Long-Term Follow-Up of Motor Cortex Stimulation for Neuropathic Pain in 23 Patients

Slotty, Philipp J.; Eisner, Wilhelm; Honey, Christopher R.; Wille, C.; Vesper, Jan

doi:10.1159/000375177

Cited by 19 publications

(13 citation statements)

References 22 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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“…Three recent publications, including one by our group, were focused on the outcomes and challenges of long‐term MCS for pain . A gradual increase in required stimulation intensity is frequently observed, and loss of treatment effect is not uncommon following years of stimulation.…”

Section: Introductionmentioning

confidence: 99%

Motor Threshold: A Possible Guide to Optimizing Stimulation Parameters for Motor Cortex Stimulation

Slotty

Chang

Honey

2015

Neuromodulation: Technology at the Neural Interface

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“…Nuti et al [18] suggested that the first month result was a predictor of long-term results. Nevertheless, Slotty et al [19] concluded that short-term response did not predict long-term results. In this report, we observed a statistically significant reduction in the total NPSI score after MCS and a strong positive correlation between the remission rates based on the NPSI and VAS scores.…”

Section: Discussionmentioning

confidence: 99%

Motor Cortex Stimulation Therapy for Relief of Central Post-Stroke Pain: A Retrospective Study with Neuropathic Pain Symptom Inventory

Zhang¹,

Zhu²,

Tao³

et al. 2018

Stereotact Funct Neurosurg

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Background: Motor cortex stimulation (MCS) has been used in the treatment of chronic neuropathic pain for more than 25 years. However, the mechanisms and outcome predictors still represent major challenges. Objectives: To investigate outcome predictors and potential mechanisms of MCS on central post-stroke pain (CPSP). Material and Methods: 16 CPSP patients were analyzed at our center. The pain intensity was assessed using a visual analog scale (VAS) before surgery and at the last follow-up. The Neuropathic Pain Symptom Inventory (NPSI) was used to assess pain intensity, analyze outcome predictors, and indicate potential mechanisms of MCS. Results: The mean VAS score before surgery (8.0 ± 0.7) was significantly higher than that of the last follow-up (5.3 ± 2.4, p < 0.001). Similarly, the mean total NPSI score before MCS (30.6 ± 12.2) was significantly reduced at the last follow-up (25.2 ± 15.1, p = 0.01). An analysis of the NPSI subscores revealed a significant association between burning pain relief and effective results (p = 0.041, Fisher’s exact test). Conclusions: Burning pain relief might predict long-term results for the therapeutic use of MCS in CPSP. The substantia gelatinosa may play an important role in the modulation of pain relief mediated by MCS.

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Long-Term Follow-Up of Motor Cortex Stimulation for Neuropathic Pain in 23 Patients

Cited by 19 publications

References 22 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

Motor Threshold: A Possible Guide to Optimizing Stimulation Parameters for Motor Cortex Stimulation

Motor Cortex Stimulation Therapy for Relief of Central Post-Stroke Pain: A Retrospective Study with Neuropathic Pain Symptom Inventory

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