Chronic motor cortex stimulation in the treatment of central and neuropathic pain. Correlations between clinical, electrophysiological and anatomical data

Abstract

Thirty-two patients with refractory central and neuropathic pain of peripheral origin were treated by chronic stimulation of the motor cortex between May 1993 and January 1997. The mean follow-up was 27.3 months. The first 24 patients were operated according to the technique described by Tsubokawa. The last 13 cases (eight new patients and five reinterventions) were operated by a technique including localisation by superficial CT reconstruction of the central region and neuronavigator guidance. The position of the central sulcus was confirmed by the use of intraoperative somatosensory evoked potentials. The somatotopic organisation of the motor cortex was established peroperatively by studying the motor responses at stimulation of the motor cortex through the dura. Ten of the 13 patients with central pain (77%) and ten of the 12 patients with neuropathic facial pain had experienced substantial pain relief (75%). One of the three patients with post-paraplegia pain was clearly improved. A satisfactory result was obtained in one patient with pain related to plexus avulsion and in one patient with pain related to intercostal herpes zooster. None of the patients developed epileptic seizures. The position of the stimulating poles effective on pain corresponded to the somatotopic representation of the motor cortex. The neuronavigator localisation and guidance technique proved to be most useful identifying the appropriate portion of the motor gyrus. It also allowed the establishment of reliable correlations between electrophysiological-clinical and anatomical data which may be used to improve the clinical results and possibly to extend the indications of this technique.

A proposed algorithm for the management of pain following spinal cord injury

“…48 Other available treatments are very invasive with limited evidence of efficacy. These include deep brain stimulation 49,50 and motor cortex stimulation, 51 dorsal root entry zone lesions (for at-level neuropathic pain) [52][53][54] and surgical approaches such as cordotomy. 55 Psychosocial and environmental contributors The person with SCI undergoes a huge adjustment in relationships, lifestyle, vocation and self-image that need to be addressed and people with a severe SCI usually have significant psychological distress.…”

Protocole de prise en charge neurochirurgicale des acouphènes invalidants : à propos de trois cas

“…Au deuxième jour postopératoire, nous avons mis en route le stimulateur, en adoptant des paramètres de stimulation proposés dans la littérature existante (Nguyen et al, 2000 ;Nguyen et al, 1999 ;De Ridder et al, 2006 ;Litre et al, 2009).…”

Recording of Corticospinal Evoked Potential for Optimum Placement of Motor Cortex Stimulation Electrodes in the Treatment of Post-stroke Pain -Two Case Reports-

“…9,21) The recommended position of the cortical stimulation electrode is over the painful area. 14,17,21) Various surgical techniques are available for the accurate placement of epidural or subdural electrodes over the motor cortex. 14,17,21) However, a standard method has not yet been established.…”

“…14,17,21) Various surgical techniques are available for the accurate placement of epidural or subdural electrodes over the motor cortex. 14,17,21) However, a standard method has not yet been established. Anatomical identification of the central sulcus by phase reversal of N20 with monitoring of the somatosensory evoked potential or magnetic resonance (MR) imaging-guided neuronavigation may allow exact positioning of the stimulation electrode on the precentral gyrus directly or epidurally.…”