Neuromodulation, defined by the International Neuromodulation Society as “the alteration of nerve activity through the delivery of electrical stimulation or chemical agents to targeted sites of the body,” is carried out to normalize – or modulate – nerve function. Neuromodulation can involve a range of electromagnetic stimuli such as a strong magnetic field (repetitive transcranial magnetic stimulation), a very small electric current or, potentially, light (optogenetics).
Electrical stimulation using implantable devices, also known as neurostimulation, came into modern usage in the 1980s and its techniques and applications have continued to develop and expand. The therapy employs the body’s natural biological response by stimulating nerve cell activity that can influence populations of nerves by releasing transmitters, such as dopamine, or other chemical messengers such as the peptide Substance P, that can modulate the excitability and firing patterns of neural circuits.
Spinal cord stimulation
A form of neuromodulation therapy in common use since the 1980s is spinal cord stimulation, a reversible, non-pharmacological therapy for chronic pain management that delivers mild electrical pulses to the spinal cord. In patients who experience pain reduction of 50 percent or more during a temporary trial, a permanent implant may be offered in which, as with a cardiac pacemaker, an implantable pulse generator about the size of a stopwatch is placed under the skin on the trunk. It delivers mild impulses along slender electrical leads leading to small electrical contacts, about the size of a grain of rice, at the area of the spine to be stimulated.
Deep brain stimulation
Another commonly used neuromodulation treatment developed in the 1980s is deep brain stimulation, which may be used to help limit symptoms of movement disorder in Parkinson’s disease, dystonia, or essential tremor.
Existing and emerging neuromodulation treatments also include application in medication-resistant epilepsy, chronic head pain conditions, and functional recovery ranging from bladder and bowel control to improvement of sensory deficits, such as hearing (cochlear implants and auditory brainstem implants) and vision (retinal implants). Technical improvements include a trend toward minimally invasive (or noninvasive) systems; as well as smaller, more sophisticated devices that may have automated feedback control, and conditional compatibility with magnetic resonance imaging.
Some types of neuromodulation, and their usual acronyms, are:
- Brain computer interface (BCI, which has been investigated as a type of functional electrical stimulation for patients with tetraplegia)
- Deep brain stimulation (DBS)
- Functional electrical stimulation (FES)
- Intrathecal drug delivery systems (ITDS, which may deliver micro-doses of painkiller or anti-spasm medicine directly to the site of action)
- Occipital nerve stimulation (ONS)
- Peripheral nerve stimulation (PNS, which refers to simulation of nerves beyond the spine or brain, and may be considered to include occipital or sacral nerve stimulation)
- Repetitive transcranial magnetic stimulation (rTMS)
- Sacral nerve stimulation (SNS or SNM for “sacral neuromodulation”)
- Spinal cord stimulation (SCS)
- Transcranial direct current stimulation (tDCS)
- Vagus nerve stimulation (VNS)
- Interventional pain management
- Auditory brainstem implant
- Brain computer interface
- Cochlear implant
- Deep brain stimulation
- Functional electrical stimulation
- International Neuromodulation Society
- North American Neuromodulation Society
- Retinal implant
- Spinal cord stimulator
- Transcranial magnetic stimulation
- Vagus nerve stimulation
- Visual prosthesis
- Neuromodulation: Technology at the Neural Interface
- Neuromodulation Appropriateness Consensus Committee (news release)
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