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

2015 ◽  
Vol 93 (3) ◽  
pp. 199-205 ◽  
Author(s):  
Philipp J. Slotty ◽  
Wilhelm Eisner ◽  
Christopher R. Honey ◽  
Christian Wille ◽  
Jan Vesper
Keyword(s):  
Neuropathic Pain ◽  
Motor Cortex ◽  
Motor Cortex Stimulation ◽  
Long Term Follow Up

scholarly journals Pre-motor versus motor cerebral cortex neuromodulation for chronic neuropathic pain

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Igor Lavrov ◽  
Timur Latypov ◽  
Elvira Mukhametova ◽  
Brian Lundstrom ◽  
Paola Sandroni ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Cerebral Cortex ◽  
Motor Cortex ◽  
Initial Assessment ◽  
Motor Cortex Stimulation ◽  
Chronic Neuropathic Pain ◽  
Long Term Effect ◽  
Stimulation Of

AbstractElectrical stimulation of the cerebral cortex (ESCC) has been used to treat intractable neuropathic pain for nearly two decades, however, no standardized approach for this technique has been developed. In order to optimize targeting and validate the effect of ESCC before placing the permanent grid, we introduced initial assessment with trial stimulation, using a temporary grid of subdural electrodes. In this retrospective study we evaluate the role of electrode location on cerebral cortex in control of neuropathic pain and the role of trial stimulation in target-optimization for ESCC. Location of the temporary grid electrodes and location of permanent electrodes were evaluated in correlation with the long-term efficacy of ESCC. The results of this study demonstrate that the long-term effect of subdural pre-motor cortex stimulation is at least the same or higher compare to effect of subdural motor or combined pre-motor and motor cortex stimulation. These results also demonstrate that the initial trial stimulation helps to optimize permanent electrode positions in relation to the optimal functional target that is critical in cases when brain shift is expected. Proposed methodology and novel results open a new direction for development of neuromodulation techniques to control chronic neuropathic pain.

scholarly journals Extradural Motor Cortex Stimulation in Parkinson’s Disease: Long-Term Clinical Outcome

2021 ◽  
Vol 11 (4) ◽  
pp. 416
Author(s):  
Carla Piano ◽  
Francesco Bove ◽  
Delia Mulas ◽  
Enrico Di Stasio ◽  
Alfonso Fasano ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Motor Cortex ◽  
Clinical Outcome ◽  
Motor Cortex Stimulation ◽  
Dopaminergic Therapy

Previous investigations have reported on the motor benefits and safety of chronic extradural motor cortex stimulation (EMCS) for patients with Parkinson’s disease (PD), but studies addressing the long-term clinical outcome are still lacking. In this study, nine consecutive PD patients who underwent EMCS were prospectively recruited, with a mean follow-up time of 5.1 ± 2.5 years. As compared to the preoperatory baseline, the Unified Parkinson’s Disease Rating Scale (UPDRS)-III in the off-medication condition significantly decreased by 13.8% at 12 months, 16.1% at 18 months, 18.4% at 24 months, 21% at 36 months, 15.6% at 60 months, and 8.6% at 72 months. The UPDRS-IV decreased by 30.8% at 12 months, 22.1% at 24 months, 25% at 60 months, and 36.5% at 72 months. Dopaminergic therapy showed a progressive reduction, significant at 60 months (11.8%). Quality of life improved by 18.0% at 12 months, and 22.4% at 60 months. No surgical complication, cognitive or behavioral change occurred. The only adverse event reported was an infection of the implantable pulse generator pocket. Even in the long-term follow-up, EMCS was shown to be a safe and effective treatment option in PD patients, resulting in improvements in motor symptoms and quality of life, and reductions in motor complications and dopaminergic therapy.

scholarly journals Long-Term Results of a Simultaneous Trial of Deep Brain and Motor Cortex Stimulation in Refractory Neuropathic Pain

2017 ◽  
Vol 3 (1) ◽  
pp. 4-15
Author(s):  
Byung-chul Son ◽  
Jin-gyu Choi ◽  
Sang-woo Ha ◽  
Deog-ryeong Kim
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
Motor Cortex ◽  
Success Rate ◽  
Rating Scale ◽  
Long Term Results ◽  
Motor Cortex Stimulation ◽  
Significant Difference ◽  
Deep Brain

Objective Although deep brain stimulation (DBS) and motor cortex stimulation (MCS) are effective in patients with refractory neuropathic pain, their application is still empirical; there is no consensus on which technique is better. Methods To enhance the success rate of trial stimulation of invasive neuromodulation techniques and identify approapriate stimulation targets in individual patients, we performed a simultaneous trial of thalamic ventralis caudalis (Vc) DBS and MCS in 11 patients with chronic neuropathic pain and assessed the results of the trial stimulation and long-term analgesia. Results Of the 11 patients implanted with both DBS and MCS electrodes, nine (81.8%) had successful trials. Seven of these nine patients (77.8%) responded to MCS, and two (18.2%) responded to Vc DBS. With long-term follow-up (56 ± 27.5 months), the mean numerical rating scale decreased significantly (P < 0.05). The degree of percentage pain relief in the chronic MCS (n = 7) and chronic DBS (n = 2) groups were 34.1% ± 18.2% and 37.5%, respectively, and there was no significant difference (P = 0.807). Five out of the seven MCS patients (71%) and both DBS patients had long-term success with the treatments, defined as >30% pain relief compared with baseline. Conclusions With simultaneous trial of DBS and MCS, we could enhance the success rate of invasive trials. Considering the initial success rate and the less invasive nature of epidural MCS over DBS, we suggest that MCS may be a better, initial means of treatment in chronic intractable neuropathic pain. Further investigations including other subcortical target-associated medial pain pathways are warranted.

Reversal of thalamic hand syndrome by long-term motor cortex stimulation

2000 ◽  
Vol 93 (5) ◽  
pp. 873-875 ◽  
Author(s):  
Angelo Franzini ◽  
Paolo Ferroli ◽  
Domenico Servello ◽  
Giovanni Broggi
Keyword(s):  
Motor Cortex ◽  
Complete Recovery ◽  
Common Mechanism ◽  
Central Pain ◽  
Motor Cortex Stimulation ◽  
Content Type ◽  
Hand Dystonia ◽  
Fine Print

✓ The authors describe a case of complete recovery from the so-called “thalamic hand” syndrome following chronic motor cortex stimulation in a 64-year-old man suffering from poststroke thalamic central pain. As of the 2-year follow-up examination, the patient's dystonia and pain are still controlled by electrical stimulation.It is speculated that a common mechanism in which the thalamocortical circuit loops are rendered out of balance may sustain hand dystonia and central pain in this case of thalamic syndrome. To the authors' knowledge this is the first reported case of its kind.

Efficacy of motor cortex stimulation in the treatment of neuropathic pain: a randomized double-blind trial

2008 ◽  
Vol 108 (4) ◽  
pp. 698-706 ◽  
Author(s):  
Francisco Velasco ◽  
Carlos Argüelles ◽  
José D. Carrillo-Ruiz ◽  
Guillermo Castro ◽  
Ana Luisa Velasco ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Motor Cortex ◽  
Evoked Potentials ◽  
Wilcoxon Test ◽  
Motor Cortex Stimulation ◽  
Double Blind ◽  
Statistical Tool ◽  
Efficient Treatment ◽  
Pain Visual Analog Scale

Object In this study the authors used a double-blind protocol to assess the efficacy of motor cortex stimulation (MCS) for treating neuropathic pain. Methods Eleven patients with unilateral neuropathic pain (visual analog scale [VAS] score 8–10) of different origins and topography were selected for MCS. A 20-contact grid was implanted through a craniotomy centered over the motor cortex contralateral to the painful area. The motor cortex strip was identified using neuroimages, somatosensory evoked potentials, acute electrical stimulation, and corticocortical evoked potentials. Subacute therapeutic stimulation trials allowed the authors to determine the most efficient pair of contacts to use for long-term MCS. The grid was replaced with a 4-contact electrode connected to an internalized stimulator. Bipolar stimulation at a 40-Hz frequency, 90-μsec pulse width, amplitude 2–7 V, and 1 hour in “ON” and 4 hours in “OFF” mode was used. Pain was evaluated using the VAS, Bourhis, and McGill pain scales applied each month for 1 year. At Day 60 or 90, the stimulators were turned to OFF mode for 30 days in a randomized, double-blind fashion. The statistical tool used was the Wilcoxon test. Results Three patients did not report improvement in the subacute trial and were excluded from long-term MCS; the remaining patients underwent long-term stimulation. Significant improvement of pain was induced by MCS (p < 0.01); this persisted during the follow-up period. Turning stimulation to OFF mode increased pain significantly (p < 0.05). Improvement at 1 year was ≥ 40% (40–86%) in all cases. Conclusions Motor cortex stimulation is an efficient treatment for neuropathic pain, according to an evaluation facilitated by a double-blind maneuver. Subacute stimulation trials are recommended to determine the optimum motor cortex area to be stimulated and to identify nonresponders.

scholarly journals Is Life Better After Motor Cortex Stimulation for Pain Control? Results at Long-Term and their Prediction by Preoperative rTMS

2014 ◽  
Vol 17;1 (1;17) ◽  
pp. 53-62 ◽  
Author(s):  
Nathalie André-Obadia
Keyword(s):  
Quality Of Life ◽  
Neuropathic Pain ◽  
Pain Relief ◽  
Motor Cortex ◽  
Predictive Value ◽  
Drug Intake ◽  
Motor Cortex Stimulation ◽  
Pain Scores

Background: A positive effect of motor cortex stimulation (MCS) (defined as subjective estimations of pain relief ≥ 30%) has been reported in 55 – 64% of patients. Repetitive magnetic cortical stimulation (rTMS) is considered a predictor of MCS effect. These figures are, however, mostly based on subjective reports of pain intensity, and have not been confirmed in the long-term. Objectives: This study assessed long-term pain relief (2 – 9 years) after epidural motor cortex stimulation and its pre-operative prediction by rTMS, using both intensity and Quality of Life (QoL) scales. Study Design: Analysis of the long-term evolution of pain patients treated by epidural motor cortex stimulation, and predictive value of preoperative response to rTMS. Setting: University Neurological Hospital Pain Center. Methods: Patients: Twenty patients suffering chronic pharmaco-resistant neuropathic pain. Intervention: All patients received first randomized sham vs. active 20Hz-rTMS, before being submitted to MCS surgery. Measurement: Postoperative pain relief was evaluated at 6 months and then up to 9 years post-MCS (average 6.1 ± 2.6 y) using (i) pain numerical rating scores (NRS); (ii) a combined assessment (CPA) including NRS, drug intake, and subjective quality of life; and (iii) a short questionnaire (HowRu) exploring discomfort, distress, disability, and dependence. Results: Pain scores were significantly reduced by active (but not sham) rTMS and by subsequent MCS. Ten out of 20 patients kept a long-term benefit from MCS, both on raw pain scores and on CPA. The CPA results were strictly comparable when obtained by the surgeon or by a third-party on telephonic survey (r = 0.9). CPA scores following rTMS and long-term MCS were significantly associated (Fisher P = 0.02), with 90% positive predictive value and 67% negative predictive value of preoperative rTMS over long-term MCS results. On the HowRu questionnaire, long-term MCSrelated improvement concerned “discomfort” (physical pain) and “dependence” (autonomy for daily activities), whereas “disability” (work, home, and leisure activities) and “distress” (anxiety, stress, depression) did not significantly improve. Limitations: Limited cohort of patients with inhomogeneous pain etiology. Subjectivity of the reported items by the patient after a variable and long delay after surgery. Predictive evaluation based on a single rTMS session compared to chronic MCS. Conclusions: Half of the patients still retain a significant benefit after 2 – 9 years of continuous MCS, and this can be reasonably predicted by preoperative rTMS. Adding drug intake and QoL estimates to raw pain scores allows a more realistic assessment of long-term benefits and enhance the rTMS predictive value. The aims of this study and its design were approved by the local ethics committee (University Hospitals St Etienne and Lyon, France). Key words: Neuropathic pain, chronic refractory pain, repetitive transcranial magnetic stimulation, rTMS, epidural motor cortex stimulation, MCS, quality of life, predictive value

Clinical Significance of Invasive Motor Cortex Stimulation for Trigeminal Facial Neuropathic Pain Syndromes

Neurosurgery ◽  
2016 ◽  
Vol 79 (5) ◽  
pp. 655-666 ◽  
Author(s):  
Dirk Rasche ◽  
Volker M. Tronnier
Keyword(s):  
Neuropathic Pain ◽  
Motor Cortex ◽  
Test Trial ◽  
Visual Analog Scale ◽  
False Positive ◽  
Motor Cortex Stimulation ◽  
Analog Scale ◽  
Pain Syndromes ◽  
Double Blinded

Abstract BACKGROUND: Invasive neuromodulation of the cortical surface for various chronic pain syndromes has been performed for &gt;20 years. The significance of motor cortex stimulation (MCS) in chronic trigeminal neuropathic pain (TNP) syndromes remains unclear. Different techniques are performed worldwide in regard to operative procedure, stimulation parameters, test trials, and implanted materials. OBJECTIVE: To present the clinical experiences of a single center with MCS, surgical approach, complications, and follow-up as a prospective, noncontrolled clinical trial. METHODS: The implantation of epidural leads over the motor cortex was performed via a burr hole technique with neuronavigation and intraoperative neurostimulation. Special focus was placed on a standardized test trial with an external stimulation device and the implementation of a double-blinded or placebo test phase to identify false-positive responders. RESULTS: A total of 36 patients with TNP were operated on, and MCS was performed. In 26 of the 36 patients (72%), a significant pain reduction from a mean of 8.11 to 4.58 (on the visual analog scale) during the test trial was achieved (P &lt;.05). Six patients were identified as false-positive responders (17%). At the last available follow-up of 26 patients (mean, 5.6 years), active MCS led to a significant pain reduction compared with the preoperative pain ratings (mean visual analog scale score, 5.01; P &lt;.05). CONCLUSION: MCS is an additional therapeutic option for patients with refractory chronic TNP, and significant long-term pain suppression can be achieved. Placebo or double-blinded testing is mandatory.

Motor cortex stimulation for refractory neuropathic pain. Long-term outcome

2005 ◽  
Vol 6 (3) ◽  
pp. S36
Author(s):  
P. Mertens ◽  
C. Nuti ◽  
G. Polo ◽  
R. Peyron ◽  
L. Garcia-Larrea ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Motor Cortex ◽  
Motor Cortex Stimulation ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals What Are the Results and the Prognostic Factors of Motor Cortex Stimulation in Patients with Facial Pain? A Systematic Review of the Literature

2021 ◽  
pp. 1-6
Author(s):  
Alessandro Rapisarda ◽  
Eleonora Ioannoni ◽  
Alessandro Izzo ◽  
Nicola Montano
Keyword(s):  
Motor Cortex ◽  
Facial Pain ◽  
Univariate Analysis ◽  
Implantation Rate ◽  
Long Term Results ◽  
Motor Cortex Stimulation ◽  
Younger Age

<b><i>Introduction:</i></b> Facial pain (FP) is a type of neuropathic pain which recognizes both central and peripheral causes. It can be difficult to treat because it can often become resistant to pharmacological treatments. Motor Cortex Stimulation (MCS) has been used in selected cases, but the correct indications of MCS in FP have not been fully established. Here we systematically reviewed the literature regarding MCS in FP analysing the results of this technique and studying the possible role of different factors in the prognosis of these patients. <b><i>Methods:</i></b> A literature search was performed through different databases (PubMed, Scopus, and Embase) according to PRISMA guidelines using the following terms in any possible combination: “facial pain” or “trigeminal” or “anaesthesia dolorosa” and “motor cortex stimulation.” <b><i>Results:</i></b> 111 articles were reviewed, and 12 studies were included in the present analysis for a total of 108 patients. Overall, at latest follow-up (FU), 70.83% of patients responded to MCS. The preoperative VAS significantly decreased at the latest FU (8.83 ± 1.17 and 4.31 ± 2.05, respectively; <i>p</i> &#x3c; 0.0001). Younger age (<i>p</i> = 0.0478) and a peripheral FP syndrome (<i>p</i> = 0.0006) positively affected the definitive implantation rate on univariate analysis. Younger age emerged as a factor strongly associated to a higher probability to go to a definitive MCS implant on multivariate analysis (<i>p</i> = 0.0415). <b><i>Conclusion:</i></b> Our results evidenced the effectiveness of MCS in treating FP. Moreover, the younger age emerged as a positive prognostic factor for definitive implantation. Further studies with longer FU are needed to better evaluate the long-term results of MCS.

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