Long-Term Results of Stimulation of the Septal Area for Relief of Neurogenic Pain

Schvarcz, J. R.

doi:10.1007/978-3-7091-9297-9_35

Cited by 15 publications

(15 citation statements)

References 5 publications

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“…The more resistant continuous pain type requires, as already indicated by surgical studies (Tsubokawa et al, 1993;Ohye, 1998;Schvarcz, 1993), the integration of a large thalamocortical network, including parietal, insular, cingulate and various frontal areas as well as their specific thalamic partners. As discussed under (A), the high relief rate of intermittent pain and allodynia may be related to phasic hypersynchronization properties of the medial thalamus, CLT controlling the symptomatology at its origin.…”

Section: Clinical Resultsmentioning

confidence: 99%

Surgical control of the human thalamocortical dysrhythmia: I. Central lateral thalamotomy in neurogenic pain

Jeanmonod

Magnin

Morel

et al. 2001

THL

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Reactualization of the medial thalamotomy, performed since the fifties in cases of neurogenic pain, has been guided by the discovery of low threshold calcium spike bursts at frequencies in the delta-theta range in the posterior part of the central lateral (CL) nucleus. This thalamic rhythmicity is transmitted to the cortex through thalamocortical resonant properties, giving rise to the thalamocortical dysrhythmia, proposed to be the mechanism of neurogenic pain as well as other central nervous system (CNS) dysfunctions. Magnetic resonance-and microelectrode-guided stereotactic CL thalamotomy was implemented in 96 patients suffering from chronic therapy-resistant peripheral or central neurogenic pain (mean age: 56 ± 15 years; pain duration before surgery: 7.5 ± 8 years). At a mean follow-up of 3 years, 9 months ± 2 years, 9 months, 53% of the patients benefited from a relief superior to 50% (complete relief in 18.7%). Further analysis of the results demonstrated a significant difference between patients suffering from intermittent as compared with continuous pain. Patients with continuous pain showed only a mean relief of 20.4 ± 25.8% in contrast to the 66 ± 39.2% obtained for patients with intermittent (episodic or paroxysmal) pain manifestations. This was confirmed by the pre-and postoperative visual analogue scale scores showing a significant decrease (59.2%) only in the patient group with intermittent pain. Allodynia was suppressed in 57.3% of the patients. Parameters such as the preoperative pain duration or the site of the causal lesion did not affect the surgical outcome. In 28 patients suffering from unilateral continuous pain, the addition of an ipsilateral CL thalamotomy provided a further significant pain relief. A suppression of drug intake was observed in 31.6% of the patients. Complications occurred in 11.5% of the patients and led to a long term significant disability in only one case. In conclusion, CL thalamotomy is a safe neurosurgical option for neurogenic pain, especially for patients suffering from intermittent pain or allodynia. Its limitation in cases of continuous pain indicates the necessity to explore other stereotactic targets outside of the medial thalamus.

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Section: Clinical Resultsmentioning

confidence: 99%

Surgical control of the human thalamocortical dysrhythmia: I. Central lateral thalamotomy in neurogenic pain

Jeanmonod

Magnin

Morel

et al. 2001

THL

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“…Given these early challenges and only moderate success, it appears that the septum has fallen out of favor. However, it should be noted that 2 works have been published by Schvarcz 18,19 that suggest a nearly 60% success rate of intractable pain relief with septal stimulation. Currently, septal targeting is not common and there is not a double-blind, randomized, placebo-controlled trial to evaluate it efficacy.…”

Section: Intracranial Targetsmentioning

confidence: 99%

Deep Brain Stimulation for Chronic Pain

Keifer

Riley

Boulis

2014

Neurosurgery Clinics of North America

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“…Schvarcz (1993) used septal stimulation to treat 19 patients with neurogenic pain over the course of 1-5 years. Each patient had initially reported severe pain.…”

Section: The Septummentioning

confidence: 99%