Clinical Neurology and Neurosurgery 101 (1999) 125–127
Case report
Efficacy of spinal cord stimulation for neuropathic pain following
idiopathic acute transverse myelitis: a case report
J.G. Laffey *, D. Murphy, J. Regan, D. O’Keeffe
Department of Anaesthesia, St. Vincent
’
s Hospital, Elm Park, Dublin
4
, Ireland
Received 5 November 1998; received in revised form 1 February 1999; accepted 3 February 1999
Abstract
Spinal cord stimulation (SCS) involves the electrical stimulation of dorsal structures within the spinal cord, and is the most
widespread application of neurostimulation for the relief of chronic pain. Idiopathic acute transverse myelitis (IATM) is an acute
monophasic lesion of the spinal cord that presents with symptoms associated with loss of cord function. The incidence of chronic
pain secondary to this condition is unknown, but is considered rare. We report the efficacy of SCS for relief of severe neuropathic
pain in both lower limbs secondary to IATM, which had failed to respond to conventional pain therapies. © 1999 Elsevier Science
B.V. All rights reserved.
Keywords
:
Electrical stimulation; Myelopathy; Neuropathic pain; Spinal cord; Transverse myelitis
1. Introduction
Spinal cord stimulation (SCS), first described by
Shealy et al. [1], is the most widespread application of
neurostimulation [2]. Idiopathic acute transverse myeli-
tis (IATM) is an acute episode of cord inflammation
that does not recur, i.e. an acute monophasic lesion [3].
Patients exhibit symptoms associated with loss of func-
tion of spinal cord segments. Precipitating causes in-
clude preceding viral infection, immunocompromise,
post-vaccine, vascular insufficiency or systemic vasculi-
tis, but it is often not identified. It may result in a
persistent disability or even death, but many patients
recover fully without sequelae [4]. A late complication
of IATM is chronic neuropathic pain below the level of
the initial spinal lesion. This report highlights the effi-
cacy of spinal cord stimulation for neuropathic pain
secondary to IATM.
2. Case report
A 43-year-old female had neuropathic pain in both
lower limbs, present secondary to IATM at the level of
T5, 4 years previously. She presented with back pain,
spinal shock and loss of sphincter control and sensori-
motor function below the level of the lesion. The diag-
nosis was based on the clinical picture, a cerebrospinal
fluid (CSF) lymphocytosis (105 white blood cells with
100% monocytes) with increased protein levels (70
mg%), and magnetic resonance imaging (MRI) find-
ings. MRI T2 weighted axial images revealed a patchy
diffuse area of increased signal intensity over multiple
vertebral segments from T5 to T7, involving the major-
ity of the cross-sectional area of the cord, which exhib-
ited diffuse enhancement with gadolinium. MRI of the
brain was normal. The aetiology remained unclear,
with CSF cultures, serology for Epstein –Barr, syphilis,
mycoplasma pneumonia, cytomegalovirus, herpes sim-
plex, varicella zoster, hepatitis A and B, toxoplasmosis,
anti-nuclear cytoplasmic antibodies and anti-dsDNA all
negative.
Treatment was commenced with high dose methyl-
prednisolone and pulse dose cyclophosphamide for 3
* Corresponding author. Current address: c/o Department of
Anaesthesia, The Toronto Hospital, General Division, 200 Elizabeth
St, Toronto, Ont., M5G 2C4, Canada.
0303-8467/99/$ - see front matter © 1999 Elsevier Science B.V. All rights reserved.
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