gms | German Medical Science

Objective: Peripheral nerve stimulation (PNS) delivers targeted relief from neuropathic pain in peripheral nerve disorders. Traditional approaches promote placement of one electrode in proximity to the nerve lesion. Durability of hardware, limited therapeutic range and motor side effects are common problems often prompting multiple revisions. In SCS it is an accepted development to improve stimulation results by more complex electrode designs or combinations of electrodes. We demonstrate PNS of the proximal sciatic nerve with two or more electrodes in patients with neuropathic pain of different origins refractory to conservative treatment or other neuromodulation approaches.

Methods: Four patients (2 male/2 female) with neuropathic foot or leg pain due to extensive trauma (2), compartment syndrome (1) or amputation (1) underwent electrode placement at the proximal portion of the sciatic nerve over a dorsal approach. Electrodes were placed adjacent to each other to allow a thorough coverage. Effects, thresholds and therapeutic range for single and combined stimulation were assessed during trial period and 3 months after stimulator placement.

Results: In all patients combined stimulation was superior to single electrode stimulation regarding therapeutic effect and range. Mean paresthesia coverage was 85% for combined vs. 45% for single stimulation. VAS improvement at mean 68% was recorded at 12-month follow-up. Median follow-up is 15 months.

Conclusions: Our preliminary data suggest improved PNS results with more complex stimulation setups. The possibility to achieve stimulation coverage and selectiveness more independently from anatomic considerations may help to avoid complications, surgical revisions und improve therapeutic success.