Case Report: Spinal cord stimulation for neuropathic pain from spinal cysticercosis

Rationale: Spinal cord cysticercosis, an exceptionally rare form of neurocysticercosis (NCC), often leads to refractory neuropathic pain and neurological deficits. Current treatments (e.g., antiparasitics or decompressive surgery) may fail to alleviate symptoms, necessitating alternative strategies. Spinal cord stimulation (SCS) is well-established for chronic pain but has rarely been reported for NCC-related pain. Patient concerns: A 69-year-old female presented with an 8-year history of progressively worsening trunk and limb pain (burning sensation, VAS 8/10), sensory abnormalities, and lower limb weakness (MMT 3/5). She had undergone laminectomy for spinal cysticercosis in South Korea, but pain persisted post-operatively. Diagnoses: MRI revealed residual cystic lesions with arachnoiditis at T12-L2, consistent with inactive spinal cysticercosis. Electromyography confirmed mixed sensorimotor polyneuropathy. Interventions: After multidisciplinary evaluation, a percutaneous SCS electrode was implanted at T10. Intraoperative testing achieved 80% pain coverage. Parameters were titrated post-operatively (frequency: 40 Hz, pulse width: 300 μs). Outcomes: At the 1-week follow-up, the patient reported significant pain relief, with her visual analog scale score dropping to 2 out of 10. Motor strength improved to grade 4 out of 5 on manual muscle testing, and sensory function returned to normal. These benefits persisted at the 3-month follow-up, accompanied by a 75% reduction in opioid requirements, measured in morphine milligram equivalents. Lessons: SCS may be a viable option for spinal cysticercosis-induced central neuropathic pain when conventional therapies fail. Its dual benefits (pain relief + functional recovery) warrant further study in NCC-related complications. Early SCS intervention could prevent chronic disability in similar cases.