1
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Zhang X, Yan X, Huang Y, Zhou H. Short-term cervical spinal cord stimulation for central post-stroke pain: a case report and literature review. Ann Med Surg (Lond) 2024; 86:3184-3188. [PMID: 38694358 PMCID: PMC11060234 DOI: 10.1097/ms9.0000000000002025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/23/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction Post-stroke central pain is disabling yet ineffectively treated with routine medical intervention. In this study, the authors presented an alternative neuromodulation therapy and conducted a brief narrative literature review to examine current evidence of spinal cord stimulation treatment for central post-stroke pain. Case presentation Here, the authors reported a case of severe post-stroke syndrome, who achieved satisfactory improvement of pain symptom, as well as muscle rigidity with a novel neuromodulation therapy of short-term implantation of cervical spinal cord stimulation. Clinical discussion It remains a great challenge in the management of post-stroke pain, which in turn significantly reduces the quality of life and worsens the burden on the public health system. Spinal cord stimulation therapy is an emerging neuromodulation approach to restore pathological pain status and functional impairment to provide a prospective insight into neuromodulation and rehabilitation options in the management of post-stroke syndrome. Conclusion A potential role of spinal cord stimulation in the treatment of post-stroke pain is proposed in combined with traditional medication or other neuromodulation strategies, to achieve better control of pain in the future.
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Affiliation(s)
- Xu Zhang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine
| | - Xuebin Yan
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine
| | - Yuzhao Huang
- Department of Orthopaedics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Haocheng Zhou
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine
- Hunan Key Laboratory of Brain Homeostasis
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2
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Busch NL, Esplin N, Patterson M, Tomycz ND. Successful relief of central poststroke pain with BurstDR spinal cord stimulation: A case series. Surg Neurol Int 2024; 15:60. [PMID: 38468662 PMCID: PMC10927220 DOI: 10.25259/sni_696_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/18/2024] [Indexed: 03/13/2024] Open
Abstract
Background Central poststroke pain (CPSP) is a commonly undertreated condition that can negatively impact a patient's quality of life. The efficacy of spinal cord stimulation (SCS) for the treatment of CPSP is not established due to limited studies. Case Description Here, two patients, ages 42 and 75, sustained strokes resulting in CPSP. After failed medical management, both underwent placement of paddle-lead SCS systems utilizing BurstDR stimulation that successfully resulted in pain resolution. Conclusion Two patients with CPSP were successfully treated with paddle lead SCS with BurstDR programming.
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Affiliation(s)
- Nisha L. Busch
- College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Nathan Esplin
- Department of Neurosurgery, Allegheny Health Network Neuroscience Institute, Pittsburgh, PA, USA
| | | | - Nestor D. Tomycz
- Department of Neurosurgery, Allegheny Health Network Neuroscience Institute, Pittsburgh, PA, USA
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3
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Yang F, Jing JJ, Fu SY, Su XZ, Zhong YL, Chen DS, Wu XZ, Zou YQ. Spinal MCP-1 Contributes to Central Post-stroke Pain by Inducing Central Sensitization in Rats. Mol Neurobiol 2023; 60:2086-2098. [PMID: 36602702 DOI: 10.1007/s12035-022-03184-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/18/2022] [Indexed: 01/06/2023]
Abstract
Central post-stroke pain (CPSP) is a highly refractory form of central neuropathic pain that has been poorly studied mechanistically. Recent observations have emphasized the critical role of the spinal dorsal horn in CPSP. However, the underlying mechanisms remain unclear. In this study, rats were subjected to thalamic hemorrhage to investigate the role of spinal monocyte chemoattractant protein-1 (MCP-1) and C-C motif chemokine receptor 2 (CCR2) in the development of CPSP. Immunohistochemical staining and ELISA were used to assess the expression changes of c-Fos, Iba-1, GFAP, MCP-1, and CCR2 in the dorsal horn of the lumbar spinal cord following thalamic hemorrhage, and the involvement of spinal MCP-1 in CPSP was examined by performing intrathecal anti-MCP-1 mAb injection to neutralize the spinal extracellular MCP-1. We demonstrated that intra-thalamic collagenase microinjection induced persistent bilateral mechanical pain hypersensitivity and facilitated the spontaneous pain behaviors evoked by intraplantar bee venom injection. Accompanying CPSP, the expression of c-Fos, Iba-1, and GFAP in the lumbar spinal dorsal horn was significantly increased up to 28 days post-intra-thalamic collagenase microinjection. Intrathecal injection of minocycline and fluorocitrate dramatically reverses the bilateral mechanical pain hypersensitivity. Moreover, intra-thalamic collagenase microinjection dramatically induced the up-regulation of MCP-1 but had no effect on the expression of CCR2 in the bilateral lumbar spinal dorsal horn, and MCP-1 was primarily localized in the neuron. Intrathecal injection of anti-MCP-1 mAb was also able to reverse CPSP and reduce the expression of c-Fos, Iba-1, and GFAP in the lumbar spinal dorsal horn. These findings indicated that spinal MCP-1 contributes to CPSP by mediating the activation of spinal neurons and glial cells following thalamic hemorrhage stroke, which may provide insights into pharmacologic treatment for CPSP.
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Affiliation(s)
- Fei Yang
- Department of Anesthesiology and Perioperative Medicine, Fuzong Clinical College/900th Hospital of the Joint Logistic Support Force, Fujian Medical University, Fuzhou, 350025, China.,Department of Anesthesiology and Perioperative Medicine, Dongfang Hospital, Xiamen University, Fuzhou, 350025, China.,Pain Research Institute, Fujian Medical University, Fuzhou, 350025, China
| | - Jun-Jie Jing
- Department of Neurosurgery, Fujian Children's Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350025, China
| | - Si-Yin Fu
- Department of Anesthesiology and Perioperative Medicine, Fuzong Clinical College/900th Hospital of the Joint Logistic Support Force, Fujian Medical University, Fuzhou, 350025, China.,Department of Anesthesiology and Perioperative Medicine, Dongfang Hospital, Xiamen University, Fuzhou, 350025, China
| | - Xiu-Zhu Su
- Department of Anesthesiology and Perioperative Medicine, Fuzong Clinical College/900th Hospital of the Joint Logistic Support Force, Fujian Medical University, Fuzhou, 350025, China.,Department of Anesthesiology and Perioperative Medicine, Dongfang Hospital, Xiamen University, Fuzhou, 350025, China
| | - Yu-Ling Zhong
- Department of Anesthesiology and Perioperative Medicine, Fuzong Clinical College/900th Hospital of the Joint Logistic Support Force, Fujian Medical University, Fuzhou, 350025, China.,Department of Anesthesiology and Perioperative Medicine, Dongfang Hospital, Xiamen University, Fuzhou, 350025, China
| | - Dong-Sheng Chen
- Department of Anesthesiology and Perioperative Medicine, Fuzong Clinical College/900th Hospital of the Joint Logistic Support Force, Fujian Medical University, Fuzhou, 350025, China. .,Department of Anesthesiology and Perioperative Medicine, Dongfang Hospital, Xiamen University, Fuzhou, 350025, China.
| | - Xiao-Zhi Wu
- Department of Anesthesiology and Perioperative Medicine, Fuzong Clinical College/900th Hospital of the Joint Logistic Support Force, Fujian Medical University, Fuzhou, 350025, China. .,Department of Anesthesiology and Perioperative Medicine, Dongfang Hospital, Xiamen University, Fuzhou, 350025, China.
| | - Yi-Qing Zou
- Department of Anesthesiology and Perioperative Medicine, Fuzong Clinical College/900th Hospital of the Joint Logistic Support Force, Fujian Medical University, Fuzhou, 350025, China. .,Department of Anesthesiology and Perioperative Medicine, Dongfang Hospital, Xiamen University, Fuzhou, 350025, China.
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4
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Tanei T, Maesawa S, Nishimura Y, Nagashima Y, Ishizaki T, Mutoh M, Ito Y, Saito R. Relief of Central Poststroke Pain Affecting Both the Arm and Leg on One Side by Double-independent Dual-lead Spinal Cord Stimulation Using Fast-acting Subperception Therapy Stimulation: A Case Report. NMC Case Rep J 2023; 10:15-20. [PMID: 36873746 PMCID: PMC9981231 DOI: 10.2176/jns-nmc.2022-0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/01/2022] [Indexed: 02/11/2023] Open
Abstract
Central poststroke pain is a chronic, intractable, central neuropathic pain. Spinal cord stimulation is a neuromodulation therapy for chronic neuropathic pain. The conventional stimulation method induces a sense of paresthesia. Fast-acting subperception therapy is one of the latest new stimulation methods without paresthesia. A case of achieving pain relief of central poststroke pain affecting both the arm and leg on one side by double-independent dual-lead spinal cord stimulation using fast-acting subperception therapy stimulation is presented. A 67-year-old woman had central poststroke pain due to a right thalamic hemorrhage. The numerical rating scale scores of the left arm and leg were 6 and 7, respectively. Using dual-lead stimulation at the Th 9-11 levels, a spinal cord stimulation trial was performed. Fast-acting subperception therapy stimulation achieved pain reduction in the left leg from 7 to 3. Therefore, a pulse generator was implanted, and the pain relief continued for 6 months. Then, two additional leads were implanted at the C 3-5 levels, and pain in the arm decreased from 6 to 4. Independent setting and adjustments of the dual-lead stimulation were required because the thresholds of paresthesia perception were significantly different. To achieve pain relief in both the arm and leg, double-independent dual-lead stimulation placed at cervical and thoracic levels is an effective treatment. Fast-acting subperception therapy stimulation may be effective for central poststroke pain, especially in cases where the paresthesia is perceived as uncomfortable or the conventional stimulation itself is ineffective.
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Affiliation(s)
- Takafumi Tanei
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Satoshi Maesawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yusuke Nishimura
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshitaka Nagashima
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tomotaka Ishizaki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Manabu Mutoh
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshiki Ito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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5
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Hosomi K, Yamamoto T, Agari T, Takeshita S, Tanei T, Imoto H, Mori N, Oshino S, Kurisu K, Kishima H, Saitoh Y. Benefit of spinal cord stimulation for patients with central poststroke pain: a retrospective multicenter study. J Neurosurg 2021; 136:601-612. [PMID: 34214987 DOI: 10.3171/2020.11.jns202999] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal cord stimulation (SCS) has been considered an ineffective procedure for patients with central poststroke pain (CPSP). However, recent case series that included small numbers of patients reported the possible efficacy of SCS as a treatment of CPSP. This multicenter retrospective study aimed to examine the outcomes of using SCS to treat patients with CPSP and to explore factors related to outcomes. METHODS The authors reviewed the medical records of patients with CPSP who underwent SCS to collect data regarding their background, surgical information, and outcomes of SCS at trial stimulation and last follow-up after long-term implantation in six study centers. Outcomes were evaluated with a pain score for intensity (range 0-10) and the Patient Global Impression of Changes (PGIC) scale. Factors associated with outcomes were explored with univariable and multivariable analyses. RESULTS The authors collected data from a total of 166 patients (mean age 63.4 years; mean pain score at baseline 8.2). Of these patients, 163 underwent trial stimulation. The mean pain score decreased by 42.0%, 104 (64%) patients had ≥ 30% decrease in pain score, and 96 (59%) reported much or very much improved condition on the PGIC scale at trial stimulation. Moreover, 106 (64%) patients underwent long-term implantation of SCS devices. The mean decrease in pain score was 41.4%, 63 (59%) patients continued to show ≥ 30% decrease in pain score at last follow-up, and 60 (56%) reported much or very much improved condition on the PGIC scale at last follow-up (median [range] follow-up period 24 [24-63] months). Eleven device-related complications and 10 permanent explantations were observed. Univariable and multivariable analyses suggested that young age, less sensory disturbance, implantation of cervical leads, treatment of upper-limb pain, and extensive treated regions were associated with satisfactory outcomes at last follow-up after long-term implantation. CONCLUSIONS These findings indicate that SCS may modestly benefit patients with CPSP. SCS has therapeutic potential for patients with intractable CPSP owing to the lower invasiveness of the SCS procedure and refractory nature of CPSP. Nevertheless, trial stimulation is necessary because of the high initial failure rate.
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Affiliation(s)
- Koichi Hosomi
- Departments of1Neuromodulation and Neurosurgery and.,2Neurosurgery, Osaka University Graduate School of Medicine, Osaka
| | - Takamitsu Yamamoto
- 3Department of Neurological Surgery, Nihon University School of Medicine, Tokyo
| | - Takashi Agari
- 4Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo.,5Department of Neurological Surgery, Kurashiki-Heisei Hospital, Okayama
| | - Shinichiro Takeshita
- 6Department of Neurosurgery and Neuroendovascular Therapy, Hiroshima Prefectural Hospital, Hiroshima
| | - Takafumi Tanei
- 7Department of Neurosurgery, Komaki City Hospital, Aichi
| | - Hirochika Imoto
- 8Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi; and
| | - Nobuhiko Mori
- Departments of1Neuromodulation and Neurosurgery and.,2Neurosurgery, Osaka University Graduate School of Medicine, Osaka
| | - Satoru Oshino
- 2Neurosurgery, Osaka University Graduate School of Medicine, Osaka
| | - Kaoru Kurisu
- 9Department of Neurosurgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Haruhiko Kishima
- 2Neurosurgery, Osaka University Graduate School of Medicine, Osaka
| | - Youichi Saitoh
- Departments of1Neuromodulation and Neurosurgery and.,2Neurosurgery, Osaka University Graduate School of Medicine, Osaka
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6
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Hagerdon KE, Villeneueve LM, O'Neal CM, Conner AK. Resolution of symptoms in idiopathic thalamic pain syndrome after implantation of a cervical and thoracic percutaneous spinal cord stimulator. Surg Neurol Int 2021; 12:50. [PMID: 33654553 PMCID: PMC7911043 DOI: 10.25259/sni_847_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Thalamic pain syndrome is classically described as chronic pain after an infarct of the thalamus. It leads to a decrease in the quality of life, especially for patients with inadequate treatment. Supportive imaging, such as a thalamic lesion or infarct, is widely accepted as necessary to diagnose this condition. Case Description: In this case report, we describe the case of a patient who developed allodynia and hyperesthesia with a hemibody distribution characteristic of thalamic pain syndrome, despite having no clear inciting event or identifiable thalamic lesion. This patient was successfully treated with cervical and thoracic spinal cord stimulation (SCS). Conclusion: We suggest that this patient may have presented with a non-lesional thalamic pain syndrome, supported by the classic hemibody allodynia and hyperesthesia and the response to SCS. Further, we demonstrate that SCS was an effective method to control this central pain disorder.
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Affiliation(s)
- Kylie E Hagerdon
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma, United States
| | - Lance M Villeneueve
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma, United States
| | - Christen M O'Neal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma, United States
| | - Andrew K Conner
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma, United States
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7
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Abstract
Neuromodulation, or the utilization of advanced technology for targeted electrical or chemical neuronal stimulation or inhibition, has been expanding in several neurological subspecialties. In the past decades, immune-modulating therapy has been the main focus of multiple sclerosis (MS) research with little attention to neuromodulation. However, with the recent advances in disease-modifying therapies, it is time to shift the focus of MS research to neuromodulation and restoration of function as with other neurological subspecialties. Preliminary research supports the value of intrathecal baclofen pump and functional electrical stimulation in improving spasticity and motor function in MS patients. Deep brain stimulation can improve MS-related tremor and trigeminal neuralgia. Spinal cord stimulation has been shown to be effective against MS-related pain and bladder dysfunction. Bladder overactivity also responds to sacral neuromodulation and posterior tibial nerve stimulation. Despite limited data in MS, transcranial magnetic stimulation and brain-computer interface are promising neuromodulatory techniques for symptom mitigation and neurorehabilitation of MS patients. In this review, we provide an overview of the available neuromodulatory techniques and the evidence for their use in MS.
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Affiliation(s)
- Hesham Abboud
- Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, Cleveland, OH, USA/School of Medicine, Case Western Reserve University, Cleveland, OH, USA/Neurology Department, Alexandria University, Alexandria, Egypt
| | - Eddie Hill
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Junaid Siddiqui
- Movement Disorders, University of Missouri- School of Medicine, Columbia, MO, USA
| | - Alessandro Serra
- Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, Cleveland, OH, USA/School of Medicine, Case Western Reserve University, Cleveland, OH, USA/Multiple Sclerosis Center of Excellence, Cleveland VA Medical Center Hub Site, East Cleveland, OH, USA
| | - Benjamin Walter
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA/Parkinson's and Movement Disorders Center, University Hospitals of Cleveland, Cleveland, OH, USA
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Noori S, Mehta N. Management of Medically Refractory Central Poststroke Pain Using High-Frequency Spinal Cord Stimulation at 10 kHz. Neuromodulation 2018; 21:823-825. [PMID: 29350884 DOI: 10.1111/ner.12718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/18/2017] [Accepted: 09/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Selaiman Noori
- Department of Anesthesiology and Pain Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Neel Mehta
- Department of Anesthesiology and Pain Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
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9
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Effect of Spinal Cord Stimulation on Gait in a Patient with Thalamic Pain. Case Rep Neurol Med 2016; 2016:8730984. [PMID: 27579198 PMCID: PMC4992542 DOI: 10.1155/2016/8730984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/17/2016] [Accepted: 07/04/2016] [Indexed: 11/29/2022] Open
Abstract
Thalamic pain is a central neuropathic pain disorder which occurs after stroke. Its severe chronic pain is often intractable to pharmacotherapies and affects the patients' activities of daily living (ADL) and quality of life (QOL). Recently, spinal cord stimulation (SCS) has been reported to be effective in relieving the pain of thalamic pain; however, the effect of SCS on gait performance in patients is unknown. Therefore, we evaluated the gait performance before and after SCS in a case with thalamic pain. A 73-year-old male with thalamic pain participated in this study. We evaluated the gait of the patient two times: before SCS insertion and after 6 days of SCS. At the second evaluation, we measured the gait in three conditions: stimulation off, comfortable stimulation, and strong stimulation. SCS succeeded in improving the pain from 7 to 2 on an 11-point numerical rating scale. Step frequency and the velocity of gait tended to increase between pre- and poststimulation periods. There were no apparent differences in gait among the three stimulation conditions (off, comfortable, and strong) at the poststimulation period. SCS may be effective on gait in patients with thalamic pain.
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10
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Provenzano DA, Williams JR, Jarzabek G, DeRiggi LA, Scott TF. Treatment of Neuropathic Pain and Functional Limitations Associated With Multiple Sclerosis Using an MRI-Compatible Spinal Cord Stimulator: A Case Report With Two Year Follow-Up and Literature Review. Neuromodulation 2016; 19:406-13. [DOI: 10.1111/ner.12409] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 01/21/2016] [Indexed: 12/26/2022]
Affiliation(s)
| | | | - Gaye Jarzabek
- Pain Diagnostics and Interventional Care; Sewickley PA USA
| | - Leonard A. DeRiggi
- Brighton Radiology Associates; Heritage Valley Sewickley Hospital; Sewickley PA USA
| | - Thomas F. Scott
- Director Multiple Sclerosis Treatment Center of Allegheny General Hospital; Drexel University School of Medicine, Pittsburgh; Sewickley PA USA
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11
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Feierabend D, Frank S, Kalff R, Reichart R. [Spinal cord stimulation for thalamic pain: Case report and review of the current literature]. Schmerz 2015; 30:152-7. [PMID: 26491023 DOI: 10.1007/s00482-015-0073-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Spinal cord stimulation (SCS) is an established procedure for treatment of chronic neuropathic pain of peripheral origin. The efficacy of SCS in case of central poststroke pain (CPSP), especially thalamic pain, has not been adequately proven. OBJECTIVES The efficacy of SCS as an extracranial neurostimulation method for the management of central pain syndrome was investigated. MATERIALS AND METHODS In this study, relevant pharmacological and nonpharmacological measures for central pain management were reviewed. A case of successful SCS for thalamic pain after ischemic insult is presented. Explanatory approaches of pathophysiological processes and a review of the current literature underline our results. RESULTS In the case presented, SCS was found effective in the treatment of thalamic pain. CONCLUSION The efficacy of SCS might be caused by segmental and supraspinal processes and collaboration of activating and inhibiting pathways. The integrity of the spinothalamic tract is mandatory. SCS is a treatment option for central pain syndrome, especially thalamic pain. Comparable studies confirm the potency of this technique. In contrast to other neuromodulation procedures spinal cord stimulation is less invasive, has a lower perioperative risk and is often less expensive. Further studies are needed to define its potential and role in the treatment of thalamic pain.
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Affiliation(s)
- D Feierabend
- Klinik für Neurochirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Deutschland.
| | - S Frank
- Klinik für Neurochirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Deutschland
| | - R Kalff
- Klinik für Neurochirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Deutschland
| | - R Reichart
- Klinik für Neurochirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Deutschland
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12
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Aly MM, Saitoh Y, Oshino S, Hosomi K, Kishima H, Yoshimine T. In Reply:. Neurosurgery 2011. [DOI: 10.1227/neu.0b013e318210f04b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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13
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Lopez Lopez JA. Spinal Cord Stimulation for Thalamic or Central Pain. Neurosurgery 2011; 68:E1507; author reply E1507-8. [DOI: 10.1227/neu.0b013e318210f024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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