Artikel
Successful high frequency burst stimulation in refractory angina pectoris
Suche in Medline nach
Autoren
-
Jan Vesper
- Department of Functional Neurosurgery and Stereotaxy, Duesseldorf, Germany
-
Stefan Schu
- Department of Functional Neurosurgery, Sana Klinikum Wedau Duisburg, Germany
-
Jarek Maciaczyck
- Department of Functional Neurosurgery and Stereotaxy, Duesseldorf, Germany
-
Gregor Bara
- Department of Functional Neurosurgery and Stereotaxy, Duesseldorf, Germany
-
Phillipp Slotty
- Department of Functional Neurosurgery and Stereotaxy, Duesseldorf, Germany
| Veröffentlicht: | 8. Juni 2016 |
|---|
Gliederung
Text
Objective: Spinal Cord Stimulation (SCS) may provide pain relief in these patients. During SCS treatment, paraesthesia is generally experienced by the patient. The significance of paraesthesia on treatment efficacy, the possible role of placebo effects, and the importance of electrode position are not well understood. However, a significant percentage of SCS patients (~20%) experiences long-term loss of effect (“non-responders”). We report on the effectiveness of a new paraesthesia-free SCS stimulation paradigm (Burst) for the treatment of angina pectoris (AP) refractory to tonic stimulation.
Method: A 60y male patient with a pre-existing 11 y history of severe coronary heart disease, diabetes mellitus, several myocardial infarctions, Bypass surgery, failed PTCA and PVD underwent conventional midline SCS. The tips of the two paramedian octrodes were placed at the Th2 level. After a successful trial period, the permanent stimulator was implanted in the right buttock. (EonMini™,SJM). Preoperatively, the patient suffered from 3-4 VAS 7/10 AP attacks daily.
Results: At the 3 months follow-up we saw a partial effect on the continuous background pain with tonic stimulation (50Hz, PW 412 µs, amplitude Perception at 5.10 mA, Comfort at 6.80mA, continuous stimulation) but not on the peak attacks (stimulation left 0 0 + + - - - +, right 3+, 4+, 5-, 6-, 7-, 8+). Since these settings failed to improve quality of life, we decided to test BURST stimulation. A single-blinded allocation for a period of 1 week each was tested: Tonic 30 Hz Stimulation, Burst Stimulation with 500Hz 1000μs, and placebo (off) stimulation (burst Frequency 500Hz, 40 bursts per second, PW 1000µs, BurstActive 5 (Pulses), Target 70% of 3, cyclic stimulation : 3600 sec. on / 15sec. off). The patient reported immediate pain relief under burst stimulation (VAS 1/10), no pain relief in placebo and tonic setting was reported. Pain relief was stable at 6 months follow-up. No stimulation induced side-effects were observed.
Conclusions: Two key findings are presented in this study: 1) SCS produces reproducible and reversible pain relief in patients suffering from AP refractory to conventional treatment and 2) paresthesia is not mandatory for effective treatment. SCS is effective both in suprathreshold tonic and high frequency burst stimulation. Overall, paraesthesia-free Burst Stimulation resulted in better pain relief in this AP patient.
