Therapeutic role of Differential Target Multiplexed (DTM) spinal cord stimulation in painful diabetic neuropathy. Case report

Diabetic peripheral polyneuropathy (DPN) is the most common cause for diabetic foot complications, including diabetic ulcers, Charcot arthropathy, and lower limb amputations. Spinal Cord Stimulation (SCS) is a safe and effective treatment used for pain reduction in neuropathic/nociceptive pain conditions; the most common stimulation modalities used for the management of painful diabetic neuropathy were conventional paresthesia-based and high-frequency SCS, which stimulate the A beta fibers in the dorsal column of the spinal cord. Differential Target Multiplexed (DTM) SCS is a novel paresthesia-free stimulation technique targeting the supportive glial cells in the nervous system, modulating glial cells and neurons with a rebalance of their interactions. We report a case of severe painful DPN who had immediate pain relief after DTM-SCS implantation, with constant pain relief during the 12 months follow-up. We also investigated the effect of neurostimulation on diabetes control, evaluating the preoperative and postoperative glucose metrics using Continuous Glucose Monitoring (CGM) and compared neurophysiological examination results of the peripheral lower limbs' nerves.