Telemedicine, telehealth, and E-health all offer significant benefits for pain management and healthcare services by fostering the physician–patient relationship in otherwise challenging circumstances. A critical component of these artificial-intelligence-based health systems is the “agent-based system”, which is rapidly evolving as a means of resolving complicated or straightforward problems. Multi-Agent Systems (MAS) are well-established modeling and problem-solving modalities that model and solve real-world problems. MAS’s core concept is to foster communication and cooperation among agents, which are broadly considered intelligent autonomous factors, to address diverse challenges. MAS are used in various telecommunications applications, including the internet, robotics, healthcare, and medicine. Furthermore, MAS and information technology are utilized to enhance patient-centered palliative care. While telemedicine, E-health, and MAS all play critical roles in managing chronic pain, the published research on their use in treating chronic pain is currently limited. This paper discusses why telemedicine, E-health, and MAS are the most critical novel technologies for providing healthcare and managing chronic pain. This review also provides context for identifying the advantages and disadvantages of each application’s features, which may serve as a useful tool for researchers.

Stereotactic neuromodulation, such as deep brain stimulation (DBS) and responsive neurostimulation (RNS), have emerged as some of the more promising means for managing drug-resistant epilepsy. This study serves as a comprehensive analysis of DBS of the anterior nucleus of the thalamus (ANT), centromedian nucleus of the thalamus, and hippocampus and RNS for seizure reduction in adult intractable epilepsy. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was conducted of PubMed, Cochrane Library, and Embase databases from January 2000 to January 2024 to objectively assess the effectiveness of the various neuromodulation modalities on seizure reduction. Different software such as EndNote and Rayyan was used to organize the 1996 total reviewed studies and to run a blinded multiphase review process. A total of 25 studies were included for review with 21 studies and 166 patients suitable for the meta-analysis. DBS ANT, DBS hippocampus, and RNS were all found to have significant individual seizure reductions of 54.0%, 70.0%, and 63.5%, respectively. DBS centromedian nucleus of the thalamus was excluded since only 1 study met inclusion criteria and was, therefore, not suitable for meta-analysis. Furthermore, the 3 analyzed procedures were found to be not significant when compared to one another. Focal versus general epilepsy in DBS ANT also had no significant difference. DBS hippocampus had a significantly higher reduction rate in patients with mesial temporal sclerosis compared to patients with normal imaging findings. These results provide a vast amount of supporting data for these neurostimulation procedures while also indicating no significant difference between operations. Therefore, in this target population, operative decisions can be made based on surgeon preference and patient circumstance without affecting seizure reduction outcomes.

Decompressive hemicraniectomy (DHC) is performed in emergent cases of uncontrollable intracranial hypertension in which noninvasive procedures or medications are not able to safely maintain pressure within the cranium, increasing the risk of morbidity and mortality. The native bone flap is then replaced, a procedure referred to as cranioplasty, nearly three to six months after injury to allow time for brain relaxation. However, in cases with persistent cerebral edema at the time of cranioplasty, techniques are often applied intraoperatively, including mannitol, external ventricular drain, or lumbar drain placement. To avoid the risks of delaying the procedure or drain placement, we demonstrate a novel technique of splitting the bone flap to adequately increase the size and flexibility. Three patients with a mean age of 44 underwent this novel technique during cranioplasty due to persistent brain edema following a DHC. The new operative technique was successfully performed to compensate for the lingering edema, and all three patients were monitored postoperatively, showing no complications. In this study we demonstrate a new technique to alter bone flap size and flexibility during cranioplasty cases with persistent brain edema, avoiding the need for invasive drain placement. All patients experienced no complications or new cranial/skull defects postoperatively.