Epidural spinal cord stimulation for the control of spasticity in spinal cord injury patients lacks long-term efficacy and is not cost-effective

Midha, Meena; Schmitt, James K.

doi:10.1038/sj.sc.3100532

Cited by 44 publications

(29 citation statements)

References 7 publications

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“…In a study of Midha 80 on the e cacy and costs of SCS for patients with spinal cord injury, no favourable results could be found. In these patients SCS did not produce long term relief of spasticity or pain, and this low e cacy in combination with the high initial costs of SCS implantation, suggested that the procedure would not be cost e ective.…”

Section: Reimbursementmentioning

confidence: 95%

Spinal cord stimulation in chronic pain syndromes

Vaarwerk

Staal²

1998

Spinal Cord

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Spinal cord stimulation (SCS) has been used for more than 30 years now, and although it has shown to be e ective under certain well-described conditions of chronic pain, conclusive evidence on its e ectiveness is still sparse.There is a need for more prospective and methodological good studies, in order to prove SCS e cacy for new or still questionable indications and to reveal prognostic factors for successful application. Especially at this moment, when governments are trying to control and reduce their health care expenses, studies on the cost-e ectiveness of SCS are important.In contrast to the early years when SCS was applied by independent physicians exploring the ®eld of neurostimulation, the importance of information exchange and coordination of studies has now been recognized. Recent technical improvements of SCS devices may positively in¯uence clinical outcome.

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Section: Reimbursementmentioning

confidence: 95%

Spinal cord stimulation in chronic pain syndromes

Vaarwerk

Staal²

1998

Spinal Cord

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“…In contrast to these findings, Midha and Schmitt [18] conducted a retrospective study in individuals having epidural stimulators implanted between 1986 and 1988 to determine their long-term status (n = 17). In only 1 of these individuals was the stimulator continuing to provide symptomatic relief.…”

Section: Discussionmentioning

confidence: 99%

Chronic Spinal Cord Stimulation in the Treatment of Cerebral and Spinal Spasticity

Dekopov

Shabalov

Tomsky

et al. 2015

Stereotact Funct Neurosurg

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Objectives: The aim of this investigation is to assess the effectiveness of spinal cord stimulation (SCS) in different groups of patients with spasticity of different origin. Materials and Methods: A retrospective study of the use of the method of SCS in 71 patients. The patient population was divided into two groups: 52 cerebral palsy (CP) cases and 19 patients diagnosed with spasticity caused by spinal injury. The mean age was 7.14 ± 4.06 and 35.68 ± 12.42 years, respectively. The CP group included 41 cases of paraparesis and 11 cases tetraparesis. One quadripolar electrode was implanted into the posterior epidural space at Th10-Th12 level and an implantable pulse generator (Itrel3, Medtronic) was placed in a standard fashion. We performed 3-5 stimulation sessions per day; each lasted 30 min. The stimulation parameters were as follows: rate 100-130 Hz, pulse width 120-300 ms, amplitude 1.5-4 V. The follow-up ranged from 2 to 9 years. Results: Decrease in muscle tone was observed in all cases in the group of patients with spinal spasticity: from 3.71 ± 0.61 on the Ashworth scale before the operation to 2.26 ± 0.56 after the operation (p < 0.001). In the group of cerebral spasticity a significant decrease in muscle tone was observed only in patients with spastic lower paraparesis: from 3.36 ± 0.41 before the operation to 1.97 ± 0.91 after the operation (p < 0.005). In patients with spastic tetraparesis we did not observe any significant change in muscle tone. In 8 cases we discontinued the therapy several years after the procedure due to improvement in spasticity: in the CP group in 7 cases and in 1 spinal spasticity case, where SCS systems were explanted. Conclusion: Chronic SCS may be a method of choice for patients with moderate spinal and cerebral spasticity with predominant spastic lower paraparesis. In patients with spastic tetraparesis SCS therapy did not prove to be effective. We encountered improvement of the spasticity and no need for further SCS therapy in a small group of patients (11%). This phenomenon requires further investigation.

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“…92 Subsequent reports of chronic epidural spinal cord stimulation are variable; Barolat et al, 15 in 1995, reported progressive improvement in quantitative measures of spasticity in a series of 48 patients with spinal cord injuries, but Midha and Schmitt, 84 in 1998, reported long-term relief of spasticity in only 1 of 17 patients. Neither series reported significant neurological or other postoperative complications.…”

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confidence: 95%

The surgical treatment of spasticity

Smyth

Peacock

2000

Muscle Nerve

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Many neurosurgical procedures have been designed for or applied to the treatment of spasticity arising from different disorders, including cerebral palsy; traumatic, ischemic, or hypoxic brain injury, multiple sclerosis, and spinal cord injury. Neurosurgical procedures are primarily aimed at reducing spasticity by interrupting the stretch reflex at various sites along the spinal reflex arc or attempting to increase the centrally mediated inhibitory influence on the pool of motor neurons in the anterior horn. Surgical interventions for spasticity can be classified into peripheral ablative procedures, such as rhizotomy or peripheral neurectomy, and central ablative procedures, such as cordectomy, myelotomy, or stereotactic procedures. Non‐ablative procedures include peripheral nerve or motor point blocks, the implantation of cerebellar or spinal stimulators, and the implantation of subdural catheters for infusion of pharmacologic agents to increase inhibitory activity. Several proposed mechanisms for spasticity are reviewed so that the rationale for the various surgical interventions for spasticity described may be better understood. © 2000 John Wiley & Sons, Inc. Muscle Nerve 23: 153–163, 2000.

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Epidural spinal cord stimulation for the control of spasticity in spinal cord injury patients lacks long-term efficacy and is not cost-effective

Cited by 44 publications

References 7 publications

Spinal cord stimulation in chronic pain syndromes

Spinal cord stimulation in chronic pain syndromes

Chronic Spinal Cord Stimulation in the Treatment of Cerebral and Spinal Spasticity

The surgical treatment of spasticity

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