Results of tonic and burst epidural spinal cord stimulation in patients with spasticity, chronic disorders of consciousness and neuropathic pain syndrome at the rehabilitation stage
Authors:   FSBSI Federal Scientific and Clinical Center for Resuscitation and Rehabilitation (FSCC RR), Vorobiev A.N. , Varyukhina M.D. ,   FSBSI Federal Scientific and Clinical Center for Resuscitation and Rehabilitation (FSCC RR), Puzin K.M. ,   FSBSI Federal Scientific and Clinical Center for Resuscitation and Rehabilitation (FSCC RR), Radutnaya M.L. ,   FSBSI Federal Scientific and Clinical Center for Resuscitation and Rehabilitation (FSCC RR), Bondar E.L. ,   FSBSI Federal Scientific and Clinical Center for Resuscitation and Rehabilitation (FSCC RR), Levin D.V. ,   FSBSI Federal Scientific and Clinical Center for Resuscitation and Rehabilitation (FSCC RR), Shaybak A.A. ,   FSBSI Federal Scientific and Clinical Center for Resuscitation and Rehabilitation (FSCC RR), Rubanes M. ,   FSAEI HE Peoples' Friendship University of Russia, Chmutin G.E. ,   FSBSI Federal Scientific and Clinical Center for Resuscitation and Rehabilitation (FSCC RR), FSAEI HE Peoples' Friendship University of Russia, Yakovlev A.A. ,   FSBSI Federal Scientific and Clinical Center for Resuscitation and Rehabilitation (FSCC RR)
Published: October 2022

The paper analyzes the experience of using epidural spinal cord stimulation in tonic and burst stimulation modes in 71 patients with the consequences of damage to the central nervous system, who underwent treatment and rehabilitation at the Research Institute of Rehabilitology named after professor I.V. Pryanikov, FSCC RR, from 2020 to 2021. The efficacy of epidural stimulation in the indicated modes for clinical manifestations of pyramidal syndrome in the extremities, chronic disorders of consciousness, neuropathic pain, and paresis of the extremities without spasticity has been studied. The use of invasive spinal cord stimulation in the burst mode in patients with spasticity and chronic disorders of consciousness is described for the first time. The impact of various factors on the effectiveness of stimulation has also been analyzed. The average age of patients in the study group was 47 ± 17 years, the average duration of test epidural stimulation was 4.3 ± 1.6 days. Twenty-eight patients (39.5%) were stimulated in the tonic mode, twenty-two patients (31%) were stimulated in the burst mode, and the remaining patients were stimulated in the combined mode. Results: positive dynamics after the use of epidural stimulation was observed in 39 patients (54.9%). The spasticity regressed in 32 patients (52.5%); in addition, an increase in the active range of motion was observed in 23 patients (37.7%) from this subgroup. The decrease in the severity of spasticity in the extremities ranged from 0.33 ± 0.1 to 0.63 ± 0.13 points (p<0.005). The signs of an increase in the level of consciousness as a result of the stimulation were noted in 8 patients (38.1%); the neuropathic pain syndrome regressed in 8 patients (72.7%). When applying this technique in patients with paresis without spasticity, the stimulation did not have an effect in any patients of this subgroup. There was no statistically significant influence of etiology, age of patients or duration of stimulation on its effect. The patients with spasticity, who were stimulated in the tonic mode, more often demonstrated the effectiveness of stimulation compared with the patients from the combined mode subgroup (p<0.013). Higher effectiveness of the burst mode stimulation compared to the combined mode stimulation in patients with spasticity was on the borderline of statistical significance (p=0.065). Thus, the use of epidural stimulation in patients with chronic neuropathic pain and spasticity showed the best results; the effect of epidural stimulation on the level of consciousness in chronic disorders requires additional studies and changes in their design.