Lerman Imanuel R, Chen Jeffrey L, Hiller David, Souzdalnitski Dmitri, Sheean Geoffrey, Wallace Mark, Barba David
University of California San Diego, San Diego, CA, USA.
Western Reserve Hospital, Cuyahoga Falls, OH, USA.
Neuromodulation. 2015 Aug;18(6):487-93; discussion 493. doi: 10.1111/ner.12281. Epub 2015 Apr 1.
The study aims to describe an ultrasound (US)-guided peripheral nerve stimulation implant technique and describe the effect of high-frequency peripheral nerve stimulation on refractory postherpetic neuralgia.
Following a cadaver pilot trial using US and confirmatory fluoroscopic guidance, a 52-year-old man with refractory left supraorbital neuralgia underwent combined US and fluoroscopic-guided supraorbital peripheral nerve stimulator trial. The patient was subsequently implanted with a percutaneous lead over the left supraorbital and supratrochlear nerve utilizing a high-frequency stimulation paradigm.
At 9 months follow-up, the pain intensity had declined from a weekly average of 8/10 to 1/10 on the pain visual analog scale (VAS). After implant, both nerve conduction and blink reflex studies were performed, which demonstrated herpetic nerve damage and frequency-specific peripheral nerve stimulation effects. The patient preferred analgesia in the supraorbital nerve distribution accomplished with high-frequency paresthesia-free stimulation (HFS) at an amplitude of 6.2 mA, a frequency of 100-1200 Hz, and a pulse width of 130 μsec, to paresthesia-mediated pain relief associated with low-frequency stimulation.
We report the implant of a supraorbital peripheral nerve stimulating electrode that utilizes a high-frequency program resulting in sustained suppression of intractable postherpetic neuralgia.
本研究旨在描述一种超声（US）引导下的周围神经刺激植入技术，并描述高频周围神经刺激对难治性带状疱疹后神经痛的影响。
在使用超声进行尸体预试验并经X线透视确认引导后，一名52岁患有难治性左眶上神经痛的男性患者接受了超声和X线透视引导下的眶上周围神经刺激器联合试验。随后，利用高频刺激模式在患者左眶上神经和滑车上神经上方植入经皮导线。
在9个月的随访中，疼痛强度从疼痛视觉模拟量表（VAS）上的每周平均8/10降至1/10。植入后，进行了神经传导和眨眼反射研究，结果显示存在疱疹性神经损伤以及频率特异性周围神经刺激效应。与低频刺激介导的感觉异常性疼痛缓解相比，患者更倾向于通过高频无感觉异常刺激（HFS）实现的眶上神经分布区域镇痛，该刺激的幅度为6.2 mA，频率为100 - 1200 Hz，脉宽为130 μsec。
我们报告了一种眶上周围神经刺激电极的植入，该电极采用高频程序，可持续抑制难治性带状疱疹后神经痛。
