Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Sacral Nerve Root Stimulation for Bladder Pain Syndrome/Interstitial Cystitis

Background and Definitions Bladder pain syndrome/interstitial cystitis (BPS/IC) is a severely debilitating chronic disorder characterized by pain perceived to arise from the bladder, exacerbated by bladder filling, and associated with urinary urgency or frequency. The condition has been known to physicians since the early 19th century when Joseph Parrish first published his report of three patients with severe lower urinary tract symptoms and labeled the condition…

Sacral Nerve Neuromodulation

Introduction In 1982, the first sacral nerve neuromodulation (SNM) was performed by Tanagho and Schmidt at the University of California in San Francisco ( ). SNM, delivered by the InterStim system and developed by Medtronic (Minneapolis, MN, USA), was first introduced in Europe in 1994. In 2002, Medtronic released a new implantable tined lead (model #3889), making the procedure less invasive. In 2006, Medtronic released a…

Neurophysiology and Neuroanatomy of the Genitourinary Organs

Introduction The urogenital system has two major subdivisions: (1) the urinary tract, which is responsible for the production, storage, and elimination of urine, and (2) the genital tract, which is involved in reproductive activity. Many functions of the urogenital system are controlled by complex neural pathways in the brain and spinal cord. These central pathways in turn regulate the activity of peripheral autonomic (sympathetic and parasympathetic)…

Colonic Electrical Stimulation for Constipation

Normal gastrointestinal (GI) motility is regulated by its own bioelectrical activity, and GI dysmotilities are often accompanied by abnormal, bioelectrical activity in the GI tract. Therefore, improving of GI motility can theoretically be achieved through external, electrical stimulation to adjust bioelectrical activity. Gastrointestinal electrical stimulation (GIES) is exactly achieved by delivering external, electrical pulses to electrodes, implanted in the GI tract, thereby controlling bioelectrical activity and…

Neuromodulation for Gastrointestinal Dysmotility in Pediatric Patients

Introduction As the use of neuromodulation for the treatment of adults with various gastrointestinal (GI) disorders has grown over the past two decades, so has interest in the application of these treatments to children with GI disorders. Some of the advantages inherent to neuromodulation-based treatments are particularly suited to pediatric patients. For children with severe symptoms refractory to medical treatment, neuromodulation is often less invasive than…

Neuromodulation for Nausea and Vomiting in Adult Patients

Introduction Nausea and vomiting (NV) are common symptoms representative of numerous etiologies; however, persistent symptoms of intractable NV are highly sensitive of GI disorders on the gastroparetic spectrum. Due to common prevalence of these symptoms in the general population, gastroparesis is often misdiagnosed in the clinical setting. These symptoms become problematic if recurrent or chronic, as they interfere with nutrition, functional status, and quality of life…

Intestinal Electrical Stimulation: Methodologies, Effects, Mechanisms, and Applications

Introduction Although the earliest study of electrical stimulation of the gut was reported more than 40 years ago, the development of the field is slow when compared to cardiac pacing or other areas of neuromodulation including spinal cord stimulation, deep brain stimulation, and motor cortex stimulation. In the earliest study regarding intestinal stimulation, published in , Bilgutay et al. reported the use of intraluminal electrical stimulation via…

Emerging Gastric Stimulation for Dysmotility Disorder and Obesity

Introduction Gastrointestinal motility disorders (GMDs) are common along the gut and are one of major causes of functional gastrointestinal (GI) diseases that affect more than 20% of general population and account for more than 40% of patients seen in GI clinic ( ). Typical diseases associated with GMD include gastroesophageal reflux, achalysia, functional dyspepsia, gastroparesis, intestinal pseudo-obstruction, postoperative ileus, irritable bowel syndrome, fecal incontinence, and constipation.…

Spinal Cord Stimulation for Chronic Abdominal Pain

Introduction The complexity of chronic abdominal pain requires an understanding of its associated physical and psychosocial features as it may cause severe disruptions in functional capacity and quality of life (QOL) ( ). Complexity of chronic abdominal pain is costly to society, causing frequent doctor visits, diagnostic imaging, and surgery interventions that may not result in expected pain relief ( ). Chronic visceral pain is frequently…

Neural Control of the Gastrointestinal System

Introduction Motility and secretion are controlled through neural, hormonal, and paracrine systems. The hierarchy of neural control begins in the enteric nervous system (ENS), a localized intrinsic system able to self-regulate control. Modification and regulation of gastrointestinal (GI) function also occurs with help of higher brain centers within the central nervous system (CNS), and the autonomic nervous system (ANS), which is comprised of sympathetic and parasympathetic…

Restoration of Cough via Functional Electrical Stimulation

Acknowledgments This work was supported by the NIH-NINDS (R01NS049516), NCRR (M01RR000080 and UL1RR024989) and NCATS (UL1TR000439). This investigation was approved by the Institutional Review Board of MetroHealth Medical Center (IRB98-00091). Conflict of Interest Notification Dr. DiMarco holds two United States Patents for technology related to the content of this paper: Method and Apparatus for Electrical Activation of the Expiratory Muscles to Restore Cough (5,999,855); Bipolar Spinal…

Stimulation for Inspiration

Conflict of Interest Disclosure Dr. Raymond Onders, University Hospitals of Cleveland and Case Western Reserve University School of Medicine have intellectual property rights involved with the diaphragm pacing system and equity in Synapse Biomedical who manufactures the device. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Neurostimulation for Asthma

Introduction When one considers electricity a digital drug , it becomes evident that any innervated organ should be amenable to neuromodulation. The field of neuromodulation is expanding greatly, with novel targets constantly being explored, from cardiac disease to urinary incontinence. Spinal cord stimulation (SCS) for pain and deep brain stimulation (DBS) for motor dysfunction, such as Parkinson’s disease, are considered mainstream therapies for those disorders. Novel…

Transvenous Phrenic Nerve Stimulation for Central Sleep Apnea

Disclosures Dr. Abraham has received consulting fees from Respicardia. Dr. Germany is an employee of Respicardia. Introduction Central sleep apnea (CSA) is a disorder in which the brain fails to send appropriate signals to the respiratory muscles to breathe, resulting in a cyclical pattern of breathing with rapid, deep breathing followed by periods of shallow or absent breathing ( ). This pattern of breathing develops due…

A Neural Prosthesis for Obstructive Sleep Apnea

Acknowledgment I would like to thank Saifur Rashid for editing this manuscript. Introduction Obstructive sleep apnea (OSA) affects 2%–4% of the adult population and is most commonly seen in middle aged, overweight men. A study at the University of Wisconsin showed that 4% of men and 2% of women, aged 30–60, have undiagnosed sleep apnea ( ). A 2004 report from MedTech Insight indicates that the…

Upper Airway Neurostimulation to Treat Obstructive Sleep Apnea

Acknowledgments This material is based upon work supported (or supported in part) by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Rehabilitation Research and Development Service. [Strohl 1I21RX002041]. This work is also supported by the National Institutes of Health, Stimulating Peripheral Activity to Relieve Conditions (SPARC) [Strohl 1U18EB021792] and will be available through the Material Sharing Policy of the program. Dr.…

Baroreceptor Activation for Hypertension and Heart Failure

Hypertension: Prevalence and Population Health Hypertension is the leading cause of morbidity and mortality in the world with an incidence that continues to rise and currently affects 25% of the adult population, roughly 1 billion people, worldwide ( ). Long-standing, poorly controlled hypertension is associated with a higher incidence of stroke, myocardial infarction, cardiomyopathy, atherosclerotic disease, renal failure, and blindness. The SPRINT Trial found that even…

Neuromodulation for Refractory Angina and Heart Failure

Neuromodulation for Refractory Angina Pectoris Definition, Pathology, and Symptomatology of Angina Pectoris Angina pectoris, first described by William Heberden in the 18th century, is a clinical syndrome characterized by discomfort in the chest, jaw, shoulder, back, or arm. described angina pectoris as a sense of strangling and anxiety in the chest, especially associated with exercise. The cardiac origin was not established until a few years later…

Spinal Cord Stimulation for Peripheral Vascular Disorders

Introduction Peripheral arterial disease (PAD) includes a diverse group of disorders that lead to progressive stenosis or occlusion of the aorta and its noncoronary branch arteries, including the carotid, upper-extremity, visceral, and lower-extremity arteries. The most common cause of lower extremity PAD worldwide is atherosclerosis and thus the epidemiology and clinical consequences of PAD are closely associated with classic atherosclerosis risk factors (e.g., smoking, diabetes mellitus,…

Autonomic Control of the Heart

Autonomic control of the heart is achieved by a complex, multilevel, interconnecting network involving central and peripheral reflexes. This network is made up of aggregates of neurons in intrathoracic (intracardiac and extracardiac) ganglia, extrathoracic sensory ganglia (nodose, dorsal root ganglia, and petrosal ganglia), and the central nervous system (CNS) ( ). The cardiac ANS is responsible for the reflex control of chronotropy, lusitropy, dromotropy, and inotropy,…