Motor cortex stimulation for neuropathic pain

Smith, Helen; Joint, Carlolf; Schlugman, David; Nandi, Dipankar; Stein, John; Aziz, Tipu Z.

doi:10.3171/foc.2001.11.3.3

Cited by 51 publications

(44 citation statements)

References 22 publications

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“…The 46.1% of the patients with more than 50% pain relief and the 69.2% with more than 40% pain relief observed in this study are similar to the rates obtained in other studies 1,14,15 , which observed that 50% of the patients treated with MSC had over 50% pain relief. In a critical review of the literature, Fontaine et al noticed that a good response to MCS (pain relief ≥40-50%) was observed in around 55% of the patients who underwent surgery, and in 45% of the 152 patients with a postoperative follow-up ≥1 year 16 .…”

Section: Discussionsupporting

confidence: 80%

“…The motor response in the painful area may also be useful. However, as pointed out by Smith et al 1 , the results from such tests are not a guarantee of a successful outcome. Therefore, we did not routinely perform any prediction-specific assessments.…”

Section: Discussionmentioning

confidence: 97%

“…In another review, Smith et al showed that a positive response was achieved in 44 to 100% of MCS-treated patients 1 .…”

Section: Discussionmentioning

confidence: 99%

“…Accurate localization of the motor cortex and precise electrode placement according to the painful areas are essential in obtaining good results 20 . Predicting pain relief from MCS is a major clinical problem 1 . Barbiturate sensitivity and opioid insensitivity have been suggested as possible predictors of the response 12,21,22 .…”

Section: Discussionmentioning

confidence: 99%

“…Neuropathic pain is one of the most difficult and worst conditions to treat in clinical practice 1,2 . Electrical stimulation at different sites in the central nervous system has been shown to induce pain relief, and is now considered to be a viable form of therapy for chronic deafferentation pain 2,3 .…”

Section: Introductionmentioning

confidence: 99%

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Motor cortex electric stimulation for the treatment of neuropathic pain

Fagundes-Pereyra

Teixeira

Reyns

et al. 2010

Arq. Neuro-Psiquiatr.

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Objective: Motor cortex stimulation (MCS) is considered to be an effective treatment for chronic neuropathic pain. The aim of the present study was to assess the efficacy of MCS for treating neuropathic pain. Method: 27 patients with chronic neuropathic pain were operated. Electrodes were implanted with the use of an stereotactic frame. Electrophysiological evaluations (motor stimulation and somatosensory evoked potentials) were performed, with guidance by means of three-dimensional reconstruction of magnetic resonance images of the brain. 10 patients (37%) presented central neuropathic pain (poststroke pain) and 17 others (63%) presented peripheral neuropathic pain (brachial plexus avulsion, phantom limb pain or trigeminal pain). Results: In 15 patients (57.7%) the pain relief was 50% or more; while in ten patients (38.5%), more than 60% of the original pain was relieved. No differences were found in relation to central and peripheral neuropathic pain (p=0.90), pain location (p=0.81), presence of motor deficit (p=0.28) and pain duration (p=0.72). No major complications were observed. Conclusion: MCS was efficient for treating patients presenting chronic central or peripheral neuropathic pain. Key words: electric motor cortex stimulation, neuropathic pain, central pain, peripheral pain, treatment.Estimulação elétrica do córtex motor no tratamento da dor neuropática RESUMO Objetivo: A estimulação do córtex motor (ECM) é método considerado eficaz no tratamento da dor neuropática crônica rebelde. O presente estudo avaliou a eficácia da ECM no tratamento de pacientes portadores de dor neuropática crônica. Método: 27 doentes foram avaliados; 10 (37,0%) apresentavam dor neuropática de origem central, enquanto 17 (63,0%), dor neuropática periférica. Avulsão de raízes do plexo braquial, dor no membro fantasma, dor decorrente de doença cerebrovascular isquêmica ou hemorrágica ou neuropatia trigeminal foram as causas mais freqüentes da dor. Os doentes foram operados com uso da técnica de localização estereotáctica do córtex motor associadamente a estudo eletroneurofisiológico (estimulação motora e potencial evocado somatossensitivo) ou ainda com uso de imagens de ressonância magnética do encéfalo reconstruídas tridimensionalmente. Resultados: O alívio da dor foi igual ou superior a 50% em 15 doentes (57,7%), sendo em 10 (38,5%), superior a 60%. Não houve diferença nos resultados quanto a origem central ou periférica (p=0,90) da dor, localização da dor (p=0,81), ocorrência ou não de déficit motor (p=0,28) e duração da sintomatologia (p=0,72). Não foram observadas complicações graves. Conclusão: A estimulação do córtex motor foi útil no tratamento da dor neuropática crônica rebelde tanto de origem central como periférica. Palavras-chave: estimulação elétrica do córtex motor, dor neuropática, dor central, dor periférica, tratamento. CorrespondenceWalter J. Fagundes-Pereyra

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 97%

“…In another review, Smith et al showed that a positive response was achieved in 44 to 100% of MCS-treated patients 1 .…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Motor cortex electric stimulation for the treatment of neuropathic pain

Fagundes-Pereyra

Teixeira

Reyns

et al. 2010

Arq. Neuro-Psiquiatr.

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Globus pallidus internus deep brain stimulation for dystonic conditions: A prospective audit

Yianni¹,

et al. 2003

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In the current era of functional surgery for movement disorders, deep brain stimulation (DBS) of the globus pallidus internus (GPi) is emerging as the favoured target in the treatment of patients with dystonia. The results of 25 consecutive patients with medically intractable dystonia (12 with generalised dystonia, 7 with spasmodic torticollis, and 6 with other types of dystonia) treated with GPi stimulation are reported. Although comparisons were limited by differences in their respective neurological rating scales, chronic DBS benefited all groups, resulting in clear and progressive improvements in their condition. This study clearly demonstrates that DBS of the GPi provides amelioration of intractable dystonia.

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Higher incidence of depression preceding the onset of Parkinson's disease: A register study

Leentjens¹,

Akker²,

Metsemakers³

et al. 2003

Movement Disorders

306

170

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Although case histories of depression preceding Parkinson's disease (PD) point to a possible pathophysiological relationship between these two disorders, there is as yet no epidemiological evidence to support this view. We compared the incidence of depression in patients later diagnosed with PD with that of a matched control population. Using data from an ongoing general practice-based register study, the lifetime incidence of depressive disorder was calculated for patients until their diagnosis of PD and compared with that of a matched control population from the same register. At the time of analysis, the register held information on 105416 people. At the time of their diagnosis of PD, 9.2% of the patients had a history of depression, compared with 4.0% of the control population (chi(2) = 22.388, df = 1, P < 0.001). The odds ratio for a history of depression for these patients was 2.4 (95% CI: 2.1-2.7). We concluded that the higher incidence of depression in patients who were later diagnosed with PD supports the hypothesis of there being a biological risk factor for depression in these patients.

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Motor cortex stimulation for neuropathic pain

Cited by 51 publications

References 22 publications

Motor cortex electric stimulation for the treatment of neuropathic pain

Motor cortex electric stimulation for the treatment of neuropathic pain

Globus pallidus internus deep brain stimulation for dystonic conditions: A prospective audit

Higher incidence of depression preceding the onset of Parkinson's disease: A register study

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