Epidural stimulation for the management of spasticity in children with spinal cord injury sequelae

Abstract

BACKGROUND: Spasticity and pain syndromes occur in 60–78% of patients with spinal cord injury above the lumbar enlargement. Spasticity and pain negatively affect rehabilitation outcomes and complicate patient care. Surgery methods initially yield good results but are associated with numerous complications in the long term. Lumbosacral spinal cord epidural stimulation significantly reduces spasticity and pain in 61.8% of adults and may be a preferred method for managing spasticity and pain syndrome in children with spinal cord injury.

AIM: To assess the long-term effectiveness of epidural spinal cord stimulation in the management of spasticity and pain syndrome in children with spinal cord injury.

MATERIALS AND METHODS: The study included 15 children aged 14 to 17 years with spinal cord injury sequelae who were admitted to the Research Institute of Emergency Pediatric Surgery and Trauma since 2020. The assessment of the current condition was conducted through clinical assessment using the ASIA scale (to assess the impairment of spinal cord conduction), Ashworth and Tardieu scales (to assess muscle tone), MRS (to evaluate muscle strength), VAS (to measure pain syndrome), and the pendulum test. Additionally, an electromyographic assessment (F-wave) was performed to evaluate the severity of spasticity.

RESULTS: An epidural stimulator was implanted in 15 patients. Positive outcomes were observed in 12 (80%) children, with a reduction in spasticity by an average of 1–2 points on the Ashworth and Tardieu scales. The pendulum test demonstrated improvement in 12 (80%) cases, showing an increase in oscillatory movements. Pain severity decreased in 12 (80%) patients, muscle strength improved in 10 (66.7%) patients, and electromyographic parameters (reduction in the number of pathological F-waves) improved in 9 (60%) patients. In 7 (46.7%) cases, the dose of antispastic medication was reduced. No clinical improvement was observed in 3 (20%) patients.

CONCLUSION: Epidural stimulation is the treatment of choice for children with severe spastic syndrome due to spinal cord injury that is refractory to conservative therapy. Proper patient selection and objective assessment of their current condition increase the effectiveness of this method. In addition to improving pathological muscle tone, epidural stimulation also alleviates pain.

Keywords

spinal cord injury / spastic syndrome / epidural stimulation of spinal cord / medical rehabilitation / epidural stimulator

References

[1] Ninel VG, Smol’kin АA, Korshunova GA, Norkin IA. Methods of neuromodulation in the treatment of spastic syndrome and their role in complex rehabilitation of patients after spine and spinal cord injuries. Spine Surgery. 2016;13(3):15–21. doi: 10.14531/ss2016.3.15-21 EDN: WKYPAN

[2] Isagulian ED, Konovalov NA. Neuromodulation of pain. Effective control of severe pain syndromes. Moscow: IP «T.A. Alekseev»; 2020. 840 p. (In Russ.)

[3] Kamadey OO, Krivoshchekov EP. Neurophysiological aspects of chronic epidural spinal cord stimulation in patients with spastic and pain syndromes. Bulletin of the Medical Institute “REAVIZ” (rehabilitation, doctor and health). 2019;(4):45–50. EDN: HPSXTG

[4] Dountz PV, Pak OI, Elitskiy AS, Gorbarenko RS. Applying chronic epidural stimulation of spinal cord. Pacific medical journal. 2012;(3):88–91. EDN: TDRZWX

[5] Rzaev DA, Rudenko VV, Pudovkin IL, et al. Spinal cord stimulation in treatment of the neuropathic pain syndromes: Initial experience. Traumatology and orthopedics of Russia. 2010;(2):68–71. doi: 10.21823/2311-2905-2010-0-2-68-71 EDN: MUQZPB

[6] Belova AN, Builova TW, Buliubash ID, et al. Scales, tests and questionnaires in medical rehabilitation: A guide for clinicians and researchers. Moscow: Antidor; 2002. 440 p. (In Russ.) EDN: SIXRNF

[7] Kan’shina DS, Kuznetsov AN, Nikolaev SG, et al. The variability of representation and latency of the F-wav. Neuromuscular diseases. 2019;9(1):61–66. doi: 0.17650/2222-8721-2019-9-1-61-66 EDN: ZDFHBZ

[8] Mokhov EM, Kadykov VA, SergeevAN,et al.Pain scoring systems and their application features in medicine (literature review). Upper Volgamedical journal. 2019;18(2):34–37. EDN: DEYKPY

RIGHTS & PERMISSIONS

Eco-Vector