Motor cortex electric stimulation for the treatment of neuropathic pain

Abstract

Objective: Motor cortex stimulation (MCS) is considered to be an effective treatment for chronic neuropathic pain. The aim of the present study was to assess the efficacy of MCS for treating neuropathic pain. Method: 27 patients with chronic neuropathic pain were operated. Electrodes were implanted with the use of an stereotactic frame. Electrophysiological evaluations (motor stimulation and somatosensory evoked potentials) were performed, with guidance by means of three-dimensional reconstruction of magnetic resonance images of the brain. 10 patients (37%) presented central neuropathic pain (poststroke pain) and 17 others (63%) presented peripheral neuropathic pain (brachial plexus avulsion, phantom limb pain or trigeminal pain). Results: In 15 patients (57.7%) the pain relief was 50% or more; while in ten patients (38.5%), more than 60% of the original pain was relieved. No differences were found in relation to central and peripheral neuropathic pain (p=0.90), pain location (p=0.81), presence of motor deficit (p=0.28) and pain duration (p=0.72). No major complications were observed. Conclusion: MCS was efficient for treating patients presenting chronic central or peripheral neuropathic pain. Key words: electric motor cortex stimulation, neuropathic pain, central pain, peripheral pain, treatment.Estimulação elétrica do córtex motor no tratamento da dor neuropática RESUMO Objetivo: A estimulação do córtex motor (ECM) é método considerado eficaz no tratamento da dor neuropática crônica rebelde. O presente estudo avaliou a eficácia da ECM no tratamento de pacientes portadores de dor neuropática crônica. Método: 27 doentes foram avaliados; 10 (37,0%) apresentavam dor neuropática de origem central, enquanto 17 (63,0%), dor neuropática periférica. Avulsão de raízes do plexo braquial, dor no membro fantasma, dor decorrente de doença cerebrovascular isquêmica ou hemorrágica ou neuropatia trigeminal foram as causas mais freqüentes da dor. Os doentes foram operados com uso da técnica de localização estereotáctica do córtex motor associadamente a estudo eletroneurofisiológico (estimulação motora e potencial evocado somatossensitivo) ou ainda com uso de imagens de ressonância magnética do encéfalo reconstruídas tridimensionalmente. Resultados: O alívio da dor foi igual ou superior a 50% em 15 doentes (57,7%), sendo em 10 (38,5%), superior a 60%. Não houve diferença nos resultados quanto a origem central ou periférica (p=0,90) da dor, localização da dor (p=0,81), ocorrência ou não de déficit motor (p=0,28) e duração da sintomatologia (p=0,72). Não foram observadas complicações graves. Conclusão: A estimulação do córtex motor foi útil no tratamento da dor neuropática crônica rebelde tanto de origem central como periférica. Palavras-chave: estimulação elétrica do córtex motor, dor neuropática, dor central, dor periférica, tratamento. CorrespondenceWalter J. Fagundes-Pereyra

Nonpharmacological Interventions in Targeting Pain-Related Brain Plasticity

“…Additionally, it is possible that thalamic activation during exercise could hinder the relay of nociceptive signals. This hypothesis is supported by both the robust and direct anatomic connections between the motor cortex and the thalamus, by clinical data showing effective neuropathic pain relief by motor cortex stimulation [84], and by preclinical data where chronic exercise was paralleled by an increased activation of the cerebellar-thalamic-cortical circuit in rats [85], thus providing additional incentive for ongoing physical activity in pain patients. For those patients with reduced mobility, ascending noxious signals can be modulated via guided imagery.…”

Current and future options for the management of phantom-limb pain

“…Some centers perform a direct implantation of the neuro-stimulator in the subcutaneous tissue (infraclavicular or abdominal), while others perform also a postoperative testing with externalized extensions of the lead and an external stimulation 98,106,108,109. Such a testing phase allows for a placebo double-blinded stimulation period, so that false positive responders can be identified 106.…”

Transcranial direct current stimulation in mild cognitive impairment: methodology for a randomized controlled trial

“…The effects of electric currents upon neuronal function have been studied for decades (Priori, 2003). More recently, after several reports of beneficial effects of TMS upon symptoms of many neuropsychiatric disorders, such as depression (Pascual-Leone et al, 1996;Boechat-Barros, 2004;Boechat-Barros & Brasil-Neto, 2004;Leo & Latif, 2007;O'Reardon et al, 2007;Brunoni et al, 2010b;Holtzheimer & Mayberg, 2012;Rothwell, 2012;Iannone et al, 2016) and chronic pain (Nguyen et al, 1999;Leo & Latif, 2007;Rosen et al, 2009;Galhardoni et al, 2015) and neuropathic pain (Brown & Barbaro, 2003;Fagundes-Pereyra et al, 2010;Nguyen et al, 2011;Nizard et al, 2012), transcranial direct current stimulation (tDCS) has also been the subject of many studies due to its ability to modulate cortical function in a non-invasive manner. For that reason, there is a great deal of interest in its potential applications in the fields of neurology and psychiatry (Alonzo et al, 2012;Demirtas-Tatlidede, VahabzadehHagh & Pascual-Leone, 2013;Elder & Taylor, 2014;Flöel, 2014;Kuo, Paulus & Nitsche, 2014;Dedoncker et al, 2016;Iannone et al, 2016).…”