![]() A preoperative assessment is advised for some patients with diabetes to confirm they are appropriate candidates for surgery. Patients with diabetes may have more frequent and severe complications with surgery. An implanted cardiac device (e.g., pacemaker, defibrillator) may damage a neurostimulator, and electrical pulses from the neurostimulator may cause inappropriate response of the cardiac device. Sources of electromagnetic interference (e.g., defibrillation, electrocautery, MRI, RF ablation, and therapeutic ultrasound) can interact with the system, resulting in unexpected changes in stimulation, serious patient injury or death. After two weeks of burst stimulation, the patient reported significant pain relief (70%) and opted to undergo permanent implantation.Spinal cord stimulation (SCS) is indicated as an aid in the management of chronic, intractable pain of the trunk and/or limbs-including unilateral or bilateral pain.ĭiathermy - Energy from diathermy can be transferred through the implanted system and cause tissue damage resulting in severe injury or death. After the tests, both the pacemaker and SCS were reset to clinically chosen parameters. As seen in Figures 1-2, no sensing activity was evident on pacemaker monitoring in both tests. In the tonic mode, stimulation with a frequency of 80 and current of 7.5 mA was reached in the burst mode, stimulation with 40 Hz frequency, 500 Hz intra-burst frequency and a maximal current of 3.9 mA was reached (clinical target: 0.45 mA). Moreover, stimulation was performed via the leads nearest to the heart (lead 1 and 2). SCS stimulation was tested in both tonic and burst modes by increasing the stimulation intensity stepwise up to the maximally tolerated energy output. ![]() ![]() Specifically, the pacemaker sensitivity threshold was reduced to the most sensitive value (0.5 mV) while pacemaker activity was fully monitored. In collaboration with cardiologists from the specialized pacemaker unit, we tested for potential interference between SCS and the cardiac pacemaker by temporarily setting SCS and the pacemaker in such a way as to maximize the probability of interference. Correct electrode placement was tested by generating paresthesia in the areas in which the patient reported pain. Under x-ray guidance, one Octrode lead was inserted by means of a peridural approach, with the tip reaching the T10-T11 level. Questo caso utilizza la stimolazione Burst, che a pari della tonica si è dimostrata sicura in pazienti con pacemaker cardiaco.Īfter the risks and benefits of SCS had been explained to the patient, he consented to try SCS. I risultati del caso clinico sono in accordo con la letteratura, che evidenza la sicurezza dell’impianto di neurostimolatore con stimolazione tonica in pazienti portatori di pacemaker cardiaco. Durante la procedura, non è stata osservata alcuna interferenza con rilevamento pacemaker. La sensibilità del pacemaker era impostata al massimo (0,5 mV). L’intensità di stimolazione SCS è stata aumentata progressivamente fino alla soglia di tollerabilità del paziente (7,5 mA tonico, 3,9 mA burst). Durante l’operazione i test di stimolazione sono stati eseguiti sia in Tonico che in Burst monitorando l’attività dell’pacemaker in tempo reale. Per trattare il dolore neuropatico è stato inserito un elettrocatetere nello spazio epidurale a livello T10-T11. Si rilevavano inoltre comorbidità con blocco atrio-ventricolare pacemaker-dipendente (terzo grado) e adenoma prolattina secernente della ghiandola pituitaria. Riassunto Un paziente maschio di 74 anni si presentava alla nostra osservazione con dolore neuropatico nella porzione distale degli arti inferiori non responsivo ai precedenti trattamenti medici.
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