Spinal Cord Stimulation
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

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Objective

To report a case with two years follow-up of neuropathic pain and functional limitations associated with multiple sclerosis (MS) effectively treated with an MRI conditional spinal cord stimulator (SCS) system that allowed for spinal imaging. To present a comprehensive literature review of spinal cord stimulator utilization in the treatment of multiple sclerosis.

Design

Case report and literature review.

Intervention

Treatment was a spinal cord stimulation implant after successful trial. Pain scores, medication utilization, and functional outcomes were reviewed. Pre- and post-SCS implant MRI spine images were obtained.

Results

At 24 months follow-up, the patient has had a 77% reduction in pain and a 99% reduction in opioid use. Furthermore, he had improvement in reported tactile sensation, spasticity levels, and ambulation. Post-SCS implant, MRI images at 18 months follow-up provided the ability to review the spinal cord with minimal artifact. No new MS documented plaques occurred during this time period. A literature review demonstrated 33 published reports including a total of 496 trialed and 744 implanted patients. Only 3 of the reports occurred after the year 2000.

Conclusions

We report the successful treatment of MS-associated pain and functional limitations with an MRI conditional spinal cord stimulator system. The ability to obtain post-implant MRI imaging of not only the brain but also the spinal cord in MS patients allows for the continued need to document and follow disease progression, especially with the advancements in pharmacological therapy.

Section snippets

INTRODUCTION

Multiple sclerosis (MS) is a chronic demyelinating autoimmune disease associated with widespread neurological manifestations including functional limitations such as blurred vision, loss of balance, weakness, malaise, bladder dysfunction, sensory impairment, fatigue, and spasticity of the extremities. The neuronal demyelination causing severe nerve damage is also known to cause neuropathic pain, dysesthesias, and paresthesias in approximately 75% of MS patients (1). Furthermore, the associated

Case Report

A 68-year-old male diagnosed with MS in 1987 was experiencing MS-associated neuropathic bilateral lower extremity pain, functional limitations including gait abnormalities, and sensory disturbances in the lower extremities. He reported pain of 9/10 on a 0–10 numerical rating scale (NRS) and consumed 105 mg of morphine equivalents per day, which proved insufficient for pain relief. In addition, the patient was utilizing baclofen, duloxetine, and gabapentin. The patient reported cognitive

DISCUSSION

We report the successful treatment of MS-induced neuropathic pain using an MRI conditional SCS system that allowed for spinal imaging. At two years follow-up, the use of SCS has resulted in sustained improvements in pain control, quality of life, and functional outcomes including walking distance. Furthermore, improvements in pain control have resulted in a significant reduction in opioid consumption. MRI monitoring has remained possible following implantation due to the MRI conditional

Authorship Statements

Dr. Provenzano, Mr. Williams, Ms. Jarzabek, Dr. DeRiggi, and Dr. Scott assisted in the research design, interpretation of the data, drafting of this article, and reviewing the manuscript critically. All authors had complete access to the study data.

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    Work for this project was completed at Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania.

    This study was not supported by any grants or by any manufacturer or third-party research funding. No manufacturer involvement occurred with this manuscript.

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