Long-term effect of motor cortex stimulation in patients suffering from chronic neuropathic pain: An observational study

Henssen, Dylan; Kurt, Erkan; Walsum, Anne van Cappellen van Marie; Arnts, Inge; Doorduin, Jonne; Kozicz, Tamás; Dongen, Robert van; Bartels, Ronald H. M. A.

doi:10.1371/journal.pone.0191774

Cited by 22 publications

(16 citation statements)

References 52 publications

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“…Risk of bias as assessed by the RoB2 showed that all included papers had a low overall risk-of-bias judgement 47,[75][76][77] . Risk of bias as assessed by the ROBINS-I showed that all included papers had a moderate overall risk-of-bias judgement 9,10,13,24,40,[42][43][44][45]55,[78][79][80][81][82][83][84][85][86] . Table 1 provides an overview of the quality of the evidence of the included papers, respectively.…”

Section: Resultsmentioning

confidence: 99%

Motor cortex stimulation in chronic neuropathic orofacial pain syndromes: a systematic review and meta-analysis

Henssen

Kurt

Walsum

et al. 2020

Sci Rep

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Invasive motor Cortex Stimulation (iMCS) was introduced in the 1990's for the treatment of chronic neuropathic orofacial pain (CNOP), although its effectiveness remains doubtful. However, CNOP is known to be a heterogeneous group of orofacial pain disorders, which can lead to different responses to iMCS. Therefore, this paper investigated (1) whether the effectiveness of iMCS is significantly different among different CNOP disorders and (2) whether other confounding factors can be impacting iMCS results in CNOP. A systematic review and meta-analysis using a linear mixed-model was performed. Twenty-three papers were included, totaling 140 CNOP patients. Heterogeneity of the studies showed to be 55.8%. A visual analogue scale (VAS) measured median pain relief of 66.5% (ranging from 0-100%) was found. Linear mixed-model analysis showed that patients suffering from trigeminal neuralgia responded significantly more favorable to iMCS than patients suffering from dysfunctional pain syndromes (p = 0.030). Also, patients suffering from CNOP caused by (supra)nuclear lesions responded marginally significantly better to iMCS than patients suffering from CNOP due to trigeminal nerve lesions (p = 0.049). No other confounding factors were elucidated. This meta-analysis showed that patients suffering from trigeminal neuralgia and patients suffering from (supra)nuclear lesions causing CNOP responded significantly more favorable than others on iMCS. No other confounding factors were found relevant.In the early 1990's, Tsubokawa and his colleagues searched for a new therapy to treat intractable neuropathic pain as other forms of therapies, including continuous deep brain stimulation of thalamic nuclei, only provided satisfactory pain relief in approximately 30% of the cases. For that reason, they started to empirically stimulate various brain regions in animal models for intractable neuropathic pain. During their experiments, they recognized the primary motor cortex as a target that could provide excellent pain relief. Within their experiments, Tsubokawa transected the spinothalamic tract in cats, which led to thalamic hyperactivity and pain-related behavior. By stimulating the primary motor cortex in these cats, it was found that both the hyperactivity was inhibited and the pain-related behavior diminished, indicating an analgesic effect of iMCS in the treated cats. These experimental findings were in line with their subsequent clinical investigations in individuals suffering from intractable neuropathic pain as a consequence of thalamic syndrome 1-5 . Since then, iMCS has been carried out in approximately 700 cases world-wide, yielding highly variable outcomes 1,6-40 . Nevertheless, iMCS has become a last resort neurosurgical therapy for different intractable neuropathic pain syndromes 3-5,14,17,21,26,35,41-44 . In 1993, Meyerson et al. reported for the first time on the use of iMCS in chronic neuropathic orofacial pain (CNOP) as a last resort treatment. They reported that, in a case series of 10 individuals suffering from CNOP...

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Section: Resultsmentioning

confidence: 99%

Motor cortex stimulation in chronic neuropathic orofacial pain syndromes: a systematic review and meta-analysis

Henssen

Kurt

Walsum

et al. 2020

Sci Rep

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“…49 Yet another study found that the duration of pain before iMCS surgery was of significant importance when it constituted >5 years, 29 whereas 1 study found no significant differences between responders and nonresponders to iMCS. 22 A more recent study from our group found that central lesions to respond more favorably to iMCS as compared with peripheral lesions, 28 which was agreed on in an expert meeting on iMCS. 34 However, none of these results were found to be of clinical importance in subsequent studies.…”

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confidence: 76%

Systematic Review and Neural Network Analysis to Define Predictive Variables in Implantable Motor Cortex Stimulation to Treat Chronic Intractable Pain

Henssen

Witkam

Dao

et al. 2019

The Journal of Pain

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“…A significant pain reduction as a response to a preoperative non-invasive rTMS test increases the probability of a good MCS therapeutic result [67]. However, since the available data is based on a limited number of patients, additional placebo-controlled, prospective clinical trials using neuronavigated rTMS are needed to manifest this relationship [13,68,69].…”

Section: Accuracy Of Rtms To Predict the Response Of Epidural Motor Cmentioning

confidence: 99%

“…DBS generally yields poor results in patients with chronic NP and is utilised only in a small subset of pain patients in whom other interventional methods have failed [8,11,12]. Although MCS has been demonstrated to produce significant pain reduction in subsets of patients with NP [13,14], the use of this technique has been hampered by difficulties to select the right patients, and to optimise and standardize stimulation parameters in order to achieve adequate, longterm pain relief [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Repetitive transcranial magnetic stimulation of the primary motor cortex in management of chronic neuropathic pain: a systematic review

Gatzinsky

Bergh

Liljegren

et al. 2020

Scandinavian Journal of Pain

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ObjectivesRepetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex (M1) with frequencies 5–20 Hz is an expanding non-invasive treatment for chronic neuropathic pain (NP). Outcome data, however, show considerable inhomogeneity with concern to the levels of effect due to the great diversity of treated conditions. The aim of this review was to survey the literature regarding the efficacy and safety of M1 rTMS, and the accuracy to predict a positive response to epidural motor cortex stimulation (MCS) which is supposed to give a more longstanding pain relief.MethodsA systematic literature search was conducted up to June 2019 in accordance with the PRISMA guidelines. We used the PICO Model to define two specific clinical questions: (1) Does rTMS of M1 relieve NP better than sham treatment? (2) Can the response to rTMS be used to predict the effect of epidural MCS? After article selection, data extraction, and study quality assessment, the certainty of evidence of treatment effect was defined using the GRADE system.ResultsData on 5–20 Hz (high-frequency) rTMS vs. sham was extracted from 24 blinded randomised controlled trials which were of varying quality, investigated highly heterogeneous pain conditions, and used excessively variable stimulation parameters. The difference in pain relief between active and sham stimulation was statistically significant in 9 of 11 studies using single-session rTMS, and in 9 of 13 studies using multiple sessions. Baseline data could be extracted from 6 single and 12 multiple session trials with a weighted mean pain reduction induced by active rTMS, compared to baseline, of −19% for single sessions, −32% for multiple sessions with follow-up <30 days, and −24% for multiple sessions with follow-up ≥30 days after the last stimulation session. For single sessions the weighted mean difference in pain reduction between active rTMS and sham was 15 percentage points, for multiple sessions the difference was 22 percentage points for follow-ups <30 days, and 15 percentage points for follow-ups ≥30 days. Four studies reported data that could be used to evaluate the accuracy of rTMS to predict response to MCS, showing a specificity of 60–100%, and a positive predictive value of 75–100%. No serious adverse events were reported.ConclusionsrTMS targeting M1 can result in significant reduction of chronic NP which, however, is transient and shows a great heterogeneity between studies; very low certainty of evidence for single sessions and low for multiple sessions. Multiple sessions of rTMS can maintain a more longstanding effect. rTMS seems to be a fairly good predictor of a positive response to epidural MCS and may be used to select patients for implantation of permanent epidural electrodes. More studies are needed to manifest the use of rTMS for this purpose. Pain relief outcomes in a longer perspective, and outcome variables other than pain reduction need to be addressed more consistently in future studies to consolidate the applicability of rTMS in routine clinical practice.

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Long-term effect of motor cortex stimulation in patients suffering from chronic neuropathic pain: An observational study

Abstract: Background

Cited by 22 publications

References 52 publications

Motor cortex stimulation in chronic neuropathic orofacial pain syndromes: a systematic review and meta-analysis

Motor cortex stimulation in chronic neuropathic orofacial pain syndromes: a systematic review and meta-analysis

Systematic Review and Neural Network Analysis to Define Predictive Variables in Implantable Motor Cortex Stimulation to Treat Chronic Intractable Pain

Repetitive transcranial magnetic stimulation of the primary motor cortex in management of chronic neuropathic pain: a systematic review

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