• Medicine · Oct 2020

    Case Reports

    Effectiveness of high-frequency cervical spinal cord stimulation in the treatment of refractory trigeminal neuropathy: A case report.

    • Daniela Floridia, Francesco Cerra, Francesco Corallo, Marcella Di Cara, Salvatore Spartà, Giovanni Nania, Alessia Bramanti, Placido Bramanti, and Antonino Naro.
    • Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino-Pulejo, Messina, Italy.
    • Medicine (Baltimore). 2020 Oct 2; 99 (40): e22304.

    RationaleTreatment of chronic neuropathic pain in the head and face regions presents a challenge for pain specialists due to the lack of reliable medical and surgical approaches.Patient ConcernsA 62-year-old patient came to our attention for an intense facial pain secondary to a lesion of the right trigeminal nerve (all branches) due to a petroclival meningioma.DiagnosesThe patient also presented with gait impairment as well as a deficit of the right facial, auditory, trochlear and abducens cranial nerves.InterventionsConventional medical management (CMM) as well as tonic SCS were already adopted but they all dramatically failed. We intervened with the use of high-frequency (10 kHz) spinal cord stimulation (HFSCS) at the cervicomedullary junction (CMJ). The patient was thus provided with HFSCS at the CMJ. Pain and quality of life (QoL) were assessed 1 and 3 months after implantation. We also tested the trigeminal-facial reflex responses.OutcomesHFSCS led to a full relief from the debilitating electric shocks like pain in the right hemiface, even though a background dull pain appeared. The gradual addition of pregabalin helped in fully relieving the painful symptomatology, with a significant improvement in QoL. Moreover, sensitivity amelioration on the inner portion of the mouth allowed the patient to start feeding again also using that side of the mouth. These findings were paralleled by a significant reshape of trigeminal-facial reflex responses suggesting an inhibition of nociceptive sensory inputs at brainstem level following HFSCS.LessonsThis is the first report suggesting the usefulness of HFSCS at the CMJ in neuropathic pain due to trigeminal nerve neuropathy non-responsive to tonic SCS and CMM.

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