Subdural motor cortex stimulation: feasibility, efficacy and security on a series of 18 consecutive cases with a follow-up of at least 3 years

Delavallée, M.; Finet, Patrice; Tourtchaninoff, Marianne de; Raftopoulos, Christian

doi:10.1007/s00701-014-2240-4

Cited by 13 publications

(8 citation statements)

References 29 publications

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“…Risk of bias as assessed by the RoB2 showed that all included papers had a low overall risk-of-bias judgement 47,[75][76][77] . Risk of bias as assessed by the ROBINS-I showed that all included papers had a moderate overall risk-of-bias judgement 9,10,13,24,40,[42][43][44][45]55,[78][79][80][81][82][83][84][85][86] . Table 1 provides an overview of the quality of the evidence of the included papers, respectively.…”

Section: Resultsmentioning

confidence: 99%

Motor cortex stimulation in chronic neuropathic orofacial pain syndromes: a systematic review and meta-analysis

Henssen

Kurt

Walsum

et al. 2020

Sci Rep

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Invasive motor Cortex Stimulation (iMCS) was introduced in the 1990's for the treatment of chronic neuropathic orofacial pain (CNOP), although its effectiveness remains doubtful. However, CNOP is known to be a heterogeneous group of orofacial pain disorders, which can lead to different responses to iMCS. Therefore, this paper investigated (1) whether the effectiveness of iMCS is significantly different among different CNOP disorders and (2) whether other confounding factors can be impacting iMCS results in CNOP. A systematic review and meta-analysis using a linear mixed-model was performed. Twenty-three papers were included, totaling 140 CNOP patients. Heterogeneity of the studies showed to be 55.8%. A visual analogue scale (VAS) measured median pain relief of 66.5% (ranging from 0-100%) was found. Linear mixed-model analysis showed that patients suffering from trigeminal neuralgia responded significantly more favorable to iMCS than patients suffering from dysfunctional pain syndromes (p = 0.030). Also, patients suffering from CNOP caused by (supra)nuclear lesions responded marginally significantly better to iMCS than patients suffering from CNOP due to trigeminal nerve lesions (p = 0.049). No other confounding factors were elucidated. This meta-analysis showed that patients suffering from trigeminal neuralgia and patients suffering from (supra)nuclear lesions causing CNOP responded significantly more favorable than others on iMCS. No other confounding factors were found relevant.In the early 1990's, Tsubokawa and his colleagues searched for a new therapy to treat intractable neuropathic pain as other forms of therapies, including continuous deep brain stimulation of thalamic nuclei, only provided satisfactory pain relief in approximately 30% of the cases. For that reason, they started to empirically stimulate various brain regions in animal models for intractable neuropathic pain. During their experiments, they recognized the primary motor cortex as a target that could provide excellent pain relief. Within their experiments, Tsubokawa transected the spinothalamic tract in cats, which led to thalamic hyperactivity and pain-related behavior. By stimulating the primary motor cortex in these cats, it was found that both the hyperactivity was inhibited and the pain-related behavior diminished, indicating an analgesic effect of iMCS in the treated cats. These experimental findings were in line with their subsequent clinical investigations in individuals suffering from intractable neuropathic pain as a consequence of thalamic syndrome 1-5 . Since then, iMCS has been carried out in approximately 700 cases world-wide, yielding highly variable outcomes 1,6-40 . Nevertheless, iMCS has become a last resort neurosurgical therapy for different intractable neuropathic pain syndromes 3-5,14,17,21,26,35,41-44 . In 1993, Meyerson et al. reported for the first time on the use of iMCS in chronic neuropathic orofacial pain (CNOP) as a last resort treatment. They reported that, in a case series of 10 individuals suffering from CNOP...

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Section: Resultsmentioning

confidence: 99%

Motor cortex stimulation in chronic neuropathic orofacial pain syndromes: a systematic review and meta-analysis

Henssen

Kurt

Walsum

et al. 2020

Sci Rep

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“…Moreover, there was the considerable confusion about the efficacy of MCS because four studies [6, 8–10] shown the invalid outcomes. Among included literatures, all reported the age of patients and the preoperative VAS scores [10, 11, 14–23]; seven reported the duration of the disease [11, 16, 17, 19–21, 23]; and 9 reported the time of follow-up [10, 15–17, 19–23]. All the information used in the present study were available in the Additional file 1.…”

Section: Resultsmentioning

confidence: 99%

Motor cortex stimulation: a systematic literature-based analysis of effectiveness and case series experience

Zhang

et al. 2019

BMC Neurol

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Background Aim to quantitatively analyze the clinical effectiveness for motor cortex stimulation (MCS) to refractory pain. Methods The literatures were systematically searched in database of Cocharane library, Embase and PubMed, using relevant strategies. Data were extracted from eligible articles and pooled as mean with standard deviation (SD). Comparative analysis was measured by non-parametric t test and linear regression model. Results The pooled effect estimate from 12 trials ( n = 198) elucidated that MCS shown the positive effect on refractory pain, and the total percentage improvement was 35.2% in post-stroke pain and 46.5% in trigeminal neuropathic pain. There is no statistical differences between stroke involved thalamus or non-thalamus. The improvement of plexus avulsion (29.8%) and phantom pain (34.1%) was similar. The highest improvement rate was seen in post-radicular plexopathy (65.1%) and MCS may aggravate the pain induced by spinal cord injury, confirmed by small sample size. Concurrently, Both the duration of disease ( r = 0.233, p = 0.019*) and the time of follow-up ( r = 0.196, p = 0.016*) had small predicative value, while age ( p = 0.125) had no correlation to post-operative pain relief. Conclusions MCS is conducive to the patients with refractory pain. The duration of disease and the time of follow-up can be regarded as predictive factor. Meanwhile, further studies are needed to reveal the mechanism of MCS and to reevaluate the cost-benefit aspect with better-designed clinical trials. Electronic supplementary material The online version of this article (10.1186/s12883-019-1273-y) contains supplementary material, which is available to authorized users.

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“…For instance, Delavall ee et al (2014) report pain to be intractable when patients were refractory to ≥2 analgesic medications, had presented neuropathic pain for ≥6 months ranging between 5 and 10 on a scale of 1 to 10, and a NRS score evaluated 4 times a day, and were evaluated by a neurosurgeon, a neurologist, and a psychiatrist. 21 The study by Saitoh et al, 55 however, used a less extensive definition of refractory pain: "patients had been treated with various medications including anticonvulsant and/or antidepressant drugs." To correct for such inconsistencies, and because a previous study found that responsiveness to gabapentin was positively correlated with iMCS outcome, 12 the authors included intake of oral analgesics in their final dataset and NNA.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Systematic Review and Neural Network Analysis to Define Predictive Variables in Implantable Motor Cortex Stimulation to Treat Chronic Intractable Pain

Henssen

Witkam

Dao

et al. 2019

The Journal of Pain

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Subdural motor cortex stimulation: feasibility, efficacy and security on a series of 18 consecutive cases with a follow-up of at least 3 years

Abstract: We report an efficacy at least as good as ED MCS, with no complications specific to SD MCS, even with prolonged follow-up. The data are insufficient to actually prove a lower energy use in SD MCS.

Cited by 13 publications

References 29 publications

Motor cortex stimulation in chronic neuropathic orofacial pain syndromes: a systematic review and meta-analysis

Motor cortex stimulation in chronic neuropathic orofacial pain syndromes: a systematic review and meta-analysis

Motor cortex stimulation: a systematic literature-based analysis of effectiveness and case series experience

Systematic Review and Neural Network Analysis to Define Predictive Variables in Implantable Motor Cortex Stimulation to Treat Chronic Intractable Pain

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