Article
Can bilateral central drop foot be treated by bilaterally implanted peroneal nerve stimulators?
Können bilaterale zentrale Fußheberparesen durch beidseitig implantierte Peroneusstimulatoren behandelt werden?
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Authors
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Daniel Martin
- Universitätsklinikum Carl Gustav Carus Dresden, Neurochirurgie, Dresden, Deutschland
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Thomas Pinzer
- Universitätsklinikum Carl Gustav Carus Dresden, Neurochirurgie, Dresden, Deutschland
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Gabriele Schackert
- Universitätsklinikum Carl Gustav Carus Dresden, Neurochirurgie, Dresden, Deutschland
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Stephan B. Sobottka
- Universitätsklinikum Carl Gustav Carus Dresden, Neurochirurgie, Dresden, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Peroneal nerve stimulation using implantable devices was shown to be highly effective in patients with central drop foot caused by stroke or multiple sclerosis (MS). The devices lead to a significant better improvement of the dynamic gait pattern than foot orthosis or surface stimulation. Here, we describe for the first time the long-term outcome after bilateral implantations.
Methods: Between 2014 and 2016 two MS patients and one hereditary spastic paraplegia (HSP) patient were bilaterally treated with implantable peroneal nerve stimulators. Each stimulation system consisted of an external control unit, a heel switch, and an implantable 4-channel nerve stimulatorwith a 12-contact electrode cuff around the peroneal nerve. The heel switch, which is worn in a sock, triggers the initiation and termination of each stimulation sequence by a radiofrequency wireless signal to the external control unit. Extensive gait analysis including video documentation and evaluation of quality of life (QoL) was performed prior to surgery and after 6, 12, 48 months.
Results: All three patients showed an impressive improvement of their gait pattern including a mean improvement of 19% in the 20-m gait test, 29% in the 6-minute walking test, and 26% in the timed up-and-go test. QoL showed a marked improvement in all patients. One MS patient was wheelchair dependent and finally managed to walk with walking aids, the HSP patient impressively improved especially in gait endurance, and one MS patient developed a much better gait safety with an almost normal gait pattern.
Conclusion: We herewith show for the first time that bilateral drop foot can be successfully treated by bilateral peroneal nerve stimulators. The stimulator systems work independently and are separately triggered by the respective heel switch of the foot that is lifted from the ground. The bilateral implantation led to an impressive improvement of the gait pattern in all three patients with marked improvements in gait analysis and QoL assessment. With a follow-up of more than 4 years without technical and surgical complications bilateral implanted peroneal nerve stimulators seem to be a good treatment option for patients with bilateral drop foot.
