title: Optimizing Stimulation in a Case of Facial Pain Through "Cross-Talk" of Peripheral and Central Leads: A Case Report.
abstract: OBJECTIVE
  To describe inter-lead (cross-talk) stimulation between a trigeminal nerve lead and a cervical epidural lead for the treatment of facial pain in a 69-year-old patient with empty nose syndrome.
  
  
  METHODS
  A trial implant was performed with a peripheral V2 trigeminal lead and a C1-C2 lead in cross-talk configuration. During permanent implant, the V2 lead was placed uneventfully while the central lead could only be advanced to C3-C4.
  
  
  RESULTS
  During the trial, pain decreased by 70%. One month after permanent implant, the patient still experienced a 60-70% reduction in pain levels and a decrease from ten to two weekly pain episodes. Nine months post implant, the patient reported complete pain relief (0/10 on a numeric rating scale ranging from 0 to 10) and medications were discontinued. Infrequent exacerbations (3/10) were controlled by increasing stimulation. Three years post implant, the patient continued to have no baseline pain and could easily control exacerbations.
  
  
  CONCLUSIONS
  Cross-talk configuration between a peripheral and a central lead created a more efficient stimulation technique. The resulting paresthesia was superior to that obtained from either lead alone and exceeded the paresthesia obtained from the combination of the two leads when used simultaneously, without an inter-lead configuration.
authors.forename: W Porter
authors.initials: WP
authors.lastname: McRoberts
mesh_terms: D000368:Aged; D001703:Biophysics; D004599:Electric Stimulation Therapy / Q000379:methods*; D004824:Epidural Space / Q000502:physiology*; D005157:Facial Pain / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014276:Trigeminal Nerve / Q000502:physiology
keywords: cervical spinal stimulation; empty-nose syndrome; facial pain; inter-lead configuration; lead cross-talk; peripheral trigeminal nerve stimulation