Motor Cortex Stimulation for Intractable Neuropathic Facial Pain Related to Multiple Sclerosis -Case Report-

Abstract

A 33-year-old man presented with ongoing severe right facial pain and sensory disturbances caused by multiple sclerosis (MS). Neuroimaging demonstrated demyelinating lesions in the right dorsal pons and medulla oblongata. The pain was refractory to carbamazepine at 800 mg/day, gabapentin at 1800 mg/day, morphine at 30 mg/day, amitriptyline at 60 mg/day, and diazepam at 4 mg/day, along with twice-monthly ketamine (60 mg) drip infusions. The patient underwent motor cortex stimulation (MCS), resulting in À60% pain relief, reduction in the required doses of pain medications, and discontinuation of ketamine administration. MCS is effective for MS-related neuropathic facial pain.

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

“…[118119120] In the worldwide literature, there is a growing interest on stimulation of the motor cortex for treatment of FCNP [Figure 1]. [96] Initially tried for thalamic pain, it has been tried for many treatment-resistant pain syndromes [54] such as phantom limb pain, [95101106] postherpetic neuralgia, brachial plexus avulsion, [57] poststroke pain, [324648505176106111] Wallenberg syndrome,[3349] complex regional pain syndrome, [2770108] pain secondary to multiple sclerosis, [112] spinal cord injury pain, [88113] and posttraumatic brain injury pain. [107] Recently, MCS has also been tried in other nonpainful conditions.…”

Pain in multiple sclerosis: A systematic review of neuroimaging studies

“…1). Thirty-eight met the inclusion criteria (Alstadhaug et al, 2008; Andrade et al, 2012; Athanasiou et al, 2005; Balasa and Bajko, 2010; Bentley et al, 2002; Broggi et al, 2004; Burkey and Abla-Yao, 2010; Carrieri et al, 2009; Cordella et al, 2009; Cruccu et al, 2009; da Silva et al, 2005; Davey and Al-Din, 2004; Deppe et al, 2013; de Santi et al, 2009; Donat, 2012; Eldridge et al, 2003; Fragoso and Brooks, 2007; Gass et al, 1997; Gee et al, 2005; Gentile et al, 2007; González-Quintanilla et al, 2012; Haas et al, 1993; Hellwig et al, 2006; Kister et al, 2010; Leandri et al, 1999; Liu et al, 2008; Marchettini et al, 2006; Meaney et al, 1995; Minagar and Sheremata, 2000; Nakashima et al, 2001; Pichiecchio et al, 2007; Ramirez-Lassepas et al, 1992; Svendsen et al, 2011; Tanei et al, 2010; Tortorella et al, 2006; Tosi et al, 1998; Vilisaar and Constantinescu, 2006; Yetimalar et al, 2008). Of these, 16 were case reports (Alstadhaug et al, 2008; Andrade et al, 2012; Bentley et al, 2002; Burkey and Abla-Yao, 2010; Carrieri et al, 2009; Davey and Al-Din, 2004; Donat, 2012; Gentile et al, 2007; González-Quintanilla et al, 2012; Haas et al, 1993; Leandri et al, 1999; Liu et al, 2008; Pichiecchio et al, 2007; Tanei et al, 2010; Tosi et al, 1998; Vilisaar and Constantinescu, 2006), nine were case series (Athanasiou et al, 2005; Cordella et al, 2009; de Santi et al, 2009; Fragoso and Brooks, 2007; Hellwig et al, 2006; Marchettini et al, 2006; Meaney et al, 1995; Minagar and Sheremata, 2000; Nakashima et al, 2001), and 13 were investigational studies (<...>…”

“…The type of MS in subjects was not fully described in 14 studies (Athanasiou et al, 2005; Balasa and Bajko 2010; Burkey and Abla-Yao, 2010; Cruccu et al, 2009; Donat, 2012; Eldridge et al, 2003; Fragoso and Brooks, 2007; González-Quintanilla et al, 2012; Kister et al, 2010; Marchettini et al, 2006; Meaney et al, 1995; Minagar and Sheremata, 2000; Ramirez-Lassepas et al, 1992; Yetimalar et al, 2008). It was relapsing–remitting in 16 ((Alstadhaug et al, 2008; Andrade et al, 2012; Bentley et al, 2002; Carrieri et al, 2009; Deppe et al, 2013; de Santi et al, 2009; Gentile et al, 2007; Haas et al, 1993; Hellwig et al, 2006; Leandri et al, 1999; Liu et al, 2008; Nakashima et al, 2001; Pichiecchio et al, 2007; Tanei et al, 2010; Tosi et al, 1998) (Minagar and Sheremata, 2000) – one case). Six studies included patients with various MS subtypes (Broggi et al, 2004; da Silva et al, 2005; Gass et al, 1997; Gee et al, 2005; Svendsen et al, 2011; Tortorella et al, 2006).…”

“…Lesions were identified in the CNS ( i.e. central neuropathic pain) in 21 studies; of these, lesions were located in the spinal cord in six studies ((Alstadhaug et al, 2008; Burkey and Abla-Yao, 2010; Tosi et al, 1998) (de Santi et al, 2009) — three cases (Hellwig et al, 2006) — four cases: only two documented with MRI (Marchettini et al, 2006) — five cases), in the brainstem in 13 studies ((Bentley et al, 2002; Donat, 2012; Gentile et al, 2007; González-Quintanilla et al, 2012; Haas et al, 1993; Leandri et al, 1999; Liu et al, 2008; Tanei et al, 2010) (Meaney et al, 1995; Nakashima et al, 2001; Vilisaar and Constantinescu, 2006) — one case (Fragoso and Brooks, 2007) — two cases (Cordella et al, 2009) — five cases), in the thalamus in one study (Deppe et al, 2013) and in multiple locations throughout the pyramidal tract in another study (Andrade et al, 2012). …”

“…These studies addressed microvascular decompression for trigeminal neuralgia (TN) (Athanasiou et al, 2005; Broggi et al, 2004; Eldridge et al, 2003), CNS stimulation (Burkey and Abla-Yao, 2010; Cordella et al, 2009; Tanei et al, 2010), and intrathecal administration of a steroid (Hellwig et al, 2006). …”