What is neuromodulation?
Neuromodulation is a treatment that involves using electrical stimulation to alter nerve activity. It involves implanting an electrical device, similar to a pacemaker, in the body, which is connected to tiny electrical wires called electrodes. Electrical signals are sent through the electrodes to specific areas to alter nerve signals to the brain. The device is aimed to be a long-term measure that is left in place for as long as it is required. Neuromodulation is mostly used to treat chronic (long-term) pain and movement disorders.
Neuromodulation treatments began in the early 19th century, and became an established treatment method for neurological disorders in the 1950s. Deep Brain Stimulation is one of the earliest methods of neuromodulation, and continues to be an important treatment option for movement disorders such as Parkinson’s disease. The development of Spinal Cord Stimulation for intractable pain (a severe, chronic pain that is difficult to manage) soon followed, and there has since been the development of different types of neuromodulation for a variety of conditions.
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What types of neuromodulation procedures are there?
There are a number of different neuromodulation procedures available:
Spinal cord stimulation
This method of neuromodulation effectively treats mixed pain conditions. It involves placing a small electrode near the spinal cord, which is attached to an electric device. This can be placed temporarily through the skin, or more permanently through a surgical procedure called a laminectomy. Small electrical impulses are sent through the electrode to reduce the feeling of pain. This highly-targeted method of neuromodulation can be used to treat specific regions of pain in the body, such as after a failed back surgery, or for other conditions such as complex regional pain syndrome (a poorly understood condition which causes very persistent and debilitating pain, often triggered by an injury, but lasting much longer than expected).
Dorsal root ganglion stimulation
Dorsal root ganglions are bundles of nerves in the spine that transmit sensory and pain signals to the brain. Dorsal root ganglion stimulation involves placing electrodes in an area near these ganglions and sending mild electrical impulses to block pain signals to the brain. Dorsal root ganglion stimulation is useful in treating areas that are relatively hard to target with spinal cord stimulation, such as the groin and foot.
Deep brain stimulation
This is one of the earliest established neuromodulation techniques. It involves implanting electrodes within certain areas of the brain and delivering electrical impulses to block or change the faulty activity that is causing symptoms. It is largely used in the treatment of movement disorders such as Parkinson’s disease, but has also been used for other conditions including epilepsy and some psychiatric conditions.
Other types of neuromodulation we offer at The London Clinic include:
Vagal nerve stimulation – a type of neuromodulation treatment which targets the Vagus nerve in the neck and can be used to reduce seizure frequency in hard to treat epilepsy.
Occipital nerve stimulation – a form of neuromodulation aimed at the Occipital nerves in the head and face to treat headaches and facial pain.
Transcranial magnetic stimulation – a non-invasive form of neuromodulation that does not require implanting electrodes. It uses magnetic fields to stimulate brain cells and is used in treatment resistant cases of depression.
Sacral nerve stimulation - a neuromodulation procedure applied to the sacral nerves in the lower spine. Sacral nerve stimulation is an option for the treatment of bowel and bladder incontinence where other treatments have been unsuccessful.
Peripheral nerve stimulation – a technique that places the electrodes next to the peripheral nerves (located beyond the spinal cord or brain), that are causing pain in order to block their signals to the brain. Peripheral nerve stimulation can be used to treat chronic pain conditions.
What conditions can be treated using neuromodulation?
Neuromodulation is a very effective method for treating movement disorders and chronic pain, particularly in patients whose pain has not been managed with medication alone. Success rates vary depending on the type of treatment and the source of chronic pain. Medical specialists will view a 50% reduction in pain as successful treatment.
Examples of specific conditions include:
- Chronic pain associated with spinal cord injuries, failed back surgery syndrome, complex regional pain syndrome, and peripheral vascular disease (a condition where fatty deposits cause narrowing of the arteries in the leg muscles and restrict blood flow)
- Involuntary movement disorders such as essential tremor, primary dystonia, Parkinson’s disease, and epilepsy
- Other conditions including cluster headaches (a series of short but extremely painful headaches, usually around the same eye, daily for clusters of weeks at a time), migraines, bladder and bowel incontinence, sight and hearing disturbances, and some psychiatric conditions.
Are there any risks to having neuromodulation treatments?
Neuromodulation treatments are relatively safe procedures. The large majority of complications are non-life-threatening events related to failure of the device. For example, there is a risk that the electrode(s) could move from the intended location, malfunction or break.
If any of these incidents occur, our specialist teams will be on hand to offer support and assistance. Special computer hardware is used to check the device faults and then specific action is taken according to the problem.
Devices are designed to last many years but will need regular maintenance depending on the system used. Specialist teams will be able to advice of these specific requirements and of the battery life.
Other general risks of neuromodulation include:
- Wearing off of the pain relief (over months to years after the system is inserted)
- Failure of the system to treat the pain
- Damage to nearby structures in the body during placement of the electrodes
- Infection at the insertion site
- Pain at the insertion site.
As with any procedure, neuromodulation procedures carry a very small risk of more serious complications. These are very rare but the specialist doctor will discuss these comprehensively prior to the procedure.
Serious complications of neuromodulation can include:
- Neurological injury either from the needle puncture, lead placement or during the procedure. This can result in loss of function, power or a sensation of numbness
- Puncture of the protective layer around the spinal cord (dura), which may cause a severe headache. This may require a further procedure with a spinal injection
- This is very rare and thought to affect around 2 patients in a million.
Why choose The London Clinic?
We offer a comprehensive range of neuromodulation procedures with access to leading specialists in the field of pain management. We are also proud to offer the very best facilities and equipment, and clinical support teams that are second to none.
What The Experts Say...
Neuromodulation is now synonymous with the treatment of chronic pain by electricity. A variety of pacemakers and stimulators exist for different conditions to reduce levels of opioids or other drugs and improve pain and quality of life. As active researchers and busy clinicians, we have experience of most and are able to provide you with a tailored and effective solution.