Motor cortex stimulation for refractory neuropathic pain: Four year outcome and predictors of efficacy

Nuti, C.; Peyron, R.; Garcia-Larrea, Luis; Brunon, J; Laurent, Bernard; Sindou, Marc; Mertens, Patrick

doi:10.1016/j.pain.2005.07.020

Cited by 222 publications

(151 citation statements)

References 22 publications

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“…the only strong predictor of long-term relief was pain relief in the first month after implantation. The interval between pain onset and surgery, the pain characteristics, the type of lesion, SSEP status and preoperative motor status were found not to be significant predictors [23]. Satisfactory long-term results are observed in 50% of all patients with MCS.…”

Section: Discussionmentioning

confidence: 85%

Motor Cortex Stimulation in Patients with Chronic Central Pain

Sokal¹,

Harat²,

Zieliński³

et al. 2015

Adv Clin Exp Med

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Background. Motor cortex stimulation is one of the neuromodulation methods of treating refractory central neurogenic pain. Objectives. The aim of this study was to retrospectively evaluate the effects of motor cortex stimulation. Material and Methods. The study group consisted of 14 consecutive patients with thalamic pain, atypical facial pain, post-brachial plexus avulsion injury pain, phantom pain and pain in syringomyelia who were treated with motor cortex stimulation at the Department of Neurosurgery of the Military Research Hospital in Bydgoszcz, Poland, from 2005 to 2013. The procedures were conducted with the use of neurosurgical navigation and intraoperative neurophysiological monitoring. The outcomes were assessed in terms of visual analog scale scores. The long-term follow-up ranged from one to six years. Results. A statistically significant reduction in the intensity of pain was noted in patients treated with motor cortex stimulation (pre-surgery median visual analog scale = 9, short-term result median visual analog scale = 3, p = 0.0009; long-term result median visual analog scale = 5, p = 0.0036). Over the long term, with follow-ups ranging from one to six years, the results were excellent (over 80% reduction in pain) in 31% of the patients and satisfactory (50-80% reduction in pain) in 23% of the patients. Unsatisfactory pain control (less than 50%) was noted in 31% of the patients and no improvement was noted in 15%. Significantly better relief of pain was observed in the early postoperative period. In this series of patients, the highest efficacy of motor cortex stimulation was observed in post-stroke or post-hemorrhagic thalamic pain (5/7 patients -71%). Long-term outcomes were not related to the age or sex of the patient, the preoperative duration of the pain, or to the position or number of implanted electrodes. Conclusions. MCS significantly reduces the intensity of neurogenic pain. The best long-term results in the present study were achieved in patients with thalamic syndrome. No significant predictors were found for a successful final outcome. The authors consider appropriate selection of patients, accurate placement of the electrodes and frequent adjusting of the stimulation parameters to be important factors increasing the efficacy of MCS (Adv Clin Exp Med 2015, 24, 2, 289-296).

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Section: Discussionmentioning

confidence: 85%

Motor Cortex Stimulation in Patients with Chronic Central Pain

Sokal¹,

Harat²,

Zieliński³

et al. 2015

Adv Clin Exp Med

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“…Three groups have described subdural placement of the MCS electrode. 41,47,48 From one of these report, there were two hemorrhages among nine patients: one of the two patients died 36 months after implantation and the other patient was left in a persistent vegetative state. 41 Programming algorithms and parameters for MCS electrodes used to treat chronic pain problems have also varied widely.…”

Section: Introductionmentioning

confidence: 94%

Motor Cortex Stimulation for Pain and Movement Disorders

Arle

Shils

2008

Neurotherapeutics

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Summary:Since initial reports in the early 1990s, stimulation of the M1 region of the cortex (MCS) has been used to treat chronic refractory pain conditions and a variety of movement disorders. A Medline search of literature between 1991 and 2007 revealed 512 cases using MCS. Although most of these relate to the treatment of pain (422), 84 of them involve movement disorders. More recently, several studies have specifically looked at treating Parkinson's disease (PD) with MCS. We report here several of our own cases using MCS to treat poststroke and non-poststroke pain syndromes and movement disorders (n ϭ 8), PD (n ϭ 4), ET (n ϭ 2), and cortico-basal degeneration (n ϭ 1). We also cover the essential history of this procedure and our current research using computational modeling to understand further the underlying mechanisms of MCS.

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“…Stellate ganglion block is another recommended therapy for PMPS that results in cervical sympathetic trunk block or vertebral ganglion, postganglionic and pre-ganglionic fibers, inferior cervical sympathetic ganglia, and thoracic sympathetic ganglia (13,37,38). Neuromodulation techniques including stimulation of brain motor cortex, SCS (spinal cord stimulation), intrathecal drug delivery, and epidural injection of local anesthetic are used to relieve PMPS (39)(40)(41). Application of complement therapy or alternative therapy has increased for improvement of health.…”

Section: Treatmentmentioning

confidence: 99%