The following is a summary of “Identifying SCS Trial Responders Immediately After Postoperative Programming with ECAP Dose-Controlled Closed-Loop Therapy,” published in the July 2024 issue of Pain by Pope et al.
Fixed-output spinal cord stimulation (SCS) screening trials may compromise outcomes and poorly predict long-term success, while Evoked compound action potential (ECAP) dose-controlled closed-loop (CL)-SCS objectively confirms therapeutic neural activation and adjusts stimulation parameters.
Researchers conducted a retrospective study examining the initial patient-reported and neurophysiological response following physiological CL-SCS and assessing the feasibility of predicting early responders in SCS trials.
They tracked changes in patient-reported pain relief, functional improvement, and willingness for permanent implant placement. Factors between the start (Day 0) and end of a trial (EOT) stimulation period were also compared for 132 participants. The ECAP-based neurophysiological measurements were analyzed on Day 0 and EOT, comparing the results between groups who responded well to the treatment.
The results showed that the initial evaluation on Day 0 accurately predicted success in most cases with a positive predictive value of 98.4% (60/61). Only a small percentage (5.6%) of the patients who passed the initial evaluation did not respond well to the EOT. ECAP measurements on Day 0 did not distinguish between patients responding immediately and controls requiring more time. According to the EOT, responders used the treatment more frequently and at higher doses than non-responders.
Investigators concluded that high positive predictive value (PPV) and low false-positive rate (FPR) from the Day 0 evaluation support the early prediction of trial outcomes, potentially reducing patient burden and complications. At the same time, ECAP dose-controlled CL-SCS enhances prognostic accuracy in SCS trials.
Source: link.springer.com/article/10.1007/s40122-024-00631-4
