Efficacy of Motor Cortex Stimulation for Intractable Central Neuropathic Pain: Comparison of Stimulation Parameters Between Post-stroke Pain and Other Central Pain

Abstract

Motor cortex stimulation (MCS) has now become the preferred option for neurosurgical management of intractable central neuropathic pain such as post-stroke pain and trigeminal neuropathic pain. However, the efficacy of MCS for other central neuropathic pain such as pain resulting from spinal cord or brainstem lesions is unclear. We retrospectively reviewed 11 consecutive patients with intractable central neuropathic pain who underwent MCS in our institution. Eight patients had poststroke pain caused by thalamic hemorrhage (n ＝ 5) or infarction (n ＝ 3) (thalamic group). Two patients had postoperative neuropathic pain caused by spinal cord lesions, and one patient had facial pain caused by a brainstem lesion associated with multiple sclerosis (brainstem-spinal group). Visual analog scale and stimulation parameters were evaluated at 1 and 6 months postoperatively. MCS was effective for six of eight patients in the thalamic group, and all three patients in the brainstem-spinal group. These efficacies continued for 6 months after surgery without significant change in the stimulation parameters compared with the parameters at 1 month in both groups. The mean amplitude at 1 month and frequency at 6 months after surgery were significantly higher in the brainstem-spinal group than the thalamic group, although the patient number was small. MCS is effective for other central neuropathic pain, but higher intensity stimulation parameters may be necessary to gain adequate pain reduction.

Motor Cortex Neurostimulation Technologies for Chronic Post-stroke Pain: Implications of Tissue Damage on Stimulation Currents

“…This study suggests that EBS, tDCS, and TMS neurostimulation current density distributions are altered in the presence of strokes in a manner that may explain discrepancies in CPSP treatment outcomes across the different stimulation techniques (André-Obadia et al, 2008, 2011, 2014; Hosomi et al, 2008, 2013; Lefaucheur et al, 2008, 2011a,b; Velasco et al, 2008; Tanei et al, 2011; Sachs et al, 2014). Currents flow down the path of least resistance, in the highly conductive CSF at an infarction location, and impact the current density distributions in magnitude, location, and orientation for EBS ( Figure 1 ), TMS ( Figure 2A ), and tDCS ( Figure 2B ) (Wagner et al, 2006, 2007a,b, 2009).…”

Motor Cortex Stimulation in Patients with Chronic Central Pain

“…This situation occurs in neuropathic trigeminal pain; in thalamic syndrome, patients generally report no sensations. The experience of other researchers indicates significant improvements in the effectiveness of MCS after changing the stimulation parameters [20,21]. In order to overcome habituation, the authors change the mode from cycling to continuous stimulation or vice versa, and in cycling mode the off period is prolonged or shortened.…”

Motor cortex stimulation for facial chronic neuropathic pain: A review of the literature

“…[52557637880104] These scales are applied in the preoperative, during the trial, as well as in the postoperative period and follow-ups. In some studies the pain outcome was also reported according to a pain relief scale, similar to this one, but there is some variation between the reports in the ranges of percentages: [77111]…”

“…[118119120] In the worldwide literature, there is a growing interest on stimulation of the motor cortex for treatment of FCNP [Figure 1]. [96] Initially tried for thalamic pain, it has been tried for many treatment-resistant pain syndromes [54] such as phantom limb pain, [95101106] postherpetic neuralgia, brachial plexus avulsion, [57] poststroke pain, [324648505176106111] Wallenberg syndrome,[3349] complex regional pain syndrome, [2770108] pain secondary to multiple sclerosis, [112] spinal cord injury pain, [88113] and posttraumatic brain injury pain. [107] Recently, MCS has also been tried in other nonpainful conditions.…”