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1.
Neuromodulation ; 24(6): 1075-1082, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33171547

RESUMO

OBJECTIVE: Foot and leg pain in complex regional pain syndrome (CRPS) presents a challenge even with neuromodulation techniques such as spinal cord stimulation (SCS). We report our experience with a novo technique of direct sciatic nerve electrical stimulation (DISNES) for intractable foot and leg pain in CRPS I. MATERIALS AND METHODS: Following Research Ethics Board (REB) approval, data were gathered for 16 patients (10 women and 6 men, age 26-61 years) who had been subjected to ipsilateral DISNES. All 16 patients had failed conventional medical management. As well, seven subjects were previously treated with SCS for CRPS I pain. These subjects reported pain relief in the thigh and leg, however the SCS was unable to alleviate the disabling foot pain despite varied and multiple programming techniques. The remaining nine subjects were treated primarily with DISNES. Evaluation was done using visual analog scale (VAS), Oswestry Disability Index version 2 (ODI), and quality of life (EQ-5D and SF-36) scores done both pre-DISNES and at two follow-ups. RESULTS: VAS scores decreased by 59% at follow-up (F/U) 1 (P = 0.00001) and 46% F/U 2. ODI improving by 40% F/U 1 (P = 0.0038) and 37% F/U 2. SF-36 scores improved by 69% F/U 1 (P = 0.015) and 80% F/U 2. EQ-5D scores improved significantly by F/U 1 (P = 0.00030) but insignificantly at F/U 2 (P = 0.81). There was also a rapid resolution of autonomic features such as edema, hyperemia, and allodynia (within 7-10 days). Three subjects returned to work post-DISNES. CONCLUSION: Our study shows that DISNES helps to control the disabling foot pain in CRPS I, thus improving the quality of life, improving ambulation and decreasing disability. DISNES also alleviates autonomic features and dystonia in CRPS I. Further studies are needed to determine long-term efficacy as this study pool is limited in size and follow-up period.


Assuntos
Síndromes da Dor Regional Complexa , Estimulação da Medula Espinal , Adulto , Síndromes da Dor Regional Complexa/terapia , Estimulação Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Nervo Isquiático , Resultado do Tratamento
2.
Rev. chil. neurocir ; 43(1): 59-68, July 2017. ilus, tab
Artigo em Inglês | LILACS | ID: biblio-869780

RESUMO

Antecedentes: Los autores presentan una revisión crítica sobre el cuadro clínico, el diagnóstico, clasificación y tratamientodel síndrome de dolor regional complejo, discutiendo todos los métodos de tratamiento y haciendo hincapié en que la reabilitación debe ser empleada con el fin de obtener un mejor resultado. Aspecto psicológico debe ser discutido en el tratamiento y también se anima equipo multidisciplinario para participar en él.


Background: The authors presented a critical review about the clinical picture, diagnosis, classification and treatment ofcomplex regional pain syndrome, discussing all methods of treatment and emphasizing that the reabiltation must be employed in order to obtain a better result. Psychological aspect must be involved in the treatment and also multidisciplinary team is encouraged to take part on it.


Assuntos
Humanos , Causalgia , Dor Crônica , Manejo da Dor/métodos , Distrofia Simpática Reflexa , Síndromes da Dor Regional Complexa/classificação , Síndromes da Dor Regional Complexa/diagnóstico , Síndromes da Dor Regional Complexa/fisiopatologia , Síndromes da Dor Regional Complexa/psicologia , Ferimentos e Lesões/complicações , Transtornos dos Movimentos , Estresse Psicológico , Traumatismos do Sistema Nervoso
3.
Cureus ; 7(12): e404, 2015 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-26819866

RESUMO

A 28-year-old man presented to the emergency room with a severe headache of one day's duration. A computerized tomography scan showed a hemorrhagic tumor measuring 3.9 x 4.4 cm in the left cerebellar hemisphere. The resection specimen revealed medulloblastoma. He had two episodes of rebleeding and multiple postoperative issues preventing the use of prone craniospinal radiotherapy. We designed a supine technique for this tall man, which was not complicated to set up. The rapid safe implementation of this technique allowed us to avoid further rebleeding and successfully treat the residual tumor. This technique is the described technique in this case report and is compared to other techniques. At 7.5 years after surgery, he is alive without cancer and with only a mild residual deficit. This case is unusual since the majority of patients with the diagnosis of hemorrhagic medulloblastoma died.

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