Objective: To present a case-study on use of closed-loop spinal cord stimulation (CL-SCS) for treating post-hypoxic myoclonus.

Background: Post-hypoxic myoclonus is severely disabling and can be refractory to conventional medical management. Limited information is available on use of SCS for treatment of this rare delayed movement disorder. Here, we report on use of novel CL-SCS technology in treatment of myoclonus with comorbid chronic pain in the upper extremities.

Method: An 88-year-old Caucasian female presented with hypertension, mild dementia, right carotid stenosis post-endarterectomy, right frontal lobe ischemic stroke with persistent left-sided deficits in 2021 and right-sided cervical radiculopathy in 2023.  The patient experienced post-hypoxic myoclonus after an ischemic stroke. The patient reported severe right-sided neck and upper extremity pain, indicative of right C5 and C6 radiculopathy in early 2023. Cervical MRI confirmed the presence of moderate right-sided neuroforaminal stenosis without significant central stenosis.

Results: Patient was refractory to conventional medical management including C7-T1 right-sided interlaminar epidural steroid injections. A successful 7-day spinal cord stimulation CL-SCS trial to treat her chronic radiculopathy resulted in > 75% neck and right upper extremity pain relief and myoclonus symptom improvement. Permanent CL-SCS implantation resulted in sustained pain relief (>80%), decreased myoclonus frequency/severity (80-85% reduction), and significant improvement in activities of daily living (ADLs) at the 3-month follow-up visit. Objective CL-SCS therapy performance metrics including amount of dorsal column fiber activation and activation accuracy were collected during the follow-up visits.

Conclusion: Although preliminary, closed-loop SCS significantly improved symptoms of stroke induced post-hypoxic myoclonus. Closed-loop SCS consistently activates primary sensory Ab neurons in the spinal cord. This may indirectly deter altered central processing of nociceptive stimuli and dysfunction in the supraspinal neurotransmission system involving subcortical structures like the basal ganglia nuclei.

« Back to 2024 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/closed-loop-spinal-cord-stimulation-a-case-report-on-a-novel-therapeutic-approach-for-post-hypoxic-myoclonus/