PurposeBrachial plexopathy can sometimes cause severe chronic pain. There are many possible treatments for such neuropathic pain, including neuromodulation. However, rigorous scientific evidence on the usefulness of spinal cord stimulation (SCS) is still scarce. Here, we report the use of high-frequency (10 kHz) SCS (HFSCS) in a patient with brachial plexus injury (root avulsion).ObjectiveTo assess the efficacy of HFSCS in root avulsion and to investigate the putative neurophysiological mechanisms of HFSCS.MethodsA 32-year-old woman visited our center following an iatrogenic brachial plexus injury. She underwent traditional, paresthesia-inducing, tonic SCS with cervical lead placement. She reported that stimulation-induced paresthesia was uncomfortable, without any pain reduction. After the successful trial of HFSCS, the patient was assessed at 1 month (T1) and 6 months (T6) after HFSCS implantation with pain and quality of life (QoL) scales. Moreover, she underwent a neurophysiological assessment (somatosensory evoked potentials [SEPs], reciprocal inhibition [RI], pain-motor integration [PMI], and the habituation of intraepidermal electrical stimulation-induced evoked potentials [IEPs]) with the stimulator switched on and switched off at T6.ResultsThe patient reported 100% paresthesia-free pain relief, a consistent improvement of QoL, and a complete discontinuation of her previous pain treatment at T1 and T6. Moreover, we found suppression of SEPs, restored habituation of IEPs, and strengthening of RI and PMI.ConclusionThis is the first report to illustrate the usefulness and safety of HFSCS for treating root avulsion in a patient with failed tonic SCS. Our data indicate that HFSCS may either block large-diameter fibers or stimulate medium-/small-diameter fibers, thus inducing analgesia without paresthesia, probably by reducing the activation of the wide-dynamic-range neurons. Moreover, HFSCS seems to modulate spinal inhibitory mechanisms and the descending corticospinal inhibitory output. Thus, HFSCS can be an effective option for treating refractory pain following root avulsion.
ular heterotopia (PNH).2 With the help of neuroimaging, coexistence of PNHs and epilepsy is now well established, but their pathophysiologic relation remains u n~l e a r .~,~ Moreover, specific attention has only recently been paid to the EEG correlates of seizures in patients with PNHs.~
Rationale:Limbic encephalitis is a parenchymal inflammation caused by viral, bacterial, or other microbial and postinfectious agents, which is usually expressed by multifocal neurological signs and cognitive impairment.Patient concerns:A 50-year-old female was admitted in postacute phase, at our rehabilitative Center, to undertake neuro-motor treatment for a period of 4 months.Diagnoses:The patient was affected by limbic encephalitis. Clinical presentation revealed attention, memory and executive dysfunctions, as well as behavioral changes, emotional dysregulation and reduction of self-awareness.Interventions:The patients received an intensive cognitive and motor rehabilitation training.Outcomes:Neuropsychological assessment and magnetic resonance imaging were performed before and after rehabilitative training to evaluate the cognitive and cerebral changes induced by treatment. The patient showed an improvement in cognitive performances and behavioral aspects.Lessons:The reducing cognitive deficits, especially memory deficits, could improve quality of life by using available cognitive resources.
Pain has a major impact on anxiety and depression levels. The aim of this study is to demonstrate how these symptoms (depression and anxiety) could positively influence the perception of pain after neurostimulation system implantation. We enrolled 100 patients and divided in 2 different groups, by using tests screening such as Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), Nursing Rating Scale (NRS): the group with spinal cord stimulation (SCS) and the group with pulsed spinal cord radiofrequency (RFP). We highlighted a significant decrease of scores (BDI, HAM-A, NRS) in each group between T0 (baseline) and T1. Moreover, the intra-group analysis showed a positive significant correlation between NRS and depressive and anxiety symptoms. We assert that the use of alternative methods (SCS and RFP) to the traditional pharmaceutical-surgical treatments, provide the reduction of the algic and anxiety-depressant symptoms, restoring also the perception of psychological well-being.
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