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Medtronic dorsal column stimulators4/16/2024 Medical history: atopic dermatitis and pleuritis Reprogramming (lowering amplitude) led to resolution of symptoms to baseline within 1 week.įBSS with unilateral neuropathic pain in left lower limbĮxperienced two unprecedented episodes of sudden urinary incontinence since placement of epidural electrode, with no urinary symptoms in between Medication use: testosterone isocaproate and lisinopril-hydrochlorothiazide. Medical history: mild obstructive urinary symptoms (untreated), Raynaud’s syndrome, gynecomastia (testosterone isocaproate once monthly), arterial hypertension, and cholecystectomy Imaging showed correct electrode position no conus/spinal cord lesion on MRI Stimulation OFF (3-day trial): immediate improvement to baseline Stimulation ON: exacerbation of obstructive symptoms: hesitancy (impossible micturition during the first minute), increased intermittency, and difficulty defecating Patient with a history of mild obstructive urinary symptoms since a revision with placement of a new epidural electrode, important exacerbation of hesitancy and intermittency (obstructive urinary symptoms) Octopolar (Medtronic, Minneapolis, MN, USA) Revision (implanting a new electrode at a higher cervical level) brought partial relief of symptoms.įBSS with bilateral neuropathic pain in lower limbs Reprogramming brought partial relief of symptoms. Medication use: gabapentin, ibuprofen, pantoprazole, amitriptyline, clonazepam, vitamin B12 Medical history: appendectomy and sleep disturbances Urodynamic study with stimulation ON: limited bladder capacity of 17 cc and immediate loss of urine due to detrusor overactivity (abnormal overactive contraction) Urodynamic study with stimulation OFF: bladder capacity of 140 cc with normal compliance and miction Strong urge to micturate and incontinence during stimulation immediate resolution with stimulation OFF Quadripolar Pisces Quad (Medtronic, Minneapolis, MN, USA) Table 1 summarizes patient-specific details and stimulation-relatedness. Of 386 patients treated with SCS at the University Hospitals Leuven between 20, three patients (0.8%) with SCS presented with new stimulation-related micturition side effects. In theory, loss of normal bladder function can be attributed to an electrical stimulation–induced alteration of functional connectivity, which induces reversible neurogenic bladder symptoms. We discuss the clinical and pathophysiological aspects and propose diagnostic and therapeutic guidance for clinicians encountering autonomic side effects in patients receiving SCS. In the present commentary article, we report on 11 patients with a normal (nonpathological) spinal cord presenting with stimulation-related autonomic side effects during SCS. Little has been reported on side effects caused by disrupting the functional connectivity of nonpathological non-pain pathways. In SCS, epidural electrodes are used to electrically modulate the circuitry in the spinal cord, thereby altering the functional connectivity between peripheral or central pain generators and pain perception networks. Since the first spinal cord electrode implantation in 1967 by Shealy et al., spinal cord stimulation (SCS) has gained an established role in standard pain practice.
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