目的:化疗引起的周围神经病变(CIPN)是在使用各种抗癌药物治疗后可能发生的并发症。在难治性CIPN病例中,脊髓刺激(SCS)引起了越来越多的关注。使用步态分析和心理物理定量感觉测试(QST)作为CIPN相关损伤的客观测量已经迅速发展;然而,对于使用爆裂或强直刺激进行SCS植入后出现CIPN的患者,这些变化尚未有报道.
方法:该手稿包括两个部分:1)通过步态和QST分析测量的CIPN接受了强直性和突发性SCS的一系列患者的疼痛改善情况,以及2)对与疼痛有关的突发性和强直性SCS刺激与CIPN相关后遗症的外推之间的步态和心理物理QST结果。
结果:在这些情况下,两名患者的步态评分均得到改善。在SCS之前,触摸阈值较高,而背足的皮肤温度较低,亚距骨,和小腿后部。在SCS之后,锐度检测得到显著改善。在审查中,患者与疼痛缓解保持一致,提示对SCS的介入结果反应良好。QST结果,特别是触摸,清晰度,热,和寒冷的刺激,然而,没有得到充分证实。类似于其他非CIPNSCS步态研究,强直性和突发性研究都提供了时空步态参数的积极结果,步态形式,和标准化的步态量表。
结论:在我们的病例系列和综述中,我们强调使用不同的SCS波形作为CIPN管理的治疗方法,以及使用心理物理测试作为诊断和监测CIPN进展的手段。
OBJECTIVE: Chemotherapy-induced peripheral neuropathy (CIPN) is a complication that may occur after treatment with various anticancer drugs. In refractory CIPN cases, spinal cord stimulation (SCS) has garnered increased attention. The use of gait analysis and psychophysical quantitative sensory testing (QST) as an objective measurement of CIPN-related damage has burgeoned; however, these changes have not been reported for patients with CIPN after SCS implantation using either burst or tonic stimulation.
METHODS: This manuscript encompasses two parts: 1) a presentation of pain improvement in a series of patients who underwent tonic vs burst SCS for CIPN measured by gait and QST analysis and 2) a narrative review on gait and psychophysical QST outcomes between burst and tonic SCS stimulation pertaining to pain and the extrapolation to CIPN-related sequalae.
RESULTS: In these cases, gait scores improved in both patients. Touch thresholds were higher before SCS whereas skin temperatures were lower at the dorsal foot, subtalus, and posterior calf. Sharpness detection was drastically improved after SCS. In the review, the patients aligned with pain relief, suggesting good response to interventional outcomes with SCS. QST outcomes, particularly touch, sharpness, heat, and cold stimuli, however, were not fully corroborated. Similarly to other non-CIPN SCS gait studies, both tonic and burst studies provided positive outcomes on spatiotemporal gait parameters, gait form, and standardized gait scales.
CONCLUSIONS: We emphasize the use of different SCS waveforms as a therapy for CIPN management and the use of psychophysical testing as a measure for diagnosis and monitoring CIPN\'s progress in our case series and review.