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.

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 ◽  
Byung-chul Son ◽  
Jin-gyu Choi ◽  
Sang-woo Ha ◽  
Deog-ryeong Kim ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Motor Cortex ◽  
Long Term Results ◽  
Motor Cortex Stimulation ◽  
Deep Brain

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

scholarly journals Deactivation of Distant Pain-Related Regions Induced by 20-day rTMS: A Case Study of Oneweek Pain Relief for Long-Term Intractable Deafferentation Pain

2014 ◽  
Vol 17;1 (1;17) ◽  
pp. E99-E105
Author(s):  
Wen-Dong Xu
Keyword(s):  
Case Report ◽  
Pain Relief ◽  
Motor Cortex ◽  
Caudate Nucleus ◽  
Cortical Plasticity ◽  
Motor Cortex Stimulation ◽  
Deafferentation Pain ◽  
Significant Difference ◽  
Stimulation Of

Background: Deafferentation pain secondary to brachial plexus avulsion, spinal cord injury, and other peripheral nerve injuries is often refractory to conventional treatments. Stimulation of the primary motor cortex (M1) has been proven to be an effective treatment for intractable deafferentation pain. The mechanisms underlying the attenuation of deafferentation pain by motor cortex stimulation remain hypothetical. Objectives: The purpose of this case report is to: (1) summarize a case in which a patient suffering chronic intractable deafferentation pain for 25 years underwent rTMS treatment over M1, (2) describe the evidence from PET imaging, and (3) reveal a possible relief mechanism with cortical plasticity. Study design: Case report. Setting: University hospital. Results: This patient had successful pain control with no transient or lasting side effects. The pain relief remained stable for at least one week. At the end of the 20-day procedure, pain relief was obtained according to the Visual Analog Scale (VAS) (-34.6%) and the McGill Pain Questionnaire (MPQ) (-31.6%). In the PET/CT scans, the glucose metabolism was significantly reduced contralaterally to the pain side in the anterior cingulate cortex (ACC), insula, and caudate nucleus. There was no statistically significant difference in any other cortical area. Limitations: Single case of a patient with long-term intractable deafferentation pain having a PET study. Conclusion: This study implies that a single session of 20 Hz rTMS over the motor cortex could reduce the pain level in patients suffering from long-term, intractable deafferentation pain. The stimulation of the M1 induces deactivation in the ACC, insula, and caudate nucleus. The changes in these pain-related regions may mirror an adaptive mechanism to pain relief after rTMS treatment. Key words: Neuropathic pain management, deafferentation pain, transcranial magnetic stimulation, motor cortex stimulation, cortical plasticity, positron emission tomography

Long-Term Results of Motor Cortex Stimulation in the Treatment of Chronic, Intractable Neuropathic Pain

2015 ◽  
Vol 93 (3) ◽  
pp. 212-218 ◽  
Author(s):  
Sang-hyuk Im ◽  
Sang-woo Ha ◽  
Deok-ryeong Kim ◽  
Byung-chul Son
Keyword(s):  
Neuropathic Pain ◽  
Motor Cortex ◽  
Long Term Results ◽  
Motor Cortex Stimulation

SUBDURAL MOTOR CORTEX STIMULATION FOR CENTRAL AND PERIPHERAL NEUROPATHIC PAIN

Neurosurgery ◽  
2008 ◽  
Vol 63 (1) ◽  
pp. 101-108 ◽  
Author(s):  
Maxime Delavallée ◽  
Basel Abu-Serieh ◽  
Marianne de Tourchaninoff ◽  
Christian Raftopoulos
Keyword(s):  
Neuropathic Pain ◽  
Motor Cortex ◽  
Therapeutic Effect ◽  
Motor Evoked Potentials ◽  
Long Term Results ◽  
Electrode Position ◽  
Motor Cortex Stimulation ◽  
Plate Electrode ◽  
Small Series

ABSTRACT OBJECTIVE In certain chronic neuropathic pain (CNP) conditions, extradural electrode implantation is preferred to a subdural location for motor cortex stimulation (MCS) therapy, but the rationale for this preference remains debatable. We provide documented long-term results of subdural MCS in CNP. METHODS Our eight consecutive patients (five men, three women; age range, 45–81 yr) had either central or peripheral CNP. We localized the central sulcus using anatomic landmarks and three-dimensional neuronavigation and by detecting the N20 wave inversion. We then created an elongated craniotomy (3 cm long × 1 cm wide), followed by a linear incision of the dura. An eight-polar plate electrode was slipped in subdurally. We used motor-evoked potentials to choose the optimal electrode position before fixing the electrode to the dura. RESULTS Six patients had favorable outcomes, and two had poor outcomes at the time of the last assessment (mean, 54 mo; range, 19–69 mo). Three patients experienced five transient complications, each having an episode of partial motor seizure, one that evolved into a secondary generalized seizure. Seizures were related to an abrupt increase in stimulation intensity. Two of these three patients also had hardware infections that required system replacement, with the electrode implanted extradurally at the second implantation in one case because of severe arachnoiditis. This change necessitated a greater intensity and a longer duration of stimulation to deliver a therapeutic effect equivalent to that with subdural MCS. CONCLUSION In this small series, subdural MCS seemed a tolerable approach in the long term for CNP patients. In addition, subdural MCS provided a therapeutic effect comparable to that obtained with extradural placement.

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.

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.

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