Motor cortex stimulation for facial chronic neuropathic pain: A review of the literature

Object The authors systematically reviewed the published literature to evaluate the efficacy of and adverse effects after motor cortex stimulation (MCS) for chronic neuropathic pain. Methods A search of the PubMed database (1991–2006) using the key words “motor cortex,” “stimulation,” and “pain” yielded 244 articles. Only original nonduplicated articles were selected for further analysis; 14 studies were identified for critical review. All were series of cases and none was controlled. The outcomes in 210 patients were assessed and expressed as the percentage of patients that improved with the procedure. Results A good response to MCS (pain relief ≥ 40–50%) was observed in ~ 55% of patients who underwent surgery and in 45% of the 152 patients with a postoperative follow-up ≥ 1 year. Visual analog scale scores were provided in 76 patients, revealing an average 57% improvement in the 41 responders. A good response was achieved in 54% of the 117 patients with central pain and 68% of the 44 patients with trigeminal neuropathic pain. Adverse effects were reported in 10 studies, including 157 patients. Infections (5.7%) and hardware-related problems (5.1%) were relatively common complications. Seizures occurred in 19 patients (12%) in the early postoperative period, but no chronic epilepsy was reported. Conclusions The results of the authors' review of the literature suggest that MCS is safe and effective in the treatment of chronic neuropathic pain. Results must be considered with caution, however, as none of the trials were blinded or controlled. Studies with a better design are mandatory to confirm the efficacy of MCS for chronic neuropathic pain.

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

Scientific Reports ◽

10.1038/s41598-021-91872-2 ◽

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.

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