Motor cortex stimulation for long-term relief of chronic neuropathic pain: A 10 year experience

Abstract

Chronic subthreshold stimulation of the contralateral precentral gyrus is used in patients with intractable neuropathic pain for more than 15 years. The aim of this study was to analyse retrospectively our own patient group with long term follow-up of 10 years. Seventeen patients with chronic neuropathic pain were treated with contralateral epidural stimulation electrodes. In 10 cases, trigeminal neuropathic pain (TNP) and in seven cases post-stroke pain (PSP) were diagnosed. The placement of the electrodes was performed in local anaesthesia using neuronavigation and intraoperative neuromonitoring. A test trial of minimum one week including double-blind testing was conducted and pain intensity was measured using a visual analogue scale (VAS). Correct placement of the electrode was achieved in all patients using intraoperative neurophysiological monitoring. Double-blind testing was able to identify 6 (35%) non-responders. In 5 of 10 (50%) with TNP and 3 of 7 (43%) with PSP a positive effect with pain reduction > or = 50% was observed. The mean follow-up period was 3.6 years (range 1-10 years) and includes a patient with 10 years of positive stimulation effect. Stimulation of the motor cortex is a treatment option for patients with chronic neuropathic pain localized in the face or upper extremity. Double-blind testing can identify non-responders. Patients with TNP profit more than patients with PSP. The positive effect can last for ten years in long-term follow-up.

Electrical Stimulation of Primary Motor Cortex for Parkinson's Syndrome

“…Several kinds of navigation systems for neurosurgical assistance can be used to estimate the position of the central sulcus from skin surface (Tirakotai et al, 2007). Neuronavigation combined with fMRI data help to decide the best position for craniotomy and for placement of the stimulating paddle (Rasche et al, 2006). A drawback of neuronavigation is the requirement that the patient's head be fixed in a 3-point pin holder or vacuum headrest (Tirakotai et al, 2007), which several patients may not tolerate under local anesthesia.…”

“…Some surgeons place the electrode perpendicular to the central sulcus above the precentral (cathode) and postcentral (anode) gyri for the supposed improved selectivity (Nguyen et al, 1999), others in a parallel fashion, i.e. with all contacts on the M1 or S1 Rasche et al, 2006). Moreover, no polarity-related difference in pain relief is seen for most patients with epidural electrodes (Katayama et al, 1998).…”

Motor Cortex Stimulation for Pain and Movement Disorders

“…10,11 Finally, in 1998, Nguyen et al 12 first reported using stimulation of this same region to treat PD, completing the overlap of treatment by using MCS to treat both chronic pain and movement disorders. For the period between 1991 and 2007, a Medline review revealed 512 cases of treatment with MCS, for either pain (422 cases 10,13-52 ), stroke rehabilitation (9 cases 13,49,53 ), or movement disorders (84 cases, 22 of them being mixed MCS and deep brain stimulation [DBS]). 12,26,54 -64 Some of the studies may have included previously reported cases.…”

Trigeminal neuropathic pain following honeybee sting: a case report

“…Tricyclic antidepressants, gabapentin, intrathecally local anaesthetics and corticosteroids are the medical treatments used. In the surgical approach, peripheral neurectomy, percutaneous gangliolysis, motor cortex stimulation, stereotactic trigeminal nucleotomy, stimulation of the Gasserian ganglion and trigeminal rootlets are used for trigeminal neuropathic pain (3,12,13,16,18,20,21,26,27). However, we performed CT-guided trigeminal tractotomy for the treatment of this special case.…”