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Epidural Spinal Cord Stimulation for Spasticity: a Systematic Review of the Literature.
Jung, Youngkyung; Breitbart, Sara; Malvea, Anahita; Bhatia, Anuj; Ibrahim, George M; Gorodetsky, Carolina.
Afiliación
  • Jung Y; Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: jessica.jung@medportal.ca.
  • Breitbart S; Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.
  • Malvea A; Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
  • Bhatia A; Department of Anesthesia and Pain Medicine, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
  • Ibrahim GM; Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toront
  • Gorodetsky C; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
World Neurosurg ; 183: 227-238.e5, 2024 Mar.
Article en En | MEDLINE | ID: mdl-38181878
ABSTRACT

OBJECTIVE:

Spasticity is a form of muscle hypertonia secondary to various diseases, including traumatic brain injury, spinal cord injury, cerebral palsy, and multiple sclerosis. Medical treatments are available; however, these often result in insufficient clinical response. This review evaluates the role of epidural spinal cord stimulation (SCS) in the treatment of spasticity and associated functional outcomes.

METHODS:

A systematic review of the literature was performed using the Embase, CENTRAL, and MEDLINE databases. We included studies that used epidural SCS to treat spasticity. Studies investigating functional electric stimulation, transcutaneous SCS, and animal models of spasticity were excluded. We also excluded studies that used SCS to treat other symptoms such as pain.

RESULTS:

Thirty-four studies were included in the final analysis. The pooled rate of subjective improvement in spasticity was 78% (95% confidence interval, 64%-91%; I2 = 77%), 40% (95% confidence interval, 7%-73%; I2 = 88%) for increased H-reflex threshold or decreased Hoffman reflex/muscle response wave ratio, and 73% (65%-80%; I2 = 50%) for improved ambulation. Patients with spinal causes had better outcomes compared with patients with cerebral causes. Up to 10% of patients experienced complications including infections and hardware malfunction.

CONCLUSIONS:

Our review of the literature suggests that SCS may be a safe and useful tool for the management of spasticity; however, there is significant heterogeneity among studies. The quality of studies is also low. Further studies are needed to fully evaluate the usefulness of this technology, including various stimulation paradigms across different causes of spasticity.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Estimulación de la Médula Espinal / Espasticidad Muscular Tipo de estudio: Systematic_reviews Límite: Humans Idioma: En Revista: World Neurosurg Asunto de la revista: NEUROCIRURGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Estimulación de la Médula Espinal / Espasticidad Muscular Tipo de estudio: Systematic_reviews Límite: Humans Idioma: En Revista: World Neurosurg Asunto de la revista: NEUROCIRURGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos