gms | German Medical Science

Objective: Regardless of the cause, spasticity leads to years of disability and reduced quality of life. The available treatments drew back because of incomplete response, limited duration and dose-limiting side effects. We present a case of severe spasticity and myoclonus treated with spinal cord stimulation (SCS).

Methods: A 39 year old male was admitted with hypoesthesia of whole left leg and involuntary movements of right leg as well as episodes of paresthesia in both hands. Low back pain and a Lhermitte’s symptom were present. On examination he did not have motor deficits but patellar clonus, Lhermitte’s sign and sensible deficits under Th8 and C8. MRI showed a disc prolaps with myelopathy in the segment C5/6. He underwent discectomy and cage implantation. The deficits were fast fully regressive. One year later, he developed dysesthesia/hypoesthesia of left leg and myoclonus in the right leg as well as paresthesia in lateral side of both arms and finger 4 and 5. He offered a severe ataxic walk and a leg-dominant left-dominant tetraparesiswith increased reflexes in the lower extremities and clonus of left foot. He underwent ventral fusion in segment C6/7 with plating C5-7. In the following 3 months, he displayed a progressive increment of myoclonus (10 Hz) and left-dominant spasticity (Ashworth II). He was treated with pregabalin and baclofen; both drugs were abandoned because of worsening and allergy, respectively. We proposed him to perform a dorsal decompression and the test of an eSCS. The pre-surgical assessment included psychosocial scores.

Results: He offered a numeric-analog-pain score 5 and SF-36 (general health) 55 points. The Patient Health Questionnaire -9 revealed a mild depression. After dorsal microsurgical decompression we placed a 16-poles plate-electrode from C5-Th1. The first postoperative session included a registration of each poles with activationof the left lowest poles at 1000 Hz and 120 µs. A complete remission of clonus was observed and he reported anesthesia of the whole left body. In further sessions, we reduced the frequency to 120 Hz and the impulse duration to 90 µs, the anesthesia improved and the clonus was further remittent. He was able to walk easier and the grasp function in the left hand improved. He got a MRI-feasible stimulator and was discharged. After 1 month he showed further improvements and the stimulation was extended to the right side (Figure 1 [Fig. 1]).

Conclusion: SCS might be a feasible medicament-free option for treatment of severe spinal spasticity.