Differential Efficacy of Electric Motor Cortex Stimulation and Lesioning of the Dorsal Root Entry Zone for Continuous vs Paroxysmal Pain After Brachial Plexus Avulsion

Ali, Mohamed I.; Saitoh, Youichi; Oshino, Satoru; Hosomi, Koichi; Kishima, Haruhiko; Morris, Shayne; Shibata, Masahiko; Yoshimine, Toshiki

doi:10.1227/neu.0b013e31820c04a9

Cited by 41 publications

(35 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, we observed that appropriate BMI training reduced pain even in these patients (Supplementary Table 3), suggesting that it could be an alternative to mirror therapy. Moreover, some patients in this study had also undergone lesioning of the dorsal root entry zone (DREZotomy)44 and reported residual pain after surgery. The BMI training significantly reduced the scores for continuous pain in the residual pain.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Induced sensorimotor brain plasticity controls pain in phantom limb patients

et al. 2016

Self Cite

View full text Add to dashboard Cite

The cause of pain in a phantom limb after partial or complete deafferentation is an important problem. A popular but increasingly controversial theory is that it results from maladaptive reorganization of the sensorimotor cortex, suggesting that experimental induction of further reorganization should affect the pain, especially if it results in functional restoration. Here we use a brain–machine interface (BMI) based on real-time magnetoencephalography signals to reconstruct affected hand movements with a robotic hand. BMI training induces significant plasticity in the sensorimotor cortex, manifested as improved discriminability of movement information and enhanced prosthetic control. Contrary to our expectation that functional restoration would reduce pain, the BMI training with the phantom hand intensifies the pain. In contrast, BMI training designed to dissociate the prosthetic and phantom hands actually reduces pain. These results reveal a functional relevance between sensorimotor cortical plasticity and pain, and may provide a novel treatment with BMI neurofeedback.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Pain after BPRA is caused by several factors, as is the pain after amputation3. In particular, the paroxysmal pain after BPRA is hypothesized to originate from the affected spinal cord and is often relieved by DREZotomy44. Moreover, in BPRA patients, some motor and sensory functions of the arm partially remain.…”

Section: Methodsmentioning

confidence: 99%

Induced sensorimotor brain plasticity controls pain in phantom limb patients

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…1,13,58 Motor cortex stimulation (MCS) has also been undertaken with equivocal results influencing paroxysms more than continuous pain, 2,33 and spinal cord stimulation (SCS) has been reported with limited success. 15,64 No trials comparing neuromodulation treatments for BPA have been reported.…”

Section: Discussionmentioning

confidence: 99%

Thalamic deep brain stimulation for neuropathic pain after amputation or brachial plexus avulsion

Pereira

Boccard

Linhares

et al. 2013

FOC

View full text Add to dashboard Cite

Object Fifteen hundred patients have received deep brain stimulation (DBS) to treat neuropathic pain refractory to pharmacotherapy over the last half-century, but few during the last decade. Deep brain stimulation for neuropathic pain has shown variable outcomes and gained consensus approval in Europe but not the US. This study prospectively evaluated the efficacy at 1 year of DBS for phantom limb pain after amputation, and deafferentation pain after brachial plexus avulsion (BPA), in a single-center case series. Methods Patient-reported outcome measures were collated before and after surgery, using a visual analog scale (VAS) score, 36-Item Short-Form Health Survey (SF-36), Brief Pain Inventory (BPI), and University of Washington Neuropathic Pain Score (UWNPS). Results Twelve patients were treated over 29 months, receiving contralateral, ventroposterolateral sensory thalamic DBS. Five patients were amputees and 7 had BPAs, all from traumas. A postoperative trial of externalized DBS failed in 1 patient with BPA. Eleven patients proceeded to implantation and gained improvement in pain scores at 12 months. No surgical complications or stimulation side effects were noted. In the amputation group, after 12 months the mean VAS score improved by 90.0% ± 10.0% (p = 0.001), SF-36 by 57.5% ± 97.9% (p = 0.127), UWNPS by 80.4% ± 12.7% (p < 0.001), and BPI by 79.9% ± 14.7% (p < 0.001). In the BPA group, after 12 months the mean VAS score improved by 52.7% ± 30.2% (p < 0.001), SF-36 by 15.6% ± 30.5% (p = 1.000), UWNPS by 26.2% ± 40.8% (p = 0.399), and BPI by 38.4% ± 41.7% (p = 0.018). Mean DBS parameters were 2.5 V, 213 microseconds, and 25 Hz. Conclusions Deep brain stimulation demonstrated efficacy at 1 year for chronic neuropathic pain after traumatic amputation and BPA. Clinical trials that retain patients in long-term follow-up are desirable to confirm findings from prospectively assessed case series.

show abstract

“…Paroxysmal pain in patients with brachial plexus avulsion responds to surgical intervention that involves lesion of the dorsal root entry zone, thereby selectively damaging second-order nociceptive neurons and sparing dorsal columns. [92][93][94] Paroxysmal extreme pain disorder is caused by a gain-of-function mutation in SCN9A, the gene encoding the sodium channel Na v 1.7, which is expressed by nociceptive fibres. 55 The paroxysmal pain that characterizes this rare condition is, therefore, presumed to be associated with abnormal activity in nociceptive fibres.…”

Section: Anatomical Denervationmentioning

confidence: 99%

Reappraising neuropathic pain in humans—how symptoms help disclose mechanisms

2013

View full text Add to dashboard Cite

Neuropathic pain--that is, pain arising directly from a lesion or disease that affects the somatosensory system--is a common clinical problem, and typically causes patients intense distress. Patients with neuropathic pain have sensory abnormalities on clinical examination and experience pain of diverse types, some spontaneous and others provoked. Spontaneous pain typically manifests as ongoing burning pain or paroxysmal electric shock-like sensations. Provoked pain includes pain induced by various stimuli or even gentle brushing (dynamic mechanical allodynia). Recent clinical and neurophysiological studies suggest that the various pain types arise through distinct pathophysiological mechanisms. Ongoing burning pain primarily reflects spontaneous hyperactivity in nociceptive-fibre pathways, originating from 'irritable' nociceptors, regenerating nerve sprouts or denervated central neurons. Paroxysmal sensations can be caused by several mechanisms; for example, electric shock-like sensations probably arise from high-frequency bursts generated in demyelinated non-nociceptive Aβ fibres. Most human and animal findings suggest that brush-evoked allodynia originates from Aβ fibres projecting onto previously sensitized nociceptive neurons in the dorsal horn, with additional contributions from plastic changes in the brainstem and thalamus. Here, we propose that the emerging mechanism-based approach to the study of neuropathic pain might aid the tailoring of therapy to the individual patient, and could be useful for drug development.

show abstract

Differential Efficacy of Electric Motor Cortex Stimulation and Lesioning of the Dorsal Root Entry Zone for Continuous vs Paroxysmal Pain After Brachial Plexus Avulsion

Abstract: EMCS was ineffective for paroxysmal pain but moderately effective for continuous pain. DREZotomy was highly effective for paroxysmal pain but moderately effective for continuous pain. It may be prudent to use EMCS for residual continuous pain after DREZotomy.

Cited by 41 publications

References 22 publications

Induced sensorimotor brain plasticity controls pain in phantom limb patients

Induced sensorimotor brain plasticity controls pain in phantom limb patients

Thalamic deep brain stimulation for neuropathic pain after amputation or brachial plexus avulsion

Reappraising neuropathic pain in humans—how symptoms help disclose mechanisms

Contact Info

Product

Resources

About