963 - Increased Seizure Frequency Following Low-Energy Burst Dorsal Root Spinal Cord Stimulator Implantation in a Patient with Chronic Low Back Pain and Pre-Existing Seizure Disorder

Case Diagnosis: 78-year-old male with chronic low back pain due to lumbar facet arthropathy and a longstanding history of seizure disorder who experienced recurrent seizures following spinal cord stimulator (SCS) implantation.

Case Description: The patient, with persistent low back pain since 2018, reported significant pain relief following a successful SCS trial and proceeded with permanent implantation. Despite a remote history of well-controlled generalized tonic-clonic seizures, he began experiencing recurrent seizures approximately 11 months post-implantation, presenting with atypical features such as loss of consciousness, tongue-biting, and postictal confusion. Seizures were correlated with SCS stimulation and typically occurred during periods of rest. Workup, including head CT and EEG, showed no acute abnormalities, but seizures ceased when the SCS was turned off, and the device was ultimately explanted to prevent further episodes.

Discussions: SCS is a well-established therapy for chronic pain, operating via neuromodulation to modulate pain pathways. However, its effects on central nervous system excitability, particularly in patients with seizure disorders, remain complex and not fully understood. Hypotheses suggest that high-frequency stimulation or closer electrode proximity to central neural structures may alter cortical or subcortical excitability, heightening seizure susceptibility in vulnerable patients. Although rare, this case suggests a potential link between SCS and seizure exacerbation, with the temporal relationship supporting a causative association.

Conclusions: This case underscores the importance of thorough patient assessment and interdisciplinary management when considering SCS for patients with seizure history. Conservative programming, careful titration, and monitoring for neurologic changes are advisable. Further research is needed to elucidate the mechanisms of SCS-induced seizure activity and to inform guidelines for SCS use in seizure-prone populations. This case contributes to the limited evidence of potential seizure risks associated with SCS and calls for continued investigation into neuromodulation effects on seizure thresholds.