Today, neuromodulation exists at the intersection of biology and physics to resolve overactive bladder and incontinence using a 20-minute, painless procedure with a 93% success rate. So how did we get here, and where did this life-changing medical technology come from? Neuromodulation—the process of altering nerve activity through targeted electrical or chemical stimuli—has a fascinating, not to mention, ancient, history.
Development of Modern Neuromodulation Techniques
The earliest records trace back to ancient Egyptians and Romans, who used electric fish to treat pain. The formal scientific investigation of bioelectricity began in the 18th century with Luigi Galvani’s discovery that nerves and muscles react to electrical stimuli, a pivotal moment that paved the way for modern neuromodulation techniques. In the 20th century, significant advancements were made in neuromodulation. The 1960s saw the development of the first spinal cord stimulator by Norman Shealy for chronic pain management. This involved implanting electrodes near the spinal cord to modulate pain signals, providing relief for patients with intractable pain.
During the same period, deep brain stimulation (DBS) emerged as a treatment for movement disorders such as Parkinson’s disease. This technique, involving the implantation of electrodes in specific brain regions, demonstrated the potential of neuromodulation to treat various neurological conditions by modulating neural circuits.
Expanding Applications
The application of neuromodulation extended to a broader range of conditions over the following decades. Vagus nerve stimulation (VNS) was developed for epilepsy and depression, while transcranial magnetic stimulation (TMS) became a non-invasive option for treating depression and other psychiatric disorders.
Peripheral nerve stimulation (PNS) also gained traction, targeting nerves outside the brain and spinal cord to treat conditions like migraines, cluster headaches, and neuropathic pain. These advancements reflected a growing understanding of the nervous system and the ability to tailor interventions to specific medical conditions.
Sacral Neuromodulation for Incontinence
One of the notable advancements in neuromodulation is sacral neuromodulation (SNM), primarily used to treat urinary and fecal incontinence. This technique involves stimulating the sacral nerves, which control the bladder, bowel, and pelvic floor muscles. The foundations of SNM were laid in the late 20th century when researchers explored electrical stimulation to manage incontinence.
In the early 1980s, Dr. Emil Tanagho and his colleague Dr. Richard Schmidt from the University of California, San Francisco, conducted pioneering work on sacral nerve stimulation. I met and worked under Dr. Tanagho for a number of weeks in the 1990s when I was a medical student at the University of California, San Francisco. His research demonstrated that electrical stimulation of the sacral nerves could effectively modulate bladder function and provide significant relief for patients with refractory incontinence. They performed the first sacral nerve stimulation implant in 1981 and published their foundational studies in the following years, with a significant paper appearing in 1982 outlining the scientific basis and clinical future of the bladder pacemaker.
Mechanism and Efficacy of Sacral Neuromodulation
Sacral neuromodulation works by modulating the neural pathways involved in bladder and bowel control. An implantable pulse generator (IPG) is placed under the skin, typically in the lower back or buttocks, with a lead that connects to the sacral nerves. The IPG sends electrical pulses to the sacral nerves, influencing the reflexes that control urinary and bowel function.
Clinical studies have shown that SNM significantly improves symptoms of urinary and fecal incontinence and overactive bladder. Patients experience fewer episodes of incontinence, reduced urgency, and improved quality of life. SNM is particularly beneficial for patients who do not respond to conventional treatments, offering a minimally invasive option with durable results. Just ask our patients!
The Bottom Line
Neuromodulation has evolved from ancient practices of electrical stimulation to sophisticated modern therapies addressing a wide range of neurological and psychiatric conditions. Sacral neuromodulation exemplifies the therapeutic potential of this field, providing effective treatment for overactive bladder and incontinence and enhancing quality of life. As research continues, neuromodulation is poised to further transform the landscape of medical treatment, offering hope for many individuals with challenging conditions.
To learn more about whether sacral neuromodulation is a fit for your incontinence symptoms, contact the Continence Center here at Nevada Surgical today. We’re happy to help.
