Motor cortex stimulation in a patient with intractable complex regional pain syndrome Type II with hemibody involvement

2003 ◽  
Vol 98 (1) ◽  
pp. 175-179 ◽  
Author(s):  
Byung Chul Son ◽  
Moon Chan Kim ◽  
Dong Eon Moon ◽  
Joon Ki Kang
Keyword(s):  
Motor Cortex ◽  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Type Ii ◽  
Motor Cortex Stimulation ◽  
Functional Disturbance ◽  
Content Type ◽  
Subjective Sensation ◽  
Fine Print

✓ The authors describe the effectiveness of motor cortex stimulation (MCS) in a patient with complex regional pain syndrome (CRPS) Type II, formerly known as causalgia, with hemibody allodynia. During MCS, a subjective sensation of warm paresthesia developed in the painful hand and forearm and spread toward the trunk. Pain and allodynia in the areas associated with this sensation were alleviated significantly. The analgesic effect of stimulation proved to be long lasting and was still present at the 12-month follow up. The authors speculate that MCS might exert its effect through the modulation of thalamic activity in this particular case of CRPS with hemisensory deficit. A central mechanism associated with functional disturbance in noxious-event processing in the thalamus might have an important role in the pathogenesis of the condition.

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.

Acute axis fractures: a review of 229 cases

1989 ◽  
Vol 71 (5) ◽  
pp. 642-647 ◽  
Author(s):  
Mark N. Hadley ◽  
Curtis A. Dickman ◽  
Carol M. Browner ◽  
Volker K. H. Sonntag
Keyword(s):  
Treatment Guidelines ◽  
Type Ii ◽  
High Likelihood ◽  
Fracture Feature ◽  
Content Type ◽  
Nonoperative Therapy ◽  
The Difference ◽  
Cervical Spine Fractures ◽  
Fine Print

✓ Eighteen percent of acute cervical spine fractures involve the C-2 vertebra. The odontoid Type II fracture is the most common axis fracture and it is also the most difficult to treat. The degree of odontoid dislocation has been identified as the single most important fracture feature that helps separate those patients who have a high likelihood of healing with nonoperative therapy from those who are likely to fail nonoperative therapy and should be offered early surgical stabilization. The difference is statistically significant (p < 0.001, x2 = 30.20). The present series includes 229 patients with acute axis fractures. Follow-up data were available in 92% of these patients, for a median duration of 4 years 9 months. Treatment guidelines and results are offered for each subtype of axis fracture based on this experience.

Painful supernumerary phantom arm following motor cortex stimulation for central poststroke pain

1999 ◽  
Vol 91 (1) ◽  
pp. 121-123 ◽  
Author(s):  
Sergio Canavero ◽  
Vincenzo Bonicalzi ◽  
Giancarlo Castellano ◽  
Paola Perozzo ◽  
Barbara Massa-Micon
Keyword(s):  
Motor Cortex ◽  
Parietal Lobe ◽  
Phantom Limb ◽  
Central Pain ◽  
Motor Cortex Stimulation ◽  
Content Type ◽  
History Of ◽  
Fine Print

✓ In this report, the authors describe a case in which the patient began to experience a supernumerary phantom arm after she received motor cortex stimulation for central pain. The patient had a history of right thalamocapsular stroke. It is speculated that the motor cortex activation triggered a response in the patient's parietal lobe, precipitating perception of the phantom limb.To the authors' knowledge this is the first reported case of its kind.

DYSPHAGIA AND NEUROPATHIC FACIAL PAIN TREATED WITH MOTOR CORTEX STIMULATION

Neurosurgery ◽  
2009 ◽  
Vol 65 (3) ◽  
pp. E626-E626 ◽  
Author(s):  
William S. Anderson ◽  
Satoshi Kiyofuji ◽  
James E. Conway ◽  
Chris Busch ◽  
Richard B. North ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Facial Pain ◽  
Symptom Relief ◽  
Pain Syndrome ◽  
Symptom Improvement ◽  
Motor Cortex Stimulation ◽  
Percutaneous Procedures ◽  
Oral Pain ◽  
History Of

Abstract OBJECTIVE We report on a patient with a neuropathic facial pain syndrome, including elements of trigeminal neuralgia, glossopharyngeal neuralgia, and dysphagia. After failing medical and surgical decompressive treatments, the patient underwent implantation of a motor cortex stimulation (MCS) system. CLINICAL PRESENTATION A 54-year-old woman presented with a 14-year history of left-sided facial pain, throat pain, and associated nausea and vomiting. The patient failed several open surgical and percutaneous procedures for her facial pain syndrome. Additionally, several medication trial attempts were unsuccessful. Imaging studies were normal. INTERVENTION The patient underwent placement of a right-sided MCS system for treatment of her neuropathic facial pain syndrome. The procedure was tolerated well, and the trial stimulator provided promising results. The permanent MCS generator needed to be reprogrammed at the time of the 5-week follow-up visit to optimize symptom relief. The patient demonstrated dramatic improvements in her neuropathic facial and oral pain, including improvements in swallowing toleration, after the 5-week follow-up examination with subthreshold MCS. A decline in treatment efficacy also occurred 2 years after implantation due to generator depletion. Symptom improvement returned with stimulation after the generator was replaced. CONCLUSION A novel implantable MCS system was used to treat this patient's neuropathic facial pain. Durable improvements were noted not only in her facial pain, but also in swallowing toleration. The ultimate role of MCS in the treatment of pain conditions is still not well-defined but might play a part in refractory cases and, as in this case, might improve other functional issues, including dysphagia.

Pain Relief and Functional Recovery in Patients with Complex Regional Pain Syndrome after Motor Cortex Stimulation

2011 ◽  
Vol 89 (3) ◽  
pp. 167-172 ◽  
Author(s):  
Erich Talamoni Fonoff ◽  
Clement Hamani ◽  
Daniel Ciampi de Andrade ◽  
Lin Tchia Yeng ◽  
Marco Antonio Marcolin ◽  
...  
Keyword(s):  
Pain Relief ◽  
Motor Cortex ◽  
Complex Regional Pain Syndrome ◽  
Functional Recovery ◽  
Pain Syndrome ◽  
Motor Cortex Stimulation

Resolution of central pain after embolization of an arteriovenous malformation

1999 ◽  
Vol 90 (3) ◽  
pp. 575-579 ◽  
Author(s):  
Toru Fukuhara ◽  
Guy M. McKhann ◽  
Paul Santiago ◽  
Joseph M. Eskridge ◽  
John D. Loeser ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Stereotactic Radiosurgery ◽  
Complete Resolution ◽  
Pain Syndrome ◽  
Central Pain ◽  
Content Type ◽  
Fine Print

✓ The authors describe a patient with right-sided central pain resulting from a left parietal arteriovenous malformation (AVM). The AVM was treated with staged embolization and stereotactic radiosurgery, and its obliteration was documented on follow-up angiographic studies. Surprisingly, the patient noted complete resolution of her pain syndrome after embolization, which is an extremely rare result. Central pain and its proposed mechanisms are discussed.

Motor cortex stimulation for central pain and peripheral deafferentation pain

2000 ◽  
Vol 92 (1) ◽  
pp. 150-155 ◽  
Author(s):  
Youichi Saitoh ◽  
Masahiko Shibata ◽  
Shun-ichiro Hirano ◽  
Masayuki Hirata ◽  
Takashi Mashimo ◽  
...  
Keyword(s):  
Pain Relief ◽  
Motor Cortex ◽  
Electrode Array ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Motor Cortex Stimulation ◽  
Content Type ◽  
Deafferentation Pain ◽  
Pharmacological Test ◽  
Fine Print

✓ The authors tested a modified motor cortex stimulation protocol for treatment of central and peripheral types of deafferentation pain. Four patients with thalamic pain and four with peripheral deafferentation pain were studied. Preoperative pharmacological tests of pain relief were performed using phentolamine, lidocaine, ketamine, thiopental, and placebo. In five patients we placed a 20- or 40-electrode grid in the subdural space to determine the best stimulation point for pain relief for a few weeks before definitive placement of a four-electrode array. In three patients, the four-electrode array was implanted in the interhemispheric fissure as a one-stage procedure to treat lower-extremity pain. In two patients with pain extending from the extremity to the trunk or hip, dual devices were implanted to drive two electrodes.Six of eight patients experienced pain reduction (two each with excellent, good, and fair relief) from motor cortex stimulation. No correlation was apparent between pharmacological test results and the effectiveness of motor cortex stimulation. Patients with peripheral deafferentation pain, including two with phantom-limb pain and two with brachial plexus injury, attained pain relief from motor cortex stimulation, with excellent results in two cases. Testing performed with a subdural multiple-electrode grid was helpful in locating the best stimulation point for pain relief. Motor cortex stimulation may be effective for treating peripheral as well as central deafferentation pain.

scholarly journals Pain Relief in CRPS-II after Spinal Cord and Motor Cortex Simultaneous Dual Stimulation

2016 ◽  
Vol 4;19 (4;5) ◽  
pp. E631-E635
Author(s):  
Erich T. Fonoff
Keyword(s):  
Spinal Cord ◽  
Motor Cortex ◽  
Brachial Plexus ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
Rescue Therapy ◽  
Pain Syndrome ◽  
Syndrome Type ◽  
Type Ii ◽  
Patient Reported

We describe a case of a 30-year-old woman who suffered a traumatic injury of the right brachial plexus, developing severe complex regional pain syndrome type II (CRPS-II). After clinical treatment failure, spinal cord stimulation (SCS) was indicated with initial positive pain control. However, after 2 years her pain progressively returned to almost baseline intensity before SCS. Additional motor cortex electrode implant was then proposed as a rescue therapy and connected to the same pulse generator. This method allowed simultaneous stimulation of the motor cortex and SCS in cycling mode with independent stimulation parameters in each site. At 2 years follow-up, the patient reported sustained improvement in pain with dual stimulation, reduction of painful crises, and improvement in quality of life. The encouraging results in this case suggests that this can be an option as add-on therapy over SCS as a possible rescue therapy in the management of CRPS-II. However, comparative studies must be performed in order to determine the effectiveness of this therapy. Key words: Chronic neuropathic pain, Complex regional pain syndrome Type II, brachial plexus injury, motor cortex stimulation, spinal cord stimulation

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