Predictors of Success for First Stage Neuromodulation: Motor Versus Sensory Response

Cohen, Brian L.; Tunuguntla, Hari Siva Gurunadha Rao; Gousse, Angelo E.

doi:10.1016/s0022-5347(06)00315-6

Cited by 94 publications

(63 citation statements)

References 11 publications

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“…Likewise, there was no association between loss of clinical response and specific diagnosis. Recent research has concentrated on identifying possible predictors for successful implantation and higher cure rates [25,26]. Further research is needed to ascertain if the failure to maintain the initial clinical response after stage II of the procedure might also represent a placebo effect in some patients.…”

Section: Discussionmentioning

confidence: 99%

Re‐operation rates after permanent sacral nerve stimulation for refractory voiding dysfunction in women

et al. 2008

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and analysis of variance were used to compare the results. RESULTSIn all, 95 patients had 105 test procedures; 30 peripheral nerve evaluation (PNE) and 75 staged tined leads. Response rates were lower in the PNE than in the tined lead (40% vs 67%, P = 0.01). The indication for SNS was associated with the response rate, with urinary retention having the highest response (71%, P = 0.01). For the 55 implanted devices, there were 18 revisions (33%) and eight explants (15%). The main reasons for revision or explants were loss of efficacy (16/26) and pain at the implant site (six of 26). The median (range) time to intervention after implantation was 17 (1.2-75.0) months, and this was significantly associated with the indication. Revisions due to pain at the implant site were within the first year, and reoperations due to loss of efficacy after 1-2 years, whereas battery replacement was required on average 4 years after initial implantation. CONCLUSIONSThis study confirms the higher response rates of the tined-lead staged technique over PNE. Unobstructive urinary retention had the highest response rates. The reason for revision appeared to be largely predicted by the length of time since implantation. KEYWORDSInterStim, urinary incontinence, urinary retention, interstitial cystitis, overactive bladder, adverse effects Study Type -Therapy (outcomes research) Level of Evidence 2c

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Section: Discussionmentioning

confidence: 99%

Re‐operation rates after permanent sacral nerve stimulation for refractory voiding dysfunction in women

et al. 2008

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“…If only sensory response was elicited, just 4.7% of patients had a positive test, whereas 95% of patients with a successful test had a positive motor response. 35 Age Ͼ55 years has been reported to reduce the chances of success by ϳ30%, and more than three chronic comorbid conditions or neurologic disease also diminishes the odds of a successful response to neuromodulation. 36 The technique of percutaneous placement of a lead directly into the sacral nerve root foramen has the limitation of stimulating a single nerve root.…”

Section: Surgical Techniquesmentioning

confidence: 99%

Sacral Nerve Stimulation: Neuromodulation for Voiding Dysfunction and Pain

Mayer

Howard

2008

Neurotherapeutics

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Summary:Voiding dysfunction, which includes incontinence, retention, and chronic pelvic pain, is a relatively frequent problem that can be difficult to manage. Neuromodulation via stimulation of the sacral nerves has been shown to improve thesesymptoms, although the exact mechanisms remain elusive. Techniques for nerve stimulation may vary, depending on the disease, location of pain, and the patient's anatomy. In addition to placement of electrodes on the sacral nerve roots, modulation has also been reported by peripheral branches of the sacral nerves including the pudendal and posterior tibial nerves. Newer surgical techniques have significantly decreased the morbidity of the procedures and increased the probability of a successful outcome.

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“…Cohen et al reported that motoric responses are superior to sensory responses in predicting clinical success so they recommend to perform permanent implantation solely when motoric responses were elicited. [8] Yet this is contradicted by data from the study of Govaert et al which showed that a correct position of the lead can be based on sensory responses alone, illustrating the importance of these sensory responses. [7] …”

Section: The Value Of Sensory Responsesmentioning

confidence: 96%

Successful sacral nerve modulation despite migration of tined lead

Dekkers

Schmitz

Heyden

et al. 2016

CSS

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Background: Sacral nerve modulation (SNM) is a minimally invasive treatment for chronic constipation or incontinence when conservative treatment is insufficient to provide relieve of symptoms. Case description: A 74-year-old patient with an implanted sacral nerve lead is presented in this case report with a dislodged lead without an adverse change in her incontinence treatment. This phenomenon has never been described before and raises the debate on sacral lead positioning in sacral nerve stimulation. Discussion: There are a lot of conflicting data regarding ideal lead positioning, such as S3 versus S2 or S4 implantation. The lead position in our case doesn't correspond to previously described locations and pathways which corroborate the legitimacy of new developments in this area such as percutaneous tibial nerve stimulation, transcutaneous tibial nerve stimulation and transcutaneous abdominal electrical stimulation (TEN). Conclusions: The implantation of SNM seems standardized but leaves voids in the technique where further research is needed to refine it.

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Predictors of Success for First Stage Neuromodulation: Motor Versus Sensory Response

Abstract: A positive quadripolar test stimulation (greater than 50% improvement in symptoms) with InterStim sacral neuromodulation is more likely when intraoperative lead placement results in positive motor response vs only sensory response.

Cited by 94 publications

References 11 publications

Re‐operation rates after permanent sacral nerve stimulation for refractory voiding dysfunction in women

Re‐operation rates after permanent sacral nerve stimulation for refractory voiding dysfunction in women

Sacral Nerve Stimulation: Neuromodulation for Voiding Dysfunction and Pain

Successful sacral nerve modulation despite migration of tined lead

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