2010 Neurological Institute Outcomes - Cleveland Clinic

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160 Innovations Neurological Center for Pain Utilizing Sphenopalatine Ganglion Stimulation to Treat Migraine Outflow of signals from the brainstem to the meninges through the sphenopalatine ganglion (SPG) may lead to the mechanisms of migraine pain. Inhibitory stimulation of the SPG and blocks of the SPG show promise in terminating primary headaches. 1,2 The Neurological Center for Pain and the Center for Neurological Restoration have teamed with the Department of Pain Management to obtain an Investigational Device Exemption from the Food and Drug Administration for a study of SPG stimulation for acute treatment and prevention of episodic migraine. Patients in the study will be implanted with a permanent SPG stimulator, and they will stimulate acute migraine attacks to see if this device can terminate migraines. After three months, doctors in the study will activate the stimulator chronically to see if continuous stimulation will prevent migraines. Patients will be able to use a second program in the device to terminate any attacks that break through the prevention. References: 1. Tepper SJ, Rezai A, Narouze S, Steiner C, Mohajer P, Ansarinia M. Acute treatment of intractable migraine with sphenopalatine ganglion electrical stimulation. Headache. 2009 Jul;49(7):983-989. 2. Ansarinia M, Rezai A, Tepper SJ, Steiner CP, Stump J, Stanton-Hicks M, Machado A, Narouze, S. Electrical stimulation of sphenopalatine ganglion (SPG) for acute treatment of cluster headaches. Headache. 2010 Jul;50(7):1164-1174. Outcomes 2010
Department of Physical Medicine and Rehabilitation Developing New Methods of Treating Chronic Pain after Spinal Cord Injury Chronic pain, which disturbs behavioral function and reduces quality of life, has emerged as a major challenge in treating spinal cord injury (SCI). There is currently no cure for chronic pain and oral pharmaceutical interventions are often inadequate, commonly resulting in a slight reduction in pain intensity. Furthermore, addiction and abuse due to continuous administration have become important clinical issues. These facts signal an urgent need to develop a new intervention to treat chronic SCI pain. After single extracellular matrix (ECM) treatment in the animal SCI model, we developed a novel and effective ECM strategy to inhibit mechanical allodynia, an indicator of chronic SCI pain, over an eight-month observation period. The data, when compared with the vehicle-treated group, showed less blood-spinal cord barrier (BSB) permeability and decreased glial fibrillary acidic protein (GFAP)- and ED1-immunopositive reactivity at the lesion site as well as the areas both rostral and caudal to the lesion site. Additionally, this treatment can modulate the sprouting of 5-HT- and CGRP-positive fibers in laminae I and II of the spinal dorsal horn that mediate pain. Collectively, results from our studies have demonstrated that onetime ECM treatment can modulate nociceptive signaling and lessen inflammation, offering a potential therapeutic strategy to treat chronic pain development after SCI and the neuropathic and/or inflammatory pain caused by other diseases. Investigating a New Modality to Prevent Deep Vein Thrombosis and Enhance Fibrinolysis Each year, 600,000 patients experience venous thromboembolism, with at least 50,000 and perhaps as Neurological Institute many as 200,000 dying from blood clots that obstruct blood flow to their lungs (pulmonary embolism). The total cost per patient for objective diagnosis and treatment of acute venous thromboembolic disease has been estimated at approximately $4,000, and does not include costs for patients who incur long-term sequelae. Functional magnetic stimulation (FMS) using a magnetic coil and applying a time-varying magnetic field has been demonstrated to be an effective modality for preventing deep vein thrombosis (DVT) and enhancing fibrinolysis. Vernon Lin, MD, PhD, and his team have demonstrated that FMS can produce a sustained enhancement of systemic fibrinolysis that may prove useful in DVT prophylaxis. The advantages of FMS include painless and noninvasive stimulation because the magnetic field generated can penetrate high-resistance structures such as bone, fat, skin, clothes and leg casts. However, the device used for FMS is bulky and difficult to secure to a patient during clinical applications. In the case of DVT, the coils must be secured in an optimal location, between the knee and ankle, to provide the desired stimulative effect. Also, the FMS coils generate heat during stimulation and can cause blisters if they touch the patient’s skin. We have proposed a design that provides a method for securing the coil in an optimal position, prevents any contact with the skin and dissipates the heat generated by the coil during stimulation. The components of this design include magnetic stimulator (any commercially available model), stimulating coil (commercially available circular model), contoured coil positioning and securing system, cooling system and control unit. The proposed design can easily be adjusted to various body sizes and applications and is portable, reusable and easy to maintain. 161
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Neurological Institute 2010 Outcome
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2010 Neurological Institute Outcomes - Cleveland Clinic

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