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Advances in Neuromodulation

September 2, 2021

Neuromodulation therapy is an emerging field in the treatment of diseases. The treatment aims to enhance or suppress the nervous system’s activity using advanced medical device technologies and focused delivery. These technologies include implantable and non-implantable devices that deliver chemical or electrical stimulation to modify brain and nerve cell activity reversibly. Many believe that early use of neuromodulation techniques for neurological disorders may be more cost-effective than medical treatments.


The field of neuromodulation is continually evolving, with significant advancements made over the past decade, especially in therapeutic efficacy. Two of the main areas of advancement have been spinal cord stimulation (SCS) and deep brain stimulation (DBS).


Spinal Cord Stimulation (SCS)


Chronic pain conditions affect much of the population and are one of the leading causes of disability. Conditions such as complex regional pain syndrome (CRPS), peripheral neuropathy, diabetic neuropathy, radiculopathy, and failed back surgery syndrome (FBSS) are often difficult to treat with more conservative medical procedures. Many times when medication management, interventional injections, and surgical options are exhausted, spinal cord stimulation is another option to offer functionality and improved lifestyle for many patients. 


The neuromodulation techniques spinal cord stimulation (SCS) has been a relatively safe and effective alternative therapy going back to 1967, as it delivers mild electrical stimulation to nerves along the spinal column, modifying nerve activity while blocking and minimizing nerve pathways and sensations to the brain. There are many studies that have shown that stimulation can increase blood flow, decrease pain scores, and improve sleep and overall lifestyle for many patients. The initial trial is done in an outpatient setting, and a permanent placement can be done as an outpatient surgery with typical recovery within a few weeks. After permanent placement, the patient can control the intensity of the stimulation with a remote control, as a small pacemaker and the electrical leads are internalized and connected allowing usual activities in life. 

Recent advances in SCS, such as high-frequency and burst SCS waveforms, have also significantly improved treatment outcomes. Along with other advances in dorsal root ganglion stimulation and peripheral nerve stimulation, it is now possible to achieve pain relief in specific areas of pain. For many patients who have tried and failed all other modalities of treatment, spinal cord stimulation offers another pathway of hope and has changed the landscape in the pain management treatment algorithm. 


Deep Brain Stimulation (DBS)


Treatment resistance remains one of the most challenging problems in psychiatry today. It has been estimated that about 30% of depressed patients do not respond adequately or at all to antidepressant drugs alone. There is no consensus on how best to treat this group of patients who have failed multiple trials of antidepressants. 


A recent study believes that neuromodulation techniques will probably revolutionize the field of neuroscience. Neural stimulation methods such as deep brain stimulation (DBS) could prove useful in treating depression-related conditions such as refractory mood disorder.


DBS advances might also help deal with neurological diseases such as Parkinson’s disease, drug-resistant epilepsy, obsessive-compulsive disorder, and Tourette’s syndrome. DBS works by inserting electrodes into specific points within the brain based on what disease you are treating to try and restore normal firing patterns and neurotransmitter patterns. DBS involves implanting electrodes within certain areas of your brain, which produce electrical impulses that regulate abnormal impulses. Like the SCS discussed earlier, a pacemaker-like device can control the amount of stimulation which can affect certain cells and chemicals in the brain.

According to one study, advances in DBS will see the size of the electrodes reduced to a submicron level. This reduction would make it easier to place them precisely where they are needed and restore normal neural function.


In Summary


Neuromodulation therapies can improve people’s lives by providing an alternative to long-term drug therapy for patients with persistent or chronic conditions. They are the fastest-growing segment of the overall medical device industry. 


Neuromodulation therapies are also easily reversible and can be easily targeted to avoid the side effects of more systemic or irreversible treatments. They can also provide an important degree of therapeutic control for patients and medical professionals. As with most medical technologies, neuromodulation devices have progressed, becoming smaller, more easily implanted and removed, more highly targeted, and more cost-effective. In 2007, the number of new neuromodulation devices approved by the Food and Drug Administration (FDA) grew by 35%.


In the future, with a greater understanding of our ability to reprogram the signaling of the human brain, we will be able to engineer more advanced probes. New methods of neuromodulation are already helping to address disorders such as migraine, bladder disorders, obesity, obsessive-compulsive disorder, and depression. These advancements will hopefully lead to continued new treatment methods and increased clinical usage.

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