Spinal Cord StimulationTreatment 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
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.
REFERENCES (49)
- et al.
The appropriate use of neurostimulation: new and evolving neurostimulation therapies and applicable treatment for chronic pain and selected disease States
Neuromodulation
(2014) - et al.
The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: the neuromodulation appropriateness consensus committee
Neuromodulation
(2014) - et al.
MRI monitoring of pathological changes in the spinal cord in patients with multiple sclerosis
Lancet Neurol
(2015) - et al.
Spinal cord stimulation and thalamic pain: long-term results of eight cases
Neuromodulation
(2009) The ongoing debate of the utility of magnetic resonance imaging conditional neuromodulation devices
Neuromodulation
(2015)MRI-compatible neuromodulation devices: critical necessity or desirable adjunct?
Neuromodulation
(2014)- et al.
Inflammation high-field magnetic resonance imaging
Neuroimaging Clin N Am
(2012) - et al.
Effect of electrical stimulation of the thoracic spinal cord on the function of the bladder in multiple sclerosis
J Urol
(1977) - et al.
Dorsal-column stimulation in the rehabilitation of patients with multiple sclerosis
Lancet
(1976) - et al.
Pain and multiple sclerosis: pathophysiology and treatment
Curr Neurol Neurosci Rep
(2013)
Symptomatic medication use in multiple sclerosis
Mult Scler
EFNS guidelines on neurostimulation therapy for neuropathic pain
Eur J Neurol
MRI in the diagnosis and monitoring of multiple sclerosis: an update
Clin Neuroradiol
Dimethyl fumarate (BG-12) for the treatment of multiple sclerosis
Expert Rev Clin Pharmacol
Dimethyl fumarate for treatment of multiple sclerosis: mechanism of action, effectiveness, and side effects
Curr Neurol Neurosci Rep
Dimethyl fumarate for multiple sclerosis
Cochrane Database Syst Rev
Percutaneous epidural dorsal cord stimulation in multiple sclerosis
Acta Neurochir (Wien)
The quantitative assessment of the influence of spinal cord stimulation on motor function in patients with multiple sclerosis
Int Rehabil Med
The effect of spinal cord stimulation on function in patients with multiple sclerosis
Brain
Spinal cord stimulation in treatment of chronic benign pain: challenges in treatment planning and present status, a 22-year experience
Neurosurgery
Successful treatment of central pain in a multiple sclerosis patient with epidural stimulation of the dorsal root entry zone
Pain Med
MRI-compatible spinal cord stimulator device and related changes in patient safety and imaging artifacts
Pain Med
Standardized MR imaging protocol for multiple sclerosis: consortium of MS Centers consensus guidelines
AJNR Am J Neuroradiol
Cited by (13)
Epidural Spinal Cord Stimulation for Spasticity: a Systematic Review of the Literature
2024, World NeurosurgeryNeural stem cell engineering for the treatment of multiple sclerosis
2022, Biomedical Engineering AdvancesMultiple Sclerosis Pain
2018, Challenging Neuropathic Pain Syndromes: Evaluation and Evidence-Based TreatmentMultiple Sclerosis Pain
2017, Challenging Neuropathic Pain Syndromes: Evaluation and Evidence-Based TreatmentA meta-analysis on the impact of spinal cord stimulation on post-operative wound healing in patients with multiple sclerosis
2024, International Wound Journal
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.
For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to http://www.wiley.com/WileyCDA/Section/id-301854.html