Definition:

Neuromodulation is the reversible therapeutic alteration of activity in various parts of the nervous system either through stimulation or medication. Targets for stimulation usually include the brain and spinal cord, but can also include the peripheral and autonomic nerves as well. Examples of neuromodulation include spinal cord stimulation, deep brain stimulation, cortical stimulation, peripheral nerve stimulation, and implanted drug delivery.

Components:

Implantable neurostimulation systems today typically consist of three implantable components (the extension, lead, and power source) and two external components (the control magnet and a handheld programmer). The extension is used to connect the lead to the power source, and the lead is used to deliver electrical stimulation to the targeted areas of the spinal cord, the nerves, or brain to block the transmission of signals that cause pain or movement disorders.

Types of Neuromodulation:

Spinal cord stimulation (SCS) delivers therapeutic doses of electrical current to the spinal cord for the management of chronic neuropathic pain.

Deep brain stimulation (DBS) delivers electrical current to the deep structures of the brain to treat a number of movement disorders including Parkinson’s disease, tremor, and dystonia. Most recently, DBS has been at the forefront for the treatment of epilepsy.

Cortical stimulation is viewed as a potential alternative to DBS and has been used to treat pain patients for various syndromes from poststroke pain to neuropathic pain. It is under investigation to treat epilepsy, movement disorders, depression, and stroke.

Peripheral nerve stimulation (PNS) involves therapeutic delivery of electrical current to the nerves located outside the brain or spinal cord. It has been most commonly recognized for its use in epilepsy with vagal nerve stimulation. Other potential indications include occipital nerve stimulation for intractable headaches as well as trigeminal nerve stimulation to reduce seizure activity in epileptics.

Drug Delivery Devices (DDD) are implantable pumps used to deliver pain medication directly to a desired target. In intrathecal implants, pain medication is delivered directly to the spinal fluid. It enables a lower dosage to be administered and decreases, if not eliminates, the side effects seen with systemic absorption. It is often used in the treatment of pain syndromes such as those associated with nerve injury or cancer pain, as well as for the treatment of spasticity seen with stroke and spinal cord injury patients.

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