Recovery of Pain Control by Intensive Reprogramming after Loss of Benefit from Motor Cortex Stimulation for Neuropathic Pain

Henderson, Jaimie M.; Boongird, Atthaporn; Rosenow, Joshua M.; LaPresto, Eric; Rezai, Ali R.

doi:10.1159/000082447

Cited by 59 publications

(44 citation statements)

References 39 publications

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“…This situation occurs in neuropathic trigeminal pain; in thalamic syndrome, patients generally report no sensations. The experience of other researchers indicates significant improvements in the effectiveness of MCS after changing the stimulation parameters [20,21]. In order to overcome habituation, the authors change the mode from cycling to continuous stimulation or vice versa, and in cycling mode the off period is prolonged or shortened.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

Motor Cortex Stimulation in Patients with Chronic Central Pain

Sokal¹,

Harat²,

Zieliński³

et al. 2015

Adv Clin Exp Med

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“…During the early course of treatment, the loss of effect can usually be overcome by intensive reprogramming, in most cases by increasing the voltage or changing the electrode configuration [11]. No detailed data on reprogramming cycles and voltages are available in the patients presented in this series, but extensive reprogramming was repeatedly performed in all patients.…”

Section: Discussionmentioning

confidence: 99%

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

Slotty

Eisner

Honey

et al. 2015

Stereotact Funct Neurosurg

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Background: Motor cortex stimulation (MCS) is being offered to patients suffering from neuropathic pain. Outcome prediction, programming and especially sustaining a long-term treatment effect represent major challenges. We report a retrospective long-term analysis of our patients treated with MCS over a median follow-up of 39.1 months. Objectives: To investigate the time course of the treatment effect in MCS for neuropathic pain. Methods: Twenty-three closely followed patients treated with MCS were retrospectively analyzed. Reduction in pain measured on a visual analogue scale (VAS) was defined as the primary outcome parameter. VAS pain level and adverse events were documented at the 1-, 3-, 6-, 12-, 18- and 24-month follow-ups. Results: The mean VAS under best medical treatment was 7.8 (SD 1.2, range 5-9) with escalation to 9.3 (SD 0.9, range 6-10) when the patients' medications were missed or delayed. About half of the patients (47.8%) experienced a satisfactory (>50%) reduction in pain during the first month of treatment. The best treatment results were seen at the 3-month follow-up (mean VAS 4.8, SD 1.9, -37.2% compared to baseline). A decline in the treatment effect was generally observed at the subsequent follow-up assessments. Six patients had their devices explanted during the follow-up period due to loss of treatment effect. Conclusions: In this study, MCS failed to provide long-term pain control for neuropathic pain. Many aspects of MCS still remain unclear, especially the neural circuits involved and their response to long-term stimulation. Means must be developed to overcome the problems in this promising technique.

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“…Seizures are a known complication of MCS and have been shown to be related to stimulation amplitude and frequency [24]. These usually occur as reversible events during MCS programming when the stimulation amplitude is set too high, but have also been reported to occur in a delayed manner in the outpatient setting with stimulation parameters that did not produce seizures during programming [25].…”

Section: Discussionmentioning

confidence: 99%

The Influence of Positioning and Muscle Activity on Motor Threshold during Motor Cortex Stimulation Programming

Chang

Ranjan²,

Slotty³

et al. 2015

Stereotact Funct Neurosurg

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Background: Stimulation parameters are crucial for the efficacy and safety of motor cortex stimulation (MCS). Motor threshold (MT) can be defined as the lowest voltage that produces motor contraction. The final stimulation parameters are always a smaller percentage of MT in order to avoid seizures. We determined how patient position and activity affect MT. Methods: Prospective MT measurements were made while patients were either lying down or sitting up, and in a resting state or while actively contracting the target muscle. Paired 1-tailed t tests were performed to assess for statistically significant differences between MT measurements made under the 4 different combinations of position and activity. Results: The MT was lower when the target muscle was being actively contracted compared to resting in both supine and upright positions (both p < 0.001). The MT was also lower when upright compared to supine in both resting and active states of muscle contraction (both p < 0.001). The mean difference between supine resting and upright active states is 0.79 V. Conclusion: When selecting final stimulation parameters for MCS, clinicians should be aware that the lowest MT is elicited while patients are seated upright and actively contracting the target muscle. Using this method of determining the MT when calculating the final stimulation parameters could reduce the chance of MCS-induced seizures.

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Recovery of Pain Control by Intensive Reprogramming after Loss of Benefit from Motor Cortex Stimulation for Neuropathic Pain

Cited by 59 publications

References 39 publications

Motor Cortex Stimulation in Patients with Chronic Central Pain

Motor Cortex Stimulation in Patients with Chronic Central Pain

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

The Influence of Positioning and Muscle Activity on Motor Threshold during Motor Cortex Stimulation Programming

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