학술논문
Burst Spinal Cord Stimulation in Pregnancy: First Clinical Experiences.
Document Type
Academic Journal
Author
Meier K; Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark; Center for Experimental Neuroscience, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark. Electronic address: kaamei@rm.dk.; Glavind J; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.; Milidou I; Department of Pediatrics and Adolescent Medicine, Regional Hospital West Jutland, Herning, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.; Sørensen JCH; Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark; Center for Experimental Neuroscience, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.; Sandager P; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.
Source
Publisher: Elsevier Country of Publication: United States NLM ID: 9804159 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-1403 (Electronic) Linking ISSN: 10947159 NLM ISO Abbreviation: Neuromodulation Subsets: MEDLINE
Subject
Language
English
Abstract
Objectives: Spinal cord stimulation (SCS) is a treatment for chronic neuropathic pain. It is based on the delivery of electric impulses to the spinal cord, traditionally in a regular square-wave pattern ("tonic" stimulation) and, more recently, in a rhythmic train-of-five "BurstDR" pattern. The safety of active SCS therapy in pregnancy is not established, and recommendations are based on limited casuistic evidence. We present in this study clinical data on a case series of six women treated with burst SCS during pregnancy. In addition, we present the ultrasonographic flow measurements of fetal and uteroplacental blood flow in a pregnant patient.
Materials and Methods: Patients were included if they had been implanted with a full SCS system at Aarhus University Hospital, Denmark, between 2006 and 2020 and received active burst SCS stimulation during a pregnancy. Telephone interviews were conducted, including details on SCS therapy, medication, pregnancy course and outcome, and health status of the offspring. In one patient, the uteroplacental and fetal blood flow was assessed in gestational week 29 by Doppler flow measurements performed during both ON and OFF phases of the SCS system.
Results: Six patients were included with a total of 11 pregnancies. Three pregnancies ended in miscarriages, all in the same patient who had preexisting significant risk factors for miscarriage. Eight resulted in a live-born child with normal birth weight for gestational age; seven were born at term, and one was born late preterm, in gestational week 36. Ultrasonographic Doppler flow, measured in one patient, was normal and did not reveal any immediate changes between burst SCS ON and OFF. Seven children were reported healthy with normal neurodevelopment and one physically healthy but with developmental delays.
Conclusions: The data presented in this study add to the accumulating evidence of the safety of SCS in pregnancy.
(Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
Materials and Methods: Patients were included if they had been implanted with a full SCS system at Aarhus University Hospital, Denmark, between 2006 and 2020 and received active burst SCS stimulation during a pregnancy. Telephone interviews were conducted, including details on SCS therapy, medication, pregnancy course and outcome, and health status of the offspring. In one patient, the uteroplacental and fetal blood flow was assessed in gestational week 29 by Doppler flow measurements performed during both ON and OFF phases of the SCS system.
Results: Six patients were included with a total of 11 pregnancies. Three pregnancies ended in miscarriages, all in the same patient who had preexisting significant risk factors for miscarriage. Eight resulted in a live-born child with normal birth weight for gestational age; seven were born at term, and one was born late preterm, in gestational week 36. Ultrasonographic Doppler flow, measured in one patient, was normal and did not reveal any immediate changes between burst SCS ON and OFF. Seven children were reported healthy with normal neurodevelopment and one physically healthy but with developmental delays.
Conclusions: The data presented in this study add to the accumulating evidence of the safety of SCS in pregnancy.
(Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)