Pruritus and urticaria induced by neurostimulation: A case report and review of literature

Chirag Goel; Anusha Manjunath; Olivia A Kozel; Archit Bharathwaj Baskaran; William Gibson; Michael R Jones; Joshua M Rosenow

doi:10.25259/SNI_1145_2022

Pruritus and urticaria induced by neurostimulation: A case report and review of literature

Surg Neurol Int. 2023 Jul 14:14:241. doi: 10.25259/SNI_1145_2022. eCollection 2023.

Authors

Chirag Goel¹, Anusha Manjunath¹, Olivia A Kozel², Archit Bharathwaj Baskaran³, William Gibson¹, Michael R Jones¹, Joshua M Rosenow¹

Affiliations

¹ Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States.
² Department of Neurosurgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, United States.
³ Department of Neurology, The University of Chicago Medicine, Chicago, Illinois, United States.

Abstract

Background: Spinal cord stimulation (SCS) consists of the implantation of neuromodulatory devices in the spinal cord to treat refractory neuropathic pain. Although SCS technology has been proven of immense clinical benefit, complications remain including refractory pain, infection risk, and electrode migration or displacement. Till date, there are minimal reports of allergic side effects following SCS implantation.

Case description: In the first case, a 36-year-old male with chronic axial and radicular neuropathic pain in underwent implantation of an open paddle lead and generator. Within 1-3 h of activating the SCS, he developed diffuse raised erythematous hives. Over time, the SCS had immense clinical benefit for his pain reduction; however, he continued to experience recurrent hives and various other allergic reactions including facial flushing and photosensitivity. Four years later, he ultimately opted to retain the device for its clinical pain benefits. In the second case, a 35-year-old female with acute, intractable bilateral occipital neuralgia and a past medical history of Type 1 Chiari Malformation status-post-posterior fossa decompression underwent implantation of an occipital nerve stimulator (ONS). At 1-month follow-up, she began to experience pruritus across the back of her head and along the subcutaneous course of the lead. At 8 months, she continued to experience persistent symptoms, ultimately opting for device removal.

Conclusion: Although allergic reactions to implanted neurostimulation systems are rare, and mechanisms not completely understood, existing studies posit multiple theories surrounding the pathophysiology of allergic reactions to these devices, such as delayed hypersensitivity reactions or contact dermatitis. Further research is needed to elucidate the cutaneous and immunologic side effects of SCS and ONS devices.

Keywords: Functional neurosurgery; Neuromodulation; Occipital nerve stimulation; Spinal cord stimulation; Stereotactic neurosurgery.

Publication types

Case Reports