Objective:

To propose a neurofunctional service model for understanding and managing loss of efficacy (LOE) in sacral neuromodulation (SNM) for colorectal disorders, addressing clinical challenges.

Approach:

Key Findings:

• LOE should be distinguished from primary treatment failure and transient fluctuations.
• Functional LOE occurs despite acceptable technical parameters, necessitating reassessment before considering hardware revision.
• Sustained stimulation may lead to neuroadaptive drift, altering response over time.
• Phenotype mismatch indicates that the dominant symptom driver may change, affecting treatment efficacy.

Interpretation:

The proposed model emphasizes the need for a structured reassessment process for patients experiencing LOE in SNM.

Limitations:

• The model is based on clinical experience and does not provide definitive proof of mechanisms.
• The scope is limited to specific bowel dysfunction phenotypes and does not encompass all constipation types.

Conclusion:

The neurofunctional service model aims to enhance understanding and management of LOE in SNM.

Attribution Notice

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