Cyclization of Motor Cortex Stimulation for Neuropathic Pain: A Prospective, Randomized, Blinded Trial

Ivanishvili, Zurab; Poologaindran, Anujan; Honey, Christopher R.

doi:10.1111/ner.12610

Cited by 10 publications

(8 citation statements)

References 24 publications

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“…The suspected loss of CMS efficacy over time could be explained by a tolerance phenomenon. 12,20,21 Some of the strategies proposed to address this effect are cyclization programing, 16,22,23 setting the amplitude at 60% of the motor threshold, 16 and patient hospitalization to perform an intensive reprograming session. 23 Regarding the biological mechanisms of action, cathodal stimulation of the motor cortex could activate cortical interneurons, which indirectly trigger descending pathways to the thalamus and spinal cord.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Results of Cortical Motor Stimulation for Neuropathic Peripheral and Central Pain: Real-World Evidence From Two Independent Centers

Aibar-Durán,

Villalba Martínez,

Freixer-Palau

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: Cortical motor stimulation (CMS) is used to modulate neuropathic pain. The literature supports its use; however, short follow-up studies might overestimate its real effect. This study brings real-world evidence from two independent centers about CMS methodology and its long-term outcomes. METHODS: Patients with chronic refractory neuropathic pain were implanted with CMS. The International Classification of Headache Disorders 3rd Edition was used to classify craniofacial pain and the Douleur Neuropathique en 4 Questions Scale score to explore its neuropathic nature. Demographics and clinical and surgical data were collected. Pain intensity at 6, 12, and 24 months and last follow-up was registered. Numeric rating scale reduction of ≥50% was considered a good response. The Clinical Global Impression of Change scale was used to report patient satisfaction. RESULTS: Twelve males (38.7%) and 19 females (61.3%) with a mean age of 55.8 years (±11.9) were analyzed. Nineteen (61.5%) were diagnosed from painful trigeminal neuropathy (PTN), and seven (22.5%) from central poststroke pain. The mean follow-up was 51 months (±23). At 6 months, 42% (13/31) of the patients were responders, all of them being PTN (13/19; 68.4%). At last follow-up, only 35% (11/31) remained responders (11/19 PTN; 58%). At last follow-up, the global Numeric rating scale reduction was 34% (P = .0001). The Clinical Global Impression of Change scale punctuated 2.39 (±0.94) after 3 months from the surgery and 2.95 (±1.32) at last follow-up (P = .0079). Signs of suspicious placebo effect were appreciated in around 40% of the nonresponders. CONCLUSION: CMS might show long-term efficacy for neuropathic pain syndromes, with the effect on PTN being more robust in the long term. Multicentric clinical trials are needed to confirm the efficacy of this therapy for this and other conditions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-Term Results of Cortical Motor Stimulation for Neuropathic Peripheral and Central Pain: Real-World Evidence From Two Independent Centers

Aibar-Durán,

Villalba Martínez,

Freixer-Palau

et al. 2023

Neurosurgery

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“…In clinical practice, programming MCS is difficult, mainly because it usually takes several days before the patients feel any change after the setting was modified. For example, the authors report in this paper that "patients typically began to feel the ill effects of an ineffective cyclized setting approximately three days after the setting was changed" (1). Exceptionally, some patients may have an ON/ OFF effect, that is, an almost immediate clinical response to MCS (2).…”

Section: Place Of Cyclization Mode In the Adjustment Of Parameters Fomentioning

confidence: 95%

“…We read with great interest the publication by Ivanishvili et al (1) entitled "Cyclization of Motor Cortex Stimulation for Neuropathic Pain: A Prospective, Randomized, Blinded Trial", published in Neuromodulation, which reports a series of six patients who were successfully treated for neuropathic pain by motor cortex stimulation (MCS) using a continuous mode of stimulation (1). The goal of the study was to investigate whether a cyclic mode for MCS therapy could be as effective as a continuous mode in a prospective, randomized, blinded trial.…”

Section: Place Of Cyclization Mode In the Adjustment Of Parameters Fomentioning

confidence: 98%

Place of Cyclization Mode in the Adjustment of Parameters for Motor Cortex Stimulation Used to Treat Neuropathic Pain

Nǵuyen¹,

Nizard

Lefaucheur

2017

Neuromodulation: Technology at the Neural Interface

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“…Similar studies have not been extended into the perioperative setting, but numerous studies have established the role of TMS and fMRI data as biomarkers to predict motor recovery following stroke, warranting further investigation following neuro-oncological resection [46,47]. Lastly, interventional neurorehabilitation can also be utilised in other patient populations following stroke-induced pain or movement disorders [48][49][50] With rising open science and international collaborative efforts, prospective registrybased clinical studies could be employed to overcome heterogeneous glioma populations and derive more practical outcomes.…”

Section: Future Directions For Interventional Neurorehabilitationmentioning

confidence: 99%

Interventional Neurorehabilitation for Promoting Functional Recovery Post-Craniotomy: A Proof-of-Concept

Poologaindran

Profyris

Young

et al. 2021

Preprint

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Purpose: The human brain is a highly plastic complex network -it is highly resilient to damage and capable of self-reorganisation after a large perturbation. Clinically, neurological deficits secondary to iatrogenic injury have very few active treatments. New imaging and stimulation technologies, though, offer promising therapeutic avenues to accelerate post-operative recovery trajectories. In this study, we sought to establish the safety profile for interventional neurorehabilitation: connectome-based therapeutic brain stimulation to drive cortical reorganisation and promote functional recovery post-craniotomy. Methods: In n=34 glioma patients who experienced post-operative motor or language deficits, we used connectomics to construct single-subject cortical networks. Based on their clinical and connectivity deficit, patients underwent network-specific Transcranial Magnetic Stimulation (TMS) sessions daily over five consecutive days. Patients were then assessed for TMS-related side effects and improvements. Results: 31/34 (91%) patients were successfully recruited and enrolled for TMS treatment within two weeks of glioma surgery. No seizures or serious complications occurred during TMS rehabilitation and one-week post-stimulation. Transient headaches were reported in 4/31 patients but improved after a single session. No neurological worsening was observed while a benefit was noted in 28/31 patients post-TMS. We present two clinical vignettes and a video demonstration of interventional neurorehabilitation. Conclusions: For the first time, we demonstrate the safety profile and ability to recruit, enrol, and complete TMS acutely post-craniotomy in a high seizure risk population. Given the lack of randomisation and controls in this study, prospective randomised sham-controlled stimulation trials are now warranted to establish the efficacy of interventional neurorehabilitation following craniotomy.

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Cyclization of Motor Cortex Stimulation for Neuropathic Pain: A Prospective, Randomized, Blinded Trial

Cited by 10 publications

References 24 publications

Long-Term Results of Cortical Motor Stimulation for Neuropathic Peripheral and Central Pain: Real-World Evidence From Two Independent Centers

Long-Term Results of Cortical Motor Stimulation for Neuropathic Peripheral and Central Pain: Real-World Evidence From Two Independent Centers

Place of Cyclization Mode in the Adjustment of Parameters for Motor Cortex Stimulation Used to Treat Neuropathic Pain

Interventional Neurorehabilitation for Promoting Functional Recovery Post-Craniotomy: A Proof-of-Concept

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