Dados do Trabalho

Título

Use of spinal electrode in a patient with vasculitic neuropathy

RESUMO

CASE PRESENTATION
Female patient, 23-year-old, reports sudden onset of petechiae on the lower limbs, from the knee to the foot, which bilateral and apparently symmetrical character. The lesions disappeared after a month, when pain appeared in the same location. After consultation with specialists, the patient underwent electroneuromyography, which revealed a distal symmetrical pattern and received a multidisciplinary diagnosis of vasculitic neuropathy. The rheumatological treatment partially improved the condition, but the intensity and frequency of pain increased after a while. An evaluation with a doctor, pain specialist, was requested to perform a spinal electrode test in the thoracolumbar region. There was a good response with the test, decreasing more than 50% on the pain scale, without intolerable side effects, and so it was decided to implant the electrode and the generator permanently. The patient is in the seventh month of follow-up, with pain intensity around 3, on the Visual Analogue Scale (VAS), with improved quality of life.
DISCUSSION
Vasculitic neuropathy is characterized by the submission of a vessel by an infiltrate of cells due to inflammation, generating ischemia and injury to peripheral nerves. The diagnosis is made by biopsy of the suspected nerve and its treatment is done with immunosuppressants. However, this condition is still poorly documented, since only 31 results were found in the search for MeSH Terms (vasculitic) AND (neuropathy) in the Pubmed database, making this issue a real challenge. The importance of spinal electrical stimulation in the treatment of neuropathic pain refractory to pharmacotherapy has become clear. Its mechanism of action works according to the pain gate theory, in which the posterior horn of the spinal cord controls the passage of stimuli by activating larger-diameter fibers and inhibiting the passage of stimuli from smaller-diameter ones.
FINAL COMMENTS
Therefore, although vasculitic neuropathy is not among the most evident pains, this work addresses the issue between it and the treatment of chronic pain through the use of spinal electrode, having in this report a good response to treatment. Considering that the electroneuromyography of the disease reveals axonal loss, It is possible that just the rheumatologic treatment, alone, is not sufficient for sensory recovery. Therefore, it is necessary to resort to complementary therapies to alleviate the patient's suffering and generate greater functionality.

Palavras Chave

vasculitic, neuropathy