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TREATMENT OF PAINFUL CONTRACTIONS AND NEUROPATHIC SYMPTOMS IN A CHILD WITH TETHERED CORD SYNDROME
ESRA Academy. Çok OY. Sep 8, 2016; 138527; 0392 Topic: MISCELLANEOUS
Assoc. Prof. Oya Yalçın Çok
Assoc. Prof. Oya Yalçın Çok

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Abstract
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Background and Aims:

Pain is a common symptom in tethered cord syndrome (TCS) and is the one most likely to be improved by surgery(1). Unfortunately, pain with neuropathic components and painful contractions due to spinal irritation might continue after surgery. Here we described the treatment with pregabalin and clonazepam in the management of neuropathic symptoms and painful contractions in a child with TCS. 

Methods:

A 4,5 years old girl with a history of TCS presented with severe pain in her lower limbs. The patient underwent surgical untethering twice but post-surgery the patient did not show significant pain relief. The patient described burning pain pointing at her feet. The family also described painful episodic contractions at her lower limbs which lasted approximately for 3 minutes. These episodes occurred 2 to 3 times per day for 3 years. Anxiety and falling asleep was triggering her pain and the patient was getting a prostration position all over the night to sleep without pain. Despite the treatment with gabapentin 3x100 mg and carpamezepine 2x100 mg she was suffering from severe chronic pain.

Results:

A 60% decrease in pain was obtained but no more recovery was achieved for painful contractions after tramadol 3x5 drops and pregabaline 2x50 mg. Management of painful contractions and neuropathic symptoms was achieved after organizing medical therapy with clonazepam 3x3 drops and  pregabaline 2x70 mg per day.

Conclusions:

In the management of pain in children with TCS, clonazepam for painful contractions due to spinal irritation and pregabaline for neuropathic symptoms would be considered. 

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