A Case Report of Successful High-Frequency 10-kHz Spinal Cord Stimulator Trial in a Patient with Refractory Thoracic Postherpetic Neuralgia

2021 ◽  
pp. 55-58
Author(s):  
Sai P. Alla
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Postherpetic Neuralgia ◽  
High Frequency ◽  
Low Frequency ◽  
Spinal Cord Stimulator ◽  
Effective Treatment Modality ◽  
Patient Reported ◽  
Frequency Stimulation ◽  
Key Words Postherpetic Neuralgia

Background: Spinal cord stimulation can be an effective treatment modality in patients suffering from postherpetic neuralgia who have failed first-line pharmacotherapy and continue to struggle from debilitating pain. Appropriate patient selection and having a wide array of stimulation waveforms can enhance the success of spinal cord stimulator trials. Case Report: In this article, we present a case report of a patient suffering from refractory thoracic postherpetic neuralgia who underwent a successful high-frequency 10-kHz spinal cord stimulator trial. Lead tips were successfully placed at the midline and left paramedial side of the top of T1 vertebral bodies at the source of the pain. The patient was followed up in our clinic 7 days post procedure. At the time of follow-up, our patient reported an 85% to 90% reduction in his pain symptom scores and a significant improvement in his quality of life. Conclusion: Similar successful trials for postherpetic neuralgia have been reported in small studies using traditional low-frequency stimulation waveforms. However, to our knowledge, this is the first report of a successful spinal cord stimulator trial using high-density 10 kHz. Key words: Postherpetic neuralgia, high-frequency spinal cord stimulator, acute herpes zoster

scholarly journals High Frequency Spinal Cord Stimulation for Complex Regional Pain Syndrome: A Case Report

2017 ◽  
Vol 1 (21;1) ◽  
pp. E177-E182
Author(s):  
Alan D. Kaye
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Therapeutic Option ◽  
Low Frequency ◽  
Pain Syndrome ◽  
Leg Pain ◽  
Caucasian Woman

Complex regional pain syndrome (CRPS) is a chronic, debilitating, neuropathic pain condition which is often misdiagnosed, difficult to manage, and lacks proven methods for remission. Most available methods provide some relief to a small percentage of patients. Recent FDA approval and superiority of the Nevro Senza 10-kHz high frequency (HF10) spinal cord stimulation (SCS) therapy over traditional low-frequency spinal cord stimulation for treatment of chronic back and leg pain may provide a new interventional therapeutic option for patients suffering from CRPS. We provide a case report of a 53-year-old Caucasian woman who suffered with CRPS in the right knee and thigh for over 7 years. Implantation of the HF10 device provided over 75% relief of pain, erythema, heat, swelling, and tissue necrosis to the entire region within 1 month of treatment. Because the HP10 therapy provides pain relief without paresthesia typical of traditional low-frequency, this system may provide relief for patients suffering from chronic pain. Key words: Complex regional pain syndrome, spinal cord stimulation, Nevro Senza HF10, erythema, knee, thigh

scholarly journals Stim Salvage: Case Series Reporting on the Effectiveness of Spinal Cord Stimulation Salvage

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Patrick Paullus ◽  
Erika A Petersen
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
New Technologies ◽  
Case Series ◽  
Low Frequency ◽  
Low Frequency Stimulation ◽  
Trial Outcomes ◽  
Frequency Stimulation ◽  
New System

Abstract INTRODUCTION Spinal cord stimulation (SCS) has been successfully used to treat chronic pain with improved levels of pain, decreased use of narcotic medications, and increased level of function. Nevertheless, for patients SCS benefit wares over time and maximal reprogramming may not achieve improvement. However, advancing technologies, such as burst and high-frequency modulation, offer stimulation which differs from the traditional low-frequency stimulation. For those with SCS already placed, these new technologies offer a possible avenue with which to salvage SCS loss of efficacy. In patients with the an ineffective system, a salvage trial with a new system can be performed. In these cases, their current generators are externalized and then, utilizing their current epidural array, the leads are connected to a new trial system. These patients return to the OR in about 1 wk time for either permanent implantation or removal of the remainder of their old system. The results of these salvage trials are presented. METHODS We reviewed serially treated patients with previously placed SCS who were taken to the operating room for a salvage trial. All patient had their SCS leads externalized and connected to a different system. Changes in VAS, functional status, the trial outcomes led to permanent placement were collected retrospectively. RESULTS Results of 15 patient who underwent SCS externalization trial between 2016 and 2019 are summarized. Trial failure rate, salvage SCS response rate, changes in VAS, and patient satisfaction with the new system are reviewed. Successful salvage was accomplished in 93%. CONCLUSION New stimulation paradigms such as burst and high frequency offer a new avenue of effective treatment for those with an ineffective SCS systems. When a patient's device is unable to deliver these paradigms, an IPG-externalization trial may be a low risk option for salvaging therapy.

Fatigue of Paralyzed and Control Thenar Muscles Induced by Variable or Constant Frequency Stimulation

2003 ◽  
Vol 89 (4) ◽  
pp. 2055-2064 ◽  
Author(s):  
Christine K. Thomas ◽  
Lisa Griffin ◽  
Sharlene Godfrey ◽  
Edith Ribot-Ciscar ◽  
Jane E. Butler
Keyword(s):  
Spinal Cord ◽  
High Frequency ◽  
Low Frequency ◽  
Constant Frequency ◽  
Time Integral ◽  
Frequency Stimulation ◽  
Force Time ◽  
And Control ◽  
Frequency Pulse ◽  
Force Time Integral

Muscles paralyzed by chronic (>1 yr) spinal cord injury fatigue readily. Our aim was to evaluate whether the fatigability of paralyzed thenar muscles ( n = 10) could be reduced by the repeated delivery of variable versus constant frequency pulse trains. Fatigue was induced in four ways. Intermittent supramaximal median nerve stimulation (300-ms-duration trains) was delivered at 1) constant high frequency (13 pulses at 40 Hz each second for 2 min); 2) variable high frequency (each second for 2 min). The first two intervals of each variable frequency train were 5 and 20 ms. The remaining pulses were evenly distributed in time across 275 ms. The number of pulses varied for each subject such that the force time integral in the unfatigued state matched that evoked by a constant 40-Hz train; 3) constant low frequency (7 pulses at 20 Hz each second for 4 min); and 4) variable low frequency (each second for 4 min). The pulse pattern was the same as that for variable high frequency except that the force-time integral was matched to that produced by the constant low-frequency stimulation. These same experiments were performed on the thenar muscles of five able-bodied control subjects. The variable high-frequency trains used to fatigue paralyzed and control muscles had an average (± SE) of 12 ± 2 and 10 ± 1 pulses, respectively. Variable low-frequency trains had 7 ± 1 and 6 ± 1 pulses, respectively. Significant mean force declines of comparable magnitude (to 20–25% initial fatigue force or to 13–21% initial 50 Hz force) were seen in paralyzed muscles with all four stimulation protocols. The force reductions in paralyzed muscles were always accompanied by significant increases in half-relaxation time and decreases in force-time integral, irrespective of the stimulation protocol. Significant force decreases also occurred in control muscles during each fatigue test. Again, these force declines were similar whether constant or variable pulse patterns were used at high or low frequencies (to 40–60% initial fatigue force or to 29–36% initial 50 Hz force). The force reductions in control muscles were significantly less than those seen in paralyzed muscles, except when constant high-frequency stimulation was used. The variations in stimulation frequency, pulse pattern, and pulse number used in this study therefore had little influence on thenar muscle fatigue in control subjects or in spinal cord–injured subjects with chronic paralysis.

scholarly journals Burst Stimulation of the Thoracic Spinal Cord near a Cardiac Pacemaker in an Elderly Patient with Postherpetic Neuralgia: A Case Report

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 337
Author(s):  
Yeon Joo Lee ◽  
Myoung Hoon Kong ◽  
Sang Sik Choi ◽  
Yong Deok Kwon ◽  
Mi Kyoung Lee ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Postherpetic Neuralgia ◽  
Cardiac Pacemaker ◽  
Functional Improvement ◽  
Spinal Cord Stimulator ◽  
Thoracic Spinal Cord ◽  
Burst Mode ◽  
First Case ◽  
Thoracic Spinal

New developments in spinal cord stimulation (SCS) have improved the treatment of patients with chronic pain. Although the overall safety of modern SCS has been established, there are no published reports regarding safety considerations when implanting a burst-mode spinal cord stimulator in patients with permanent cardiac pacemakers (PCPs). An 80-year-old man with a complete atrioventricular block implanted with a PCP was considered as a candidate for burst-mode SCS due to well-established postherpetic neuralgia (>180 days after rash). Cardiac monitoring during the burst-mode spinal cord stimulator trial and insertion did not indicate any interference. After the insertion of the burst-mode spinal cord stimulator, the patient showed functional improvement and significant pain relief. The safety of traditional tonic-mode SCS in patients with PCP has been previously reported. This is the first case report describing the safe and effective use of burst-mode SCS in a patient with PCP.

scholarly journals MONOSYNAPTIC REFLEX RESPONSE OF INDIVIDUAL MOTONEURONS AS A FUNCTION OF FREQUENCY

1957 ◽  
Vol 40 (3) ◽  
pp. 435-450 ◽  
Author(s):  
David P. C. Lloyd
Keyword(s):  
High Frequency ◽  
Temporal Summation ◽  
Low Frequency ◽  
Stimulation Frequency ◽  
Monosynaptic Reflex ◽  
Reflex Response ◽  
High Frequency Stimulation ◽  
Low Frequency Stimulation ◽  
Frequency Stimulation ◽  
Frequency Of Stimulation

An assemblage of individual motoneurons constituting a synthetic motoneuron pool has been studied from the standpoint of relating monosynaptic reflex responses to frequency of afferent stimulation. Intensity of low frequency depression is not a simple function of transmitter potentiality. As frequency of stimulation increases from 3 per minute to 10 per second, low frequency depression increases in magnitude. Between 10 and approximately 60 per second low frequency depression apparently diminishes and subnormality becomes a factor in causing depression. At frequencies above 60 per second temporal summation occurs, but subnormality limits the degree of response attainable by summation. At low stimulation frequencies rhythm is determined by stimulation frequency. Interruptions of rhythmic firing depend solely upon temporal fluctuation of excitability. At high frequency of stimulation rhythm is determined by subnormality rather than inherent rhythmicity, and excitability fluctuation leads to instability of response rhythm. In short, whatever the stimulation frequency, random excitability fluctuation is the factor disrupting rhythmic response. Monosynaptic reflex response latency is stable during high frequency stimulation as it is in low frequency stimulation provided a significant extrinsic source of random bombardment is not present. In the presence of powerful random bombardment discharge may become random with respect to monosynaptic afferent excitation provided the latter is feeble. When this occurs it does so equally at low frequency and high frequency. Thus temporal summation is not a necessary factor. There is, then, no remaining evidence to suggest that the agency for temporal summation in the monosynaptic system becomes a transmitting agency in its own right.

scholarly journals Magnetic Resonance Imaging of the Lumbar Spine in a Patient with a Spinal Cord Stimulator

2013 ◽  
Vol 3;16 (3;5) ◽  
pp. E295-E300
Author(s):  
Thomas T. Simopoulos
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Case Report ◽  
Lumbar Spine ◽  
Magnetic Resonance ◽  
Adverse Events ◽  
Spinal Cord Stimulation ◽  
Spinal Cord Stimulator ◽  
Resonance Imaging ◽  
Lumbar Mri

Background: The use of magnetic resonance imaging (MRI) is continuously escalating for the evaluation of patients with persistent pain following lumbar spine surgery (LSS). Spinal cord stimulation (SCS) therapy is being clinically applied much more commonly for the management of chronic pain following LSS. There is an increased probability that these 2 incompatible modalities may be accidentally used in the same patient. Objectives: The purpose of this case report is to: (1) summarize a case in which a patient with a thoracic spinal cord stimulator underwent a diagnostic lumbar MRI, (2) describe the 3 magnetic fields used to generate images and their interactions with SCS devices, and (3) summarize the present literature. Study design: Case report. Setting: University hospital. Results: Aside from mild heat sensations in the generator/pocket site and very low intensity shocking sensations in the back while in the MRI scanner, the patient emerged from the study with no clinically detected adverse events. Subsequent activation of the SCS device would result in a brief intense shocking sensation. This persisted whenever the device was activated and required Implantable Pulse Generator (IPG) replacement. Electrical analysis revealed that some of the output circuitry switches, which regulate IPG stimulation and capacitor charge balancing, were damaged, most likely by MRI radiofrequency injected current. Limitations: Single case of a patient with a thoracic SCS having a lumbar MRI study. Conclusion: This case demonstrates the lack of compatibility of lumbar MRI and the Precision SCS system as well as one of the possible patient adverse events that can occur when patients are exposed to MRI outside of the approved device labeling. Key words: Spinal cord stimulation devices, magnetic resonance imaging

scholarly journals High Frequency Spinal Cord Stimulation in a Patient with Bilateral Cochlear Implants

2021 ◽  
pp. 189-191
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Pain Relief ◽  
Cochlear Implant ◽  
Cochlear Implants ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Pain Clinic ◽  
Bilateral Cochlear Implants ◽  
Patient Reported

BACKGROUND: High-frequency spinal cord stimulation (HF-SCS) has become very popular in the management of chronic pain worldwide. As it relies on generating high-frequency electrical impulses, there is a risk of interference with other devices such as cochlear implants that utilize similar principles. A literature search did not reveal any case reports of HF-SCS implantation in a patient with cochlear implants. CASE REPORT: A 75-year-old White woman with a history of bilateral cochlear implants (Cochlear Americas Nucleus® with cp910 processor) for severe sensorineural hearing loss presented to our chronic pain clinic with lumbosacral radiculopathy. The patient underwent a HF-SCS trial with entry point at the L1-L2 space and the leads positioned at the top and bottom of T8. The patient did not experience any auditory interference with her Cochlear implant at triple the average SCS stimulation strength. During the follow-up visit the next week, the patient reported nearly 80% symptomatic pain relief and significant functional improvement. There was no change in her hearing and no evidence of interference. The patient ultimately underwent percutaneous SCS paddle electrode placement and at 3 months, continues to have excellent pain relief without any auditory interactions. CONCLUSION: We successfully implanted a HF-SCS at the thoracic level in a patient with bilateral cochlear implants without any auditory interference. KEY WORDS: Cochlear implant, lumbar radiculopathy, spinal cord stimulation

Severe Leg Pain Following Spinal Cord Stimulator Implantation – A Case Report

PM&R ◽  
2019 ◽  
Vol 11 (3) ◽  
pp. 317-321
Author(s):  
Weibin Shi ◽  
Shannon Schultz ◽  
David R. Gater
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Leg Pain ◽  
Spinal Cord Stimulator
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