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Stimulation médullaire Matériel : Stimulateurs Test

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Stimulation médullaire Matériel : Stimulateurs Test. ENS 37021 Double canal Octopolaire. + Cable Test 3550-31 + N’Vision 8840 +Télécommande 37742. Double. Double. -. -. Canal = SYNERGY. Mono. Mono. -. -. Canal = ITREL. â. 3. (7427 ou 7729 = KIT). (7425 ou 7425KIT). - PowerPoint PPT Presentation

Text of Stimulation médullaire Matériel : Stimulateurs Test

  • **Stimulation mdullaire Matriel : Stimulateurs TestENS 37021Double canalOctopolaire+ Cable Test 3550-31+ NVision 8840+Tlcommande 37742

  • **Stimulation double-canalStimulation mdullaire Matriel : Stimulateurs

  • La stimulation Double CanalPermet une meilleure couverture du dos et des jambesAmliore les rsultats long termeAugmente le taux de succs chez des patients prsentant des douleurs multifocales**

  • RESTORE 377111er stimulateur rechargeable dune dure de vie de 9 ans quels que soient les paramtres.Adapt pour des douleurs multifocales et pour les fortes stimulations.Repositionnement lectronique possibleMoins dinterventions chirurgicales pour le patient Recharge scurise**Stimulation mdullaire Matriel : Stimulateurs

  • **Stimulation mdullaire Matriel : le systme Restore

  • Le systme Restore Complet**Stimulation mdullaire Matriel : le systme Restore

  • ** Quel stimulateur pour quel type de douleur ?

  • ** Matriel : programmateur NVision 8840

  • Programmation non invasive**Matriel : programmateur NVision 8840

  • CONSENSUS EUROPEEN (1998)

    Les techniques de neuromodulation utilises pour traiter la douleur chronique irrductible sont efficaces et rentables

    Consensus europen sur les thrapies avances de la douleur :Publi dans le European Journal of Pain en septembre 1998Prsent au Parlement Europen en novembre 1998 : prsent par des dputs du parlement, l EFIC (collge de la Douleur europen, manant de lIASP) et lOMS.**

  • Confrence de consensus

    Les techniques de neuromodulation offrent une alternative non destructive et rversible pour le traitement de la douleur chronique irrductible l o les traitements plus conservateurs et/ou les procdures ablatives ne sont pas efficaces ou contre indiques**

  • Preuves cliniques de la SMEChez des patients bien slectionns, la SME est une thrapie efficace et rentableTraitement pharmacologique : seulement 50% des patients ont un soulagement suffisant 1SME: 62% des patients FBSS ont un soulagement 50% maintenu long terme 2Un soulagement de la douleur de 50% est le critre gold standard utilis dans les mta-analysesCependant, mme une rduction de 30% de ladouleur reprsente une diffrence clinique importante 3**Eisenberg E et al. JAMA 2005; 293(24): 3043-52Taylor R et al. Spine 2005; 30(1): 152-60Cruccu G et al. Eur J Neurol 2004, 11: 153-62

  • A long terme, la SME rduit significativement la douleur dans le FBSSDe nombreuses tudes ont t menes sur le FBSS et la SME, avec plus de 10 ans de suivi :

    Bons excellents rsultats chez 68% des patients1 EVA moyenne amliore significativement de 57%1Le soulagement est maintenu dans le temps2Une diminution de 50% de la prise de mdicaments1Les mdicaments sont plus efficaces aprs la SME1**Van Buyten J-P et al. Eur J Pain 2001; 5: 299307Kumar K et al. Surg Neurol 1998; 50: 11021

  • **Van Buyten J-P et al. Eur J Pain 2001; 5: 299307

  • En particulier la capacit se dtendre (42%) et une indpendance augmente (43.8%)127% damlioration de QdV avec la SME, mais seulement 12% avec les thrapies conventionnelles2**La SME amliore significativement la Qualit de vie (QdV) des patients FBSS1,2Van Buyten J-P et al. Eur J Pain 2001; 5: 299307Kumar K et al. Neurosurgery 2002; 51: 106-16

  • La SME abouti une satisfaction substantielle des patients88% des patients FBSS170% des patients prsentant des douleurs lombaires prdominantes275.8% des patients stimuls seraient prts recommencer lintervention78.8% des patients recommanderaient la SME**Kumar K et al. Neurosurgery 2002; 51: 106-16Ohnmeiss DD, Rashbaum RF. Spine J 2001; 358-63Rsultats de la SME dans lasatisfaction des patients2

  • La SME permet certains patients une reprise du travail73.6% des patients FBSS ont not une augmentation significative des activits de leur vie quotidienne 1Prs de 31% des patients stimuls ont pu reprendre le travail3-5Ceci grce un meilleur contrle de la douleur et une diminution de la prise de mdicaments3**Sunderaj SR et al. J Clin Neurosci 2005; 12(3): 264-70Kumar K et al. Surg Neurol 1998; 50: 110-21Kumar K et al. Neurosurgery 2002; 51: 106-16Van Buyten J-P et al. Eur J Pain 2001; 5: 1-10Taylor R et al. Spine 2005; 30(1): 152-60

  • **Taylor R. JPSM 2006, in publicationMontrant des amliorations significatives dans le soulagement de la douleur, la consommation dantalgiques, la reprise du travail et la satisfaction des patients

  • **Une slection rigoureuse des patient est essentielle pour un traitement efficace

  • Lazorthes, 1995 :Exprience sur 20 ans692 patients (279 Toulouse / 413 Zrich)Succs court terme = 86% (1 mois)LONG TERME (recul moyen = 9 ans) :Rsultats bons excellents dans 53% des cas (cumulant une analgsie >50%, une faible mdication, et une rcupration sociale et fonctionnelle)volution favorable dans le temps (amlioration des critres de slection et volution de la technique/matriel) : Bons rsultats dans plus de 60% des cas pour la priode 1984-90

    **Lazorthes Y et al. Neurochirurgie, 1995, 41, n2, 73-88

  • Lazorthes, 1995 : Rsultats / indication**Rsultats = % de succs (nombre de patients)Lazorthes Y et al. Neurochirurgie, 1995, 41, n2, 73-88De meilleurs rsultats pour les lsions priphriques

    ***Single-lead SCS may be inadequate to produce paresthesia coverage and corresponding pain relief in the lower back, as well as the legTherefore, dual-lead stimulation systems (e.g. with two Octad leads) may enable better coverage and improve long-term treatment outcomesTwo leads may be used to steer paresthesias, to correct for differences between the anatomical and physiological midline and to obtain better paresthesia coverage Dual-lead stimulation systems provide the potential to manage conditions with prominent low back pain or multiple pain fociThus, the choice of leads is important to the success of SCS: Those with a predominant neuropathic leg pain component of FBSS respond best to single lead SCS, while greater success is seen with dual leads in patients who are more difficult to treat, such as those with complex, multilateral pain (e.g. severe FBSS)1Study has shown that 90% of patients with predominant axial low back pain initially treated with a single-lead system later required a second lead2The addition of a second lead resulted in 60% of patients considering themselves improved from their pre-operative conditionThe authors concluded that these technological advancements have broadened the potential indications for this mode of therapy

    Al KM, Holsheimer J. Neurosurgery 2002; 50: 690704 Ohnmeiss DD, Rashbaum RF. Spine J 2001; 1: 358-63*********Pharmacological management is the mainstay of treatment for neuropathic pain, yet only 50% of patients achieve adequate pain relief1The gold standard criterion of 50% or greater pain relief is a stringent measure and the fact that the majority of FBSS patients (62%)2 achieve this highlights the efficacy of SCSEven a 30% reduction in pain represents a clinically important difference3

    Eisenberg E. JAMA 2005; 293(24): 304352 Taylor R et al. Spine 2005; 30(1): 152-60Cruccu G et al. Eur J Neurol 2004, 11: 153-62*SCS has been used successfully in FBSS for many years and has resulted in sustained pain relief in 68% of patients1Distressing pain was reduced by 12.6% and horrible pain was reduced by 43.5%This allows concomitant pain medication to be reduced (from 3-4 intakes per week before SCS to 1-2 intakes per day after SCS, corresponding to an improvement of more than 50%)Opioid consumption also decreasedPain relief is sustained over time, with 59% of patients treated with SCS continuing to receive successful pain relief2Of these, 43% had excellent (75%) pain relief and 57% had good (50-70%) pain reliefSustained pain relief was also seen in patients treated with SCS for low back pain and radicular pain after multiple failed back surgeries375% continued to report at least 50% pain relief after 34 months follow up

    Van Buyten J-P et al. Eur J Pain 2001; 5: 299-307Kumar K et al. Surg Neurol 1998; 50: 110-21Leveque JC et al. Neuromodulation 2001; 4(1): 1-9**The improvement in quality of life with SCS is more than double that seen with conventional pain therapies in patients with FBSS1Difficulties in sleeping and waking during the night as a result of pain also diminished markedly after SCSThe duration of sleep was significantly increased from 4.5 h per night before SCS to 6.2 h after SCS

    Kumar K et al. Neurosurgery 2002; 51: 106-16*Significant technological advances in stimulator design have broadened the indications for SCS to include axial low back pain, a group that is generally difficult to treat188% of patients with unspecified FBSS were satisfied with treatment2, as were 70% of patients with predominantly axial low back pain1The majority of patients would have SCS, knowing what their outcome would be, and 78.8% would recommend SCS to others in a similar situation1

    Ohnmeiss DD, Rashbaum RF. Spine J 2001; 358-63Kumar K et al. Neurosurgery 2002; 51: 106-16**The table shows a meta-analysis of pooled outcomes with SCS for refractory neuropathic back and leg pain/FBSS case series (median follow-up 18 months) In some studies, good or excellent pain relief was taken as the equivalent to the 50% or more cutoffAnalysis showed that patient indication, study setting and duration of follow-up review were all significant predictors of pain reliefOther clinical results that were also reported:A significant improvement in pooled functional capacity was seen across the three case series that reported this measureA pooled improvement in total Sickness Impact Profile (a quality of life measure) was seen across the two trials that assessed this criterionIn the case series, 43% of patients with CBLP/FBSS experienced one or more complications with SCSThe majority of these were due to electrode or lead problems (27%)Infections (6%), generator problems (6%), extension cable problems (10%), or other issues such as cerebrospinal fluid leaks (7%), accounted for the remainderNo neurologic-related complications were reportedMany complications may be reduced by following guidelines designed to improve the implantation technique1

    Kumar K et al. Spinal cord stimulation: practical guidelines to help avoid complications from an expert pan-European panel. Manuscript in preparation, 2005

    **Intrt = grand nombre de patients, et varit des indications*Rsultats par indication : montrent clairement que plus la lsion est distale (lsion priphrique), plus leffet de la stimulation est importantAu contraire, les lsions mdullaires, provoquant une dgnerescence des cordons postrieurs de la moelle, ne permettent pas dobtenir de rsultats significatifs