gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Peripheral nerve stimulation (PNS) – extended therapeutic options with complex stimulation systems – case series

Meeting Abstract

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  • J. Perrin - Neurochirurgische Klinik, Abteilung Neuromodulation, Universitätsklinikum Düsseldorf
  • C. Wille - Neurochirurgische Klinik, Abteilung Neuromodulation, Universitätsklinikum Düsseldorf
  • J. Vesper - Neurochirurgische Klinik, Abteilung Neuromodulation, Universitätsklinikum Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 031

DOI: 10.3205/12dgnc418, URN: urn:nbn:de:0183-12dgnc4182

Published: June 4, 2012

© 2012 Perrin et al.
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Outline

Text

Objective: Peripheral nerve stimulation (PNS) delivers targeted relief from neuropathic pain in peripheral nerve disorders. Traditional approaches promote placement of one electrode in proximity to the nerve lesion. Durability of hardware, limited therapeutic range and motor side effects are common problems often prompting multiple revisions. In SCS it is an accepted development to improve stimulation results by more complex electrode designs or combinations of electrodes. We demonstrate PNS of the proximal sciatic nerve with two or more electrodes in patients with neuropathic pain of different origins refractory to conservative treatment or other neuromodulation approaches.

Methods: Four patients (2 male/2 female) with neuropathic foot or leg pain due to extensive trauma (2), compartment syndrome (1) or amputation (1) underwent electrode placement at the proximal portion of the sciatic nerve over a dorsal approach. Electrodes were placed adjacent to each other to allow a thorough coverage. Effects, thresholds and therapeutic range for single and combined stimulation were assessed during trial period and 3 months after stimulator placement.

Results: In all patients combined stimulation was superior to single electrode stimulation regarding therapeutic effect and range. Mean paresthesia coverage was 85% for combined vs. 45% for single stimulation. VAS improvement at mean 68% was recorded at 12-month follow-up. Median follow-up is 15 months.

Conclusions: Our preliminary data suggest improved PNS results with more complex stimulation setups. The possibility to achieve stimulation coverage and selectiveness more independently from anatomic considerations may help to avoid complications, surgical revisions und improve therapeutic success.