. Conclusion : Simultaneous application of the peripheral nerve sensory stimulation and task-oriented training was found to be superior to task-oriented training for improving upper extremity motor function of adults with stroke.

경피신경 전기자극이 말초신경병증 통증의 전류지각역치에 미치는 효과

하미숙,이태식,송민영 한국자료분석학회 2010 Journal of the Korean Data Analysis Society Vol.12 No.4

The purpose of this study was verify the effectiveness of transcutaneous electrical nerve stimulation(TENS) aimed at A-beta, A-delta and C fiber, utilizing the characteristic of current perception threshold(CPT) test in peripheral neuropathic pain patients. The subjects of this study were the neuropathic patients complaining of significant neuropathy symptoms such as numbness, dullness and paraesthesia. Electric stimulation was applied over acromion of the shoulder for 20 minutes by TENS. Stimulations of 5Hz, 250Hz and 2000Hz of frequency were generated with Neurometer CPT and engaged selectively to C fiber, A fiber and A fiber, respectively. Increasing the current, when the patients began to feel the current sensory at the skin to which electrodes were attached, the perception threshold was measured within 20㎂ of error limit by engaging 6 to 10 times of actual stimulations or pseudostimulations to the patients with the stimulation of that intensity or of higher. The threshold score of C fiber in experimental group was higher than control group(p<.05) and A fiber in experimental group was lower than control group(p<.05). Based on the findings of the study, patients with neuropathic pain are helpful to change of nerve firing by TENS. 본 연구는 말초신경병성 통증 환자에게 각각 C섬유, A 섬유, A 섬유에 선택적으로 자극을 주어 TENS가 각각의 섬유에 어떠한 효과를 미치는지에 대하여 감각신경섬유별 전류지각역치를 알아보는데 목적이 있다. 손발저린감이나 멍멍함, 감각이상 등의 유의한 증상 등을 호소하며 말초성 신경병증으로 진단된 환자를 대상으로 하였다. 전기치료는 TENS를 사용하여 어깨 봉우리 주위로 고무패드를 부착하였고, 대상자가 통증을 느끼지 않는 정도의 강도로 20분간 적용하였다. 전류지각역치의 측정은 수동으로 실시하였는데 전극의 표면에 얇게 전도매질을 바른 후 접착테이프로 빗장뼈의 봉우리 아래 세모가슴근고랑(deltopectoral groove)에 부착하였다. 전류를 증가시키는 도중에 환자가 전극에 접촉된 피부에서 전류 감각을 느끼기 시작하면 그 자극의 세기에서부터 단순맹검법으로 피검자에게 6회에서 10회 정도의 실제 자극이나 거짓자극을 주어 20㎂의 오차 한계 내에서 지각 역치를 측정하였다. C 신경섬유의 지각역치 값은 대조군보다 실험군에서 높게 나타났으며, A 신경섬유의 지각역치는 대조군보다 실험군에서 낮게 나타났다. 이러한 결과로 보아 TENS 자극에 의해 신경의 흥분성을 바꾸어 주게 되어 통증완화 효과가 있는 것으로 생각된다.