Spinal cord stimulation (SCS) induced favorable neuromodulative outcome in the treatment of chronic neuropathic pain syndrome in children

Abstract

Background

Chronic pharmaco-resistant pain syndrome (CPS) requires different therapeutic approaches based on the underlying pathology. Spinal cord stimulation (SCS) in children with chronic neuropathic pain syndrome (CNPS) has been scarcely reported in the literature.

Objectives

To present SCS as the rational treatment approach in children with chronic regional and generalized chronic neuropathic pain syndrome, its efficiency, complications and the role in neuromodulation.

We present two children with chronic pain syndrome treated with SCS. A 14-year-old girl at the age of 8 manifested with signs of chronic regional pain syndrome (CRPS) type 1 in wrist and afterwards in knee, associated with allodynia, signs of local autonomic dysfunction, trophic changes of the skin, and loss of ambulation. Nerve biopsy showed inflammatory infiltrates and loss of small unmyelinated C in skin biopsy.

A 17-year-old boy manifested at the age of 9 with clinical signs of acute central (CNS) and peripheral nervous system (PNS) involvement associated with headache, photophobia, ataxia, paraparesis, autonomic dysfunction and intensive generalized global neuropathic pain, especially in the lower extremities. Electromyoneurography (EMNG) at the first exam was compatible with Guillain Barre syndrome and subsequently several times during follow up EMNG and nerve biopsy were compatible with chronic inflammatory demyelinating polyneuropathy (CIDP). Treatment was maintained with i.v. immunoglobulins (IVIG) and steroids without functional improvement.

In both children functional psychosomatic, orthopedic and rheumatologic causes were excluded including painful genetic neuropathies. Seven and eight years after the onset of symptoms and signs of CPS in both children, epidural SCS was implanted, followed by pain relief up to 100 % with complete recovery of motor function, local skin changes and of intraepidermal nerve fiber density in a girl. A boy became ambulant, 50 % up to 75 % pain control was attained, and only partial recovery of sphincter control.

Conclusion

SCS as minimally invasive neurosurgical method may be efficient in resolving chronic pain and in restoring functional abilities of affected extremities. SCS should be considered as a treatment approach in children with chronic regional and generalized (pharmacoresistant) neuropathic pain syndrome resistant to all established treatment modalities.