Chronic Motor Cortex Stimulation for Phantom Limb Pain: Correlations between Pain Relief and Functional Imaging Studies

Abstract

Chronic motor cortex stimulation (CMCS) has provided satisfactory control of pain in patients with central or trigeminal neuropathic pain. We used this technique in 3 patients with intractable phantom limb pain after upper limb amputation. Functional magnetic resonance imaging (fMRI) correlated to anatomical MRI permitted frameless image guidance for electrode placement. Pain control was obtained for all the patients initially and the relief was stable in 2 of the 3 patients at 2 year follow-up. CMCS can be used to relieve phantom limb pain. fMRI data are useful in assisting the neurosurgeon in electrode placement for this indication.

Recovery of Pain Control by Intensive Reprogramming after Loss of Benefit from Motor Cortex Stimulation for Neuropathic Pain

“…Initial reports suggested that approximately 70% of patients had continued beneficial effect after 1 year. Subsequently, several authors have reported on the effectiveness of MCS for the treatment of both central and peripheral deafferentation pain, including trigeminal neuropathic pain, phantom limb pain and poststroke pain [6][7][8][12][13][14]. Overall, it appears that between 50 and 75% of patients achieve some long-term benefit from MCS.…”

Combination of Functional Magnetic Resonance Imaging-guided Neuronavigation and Intraoperative Cortical Brain Mapping Improves Targeting of Motor Cortex Stimulation in Neuropathic Pain

“…Furthermore, these results allow many authors to consider fMRI as highly valuable before surgery for risk assessment, therapeutic decision making, and surgical planning in eloquent cortical areas (1,2,6,16,24,26,45,47,56,60,66). To our knowledge, only one team has tested this combination in a short preliminary series of NP patients (49,51,59). Indeed, Roux et al (49,51) and Sol et al (59) observed a correspondence between the two techniques.…”

“…To our knowledge, only one team has tested this combination in a short preliminary series of NP patients (49,51,59). Indeed, Roux et al (49,51) and Sol et al (59) observed a correspondence between the two techniques. They suggested that fMRI guidance could help in guiding electrode positioning in MCS and could even replace iCM in detection of the CS.…”

Motor cortex stimulation and neuropathic facial pain

“…Although in many studies no adverse events with MCS have been reported, 16,18,19,[38][39][40]42,44 there have been some serious complications reported in the literature. Two epidural hematomas have been reported, one small and asymptomatic, 26 and the other requiring evacuation and associated with persistent dysphasia.…”