Motor Cortex Stimulation for Phantom Limb Pain: Comprehensive Therapy with Spinal Cord and Thalamic Stimulation

Katayama, Yoichi; Yamamoto, Takamitsu; Kobayashi, Kazuhiko; Kasai, Masahiko; Oshima, Hideki; Fukaya, Chikashi

doi:10.1159/000064593

Cited by 96 publications

(56 citation statements)

References 6 publications

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“…A small comparative case series of 19 amputees has suggested that DBS was superior to SCS and MCS in ameliorating phantom limb pain in 60% of patients versus 32% with SCS and 20% with MCS, with 2 patients with both DBS and MCS implanted experiencing better analgesia from DBS. 30 Mazars et al reported 5 patients with phantom limb pain whose pain disappeared after thalamic DBS. 42 Other pioneers of DBS for pain such as Hosobuchi, Kumar, Young, and Levy, have all also reported improvements in phantom limb pain with DBS.…”

Section: Discussionmentioning

confidence: 99%

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

Pereira

Boccard

Linhares

et al. 2013

FOC

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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.

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Section: Discussionmentioning

confidence: 99%

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

Pereira

Boccard

Linhares

et al. 2013

FOC

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“…They found that 59% of patients who underwent DBS or MCS for poststroke involuntary movements had benefit and that 19% of the patients who underwent MCS primarily for pain control also showed improvement in their movement problems. 24 For patients with phantom limb pain, 27 the results were somewhat different. Of the five patients with MCS, only one (20%) demonstrated better pain relief than with either DBS in the ventrocaudal nucleus of the thalamus (6/10, or 60%), SCS (6/19, or 32%), or a combination thereof.…”

Section: Introductionmentioning

confidence: 97%

“…[23][24][25][26][27]59 A review of their publications indicates a total of 88 patients (some patients apparently are included in multiple reports). They not only explored MCS alone but also compared it to DBS and SCS as separate therapies and in combination.…”

Section: Introductionmentioning

confidence: 99%

Motor Cortex Stimulation for Pain and Movement Disorders

Arle

Shils

2008

Neurotherapeutics

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Summary:Since initial reports in the early 1990s, stimulation of the M1 region of the cortex (MCS) has been used to treat chronic refractory pain conditions and a variety of movement disorders. A Medline search of literature between 1991 and 2007 revealed 512 cases using MCS. Although most of these relate to the treatment of pain (422), 84 of them involve movement disorders. More recently, several studies have specifically looked at treating Parkinson's disease (PD) with MCS. We report here several of our own cases using MCS to treat poststroke and non-poststroke pain syndromes and movement disorders (n ϭ 8), PD (n ϭ 4), ET (n ϭ 2), and cortico-basal degeneration (n ϭ 1). We also cover the essential history of this procedure and our current research using computational modeling to understand further the underlying mechanisms of MCS.

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“…Viswanathan et al [18] reported more than 80 % pain relief on a numerical pain scale in all four patients. Katayama et al [37] noted that 32 % of patients (six of 19) reported more than 80 % long-term pain control with SCS. Patients in whom SCS failed to relive symptoms were evaluated for deep brain or motor cortex stimulation, with no remarkable benefit in controlling phantom limb pain over SCS being reported.…”

Section: Phantom Limb Painmentioning

confidence: 99%

Advances in Spinal Cord Stimulation for Treatment of Chronic Pain

Jung

Ignatius

Schulz

et al. 2013

Curr Phys Med Rehabil Rep

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Spinal cord stimulation (SCS) continues to gain validation as an effective and safe treatment option for a variety of chronic pain syndromes, including failed back surgery syndrome, complex regional pain syndrome, refractory angina pectoris, and phantom limb pain. Over the past 30 years, SCS has demonstrated successful outcomes in pain reduction, as well as improvement in quality of life and function. Additionally, there are promising developments under way with cervical spine level SCS and non-painrelated indications. Despite the success of SCS thus far, there is still a paucity of randomized control trials, and further clinical research is warranted to better establish SCS's efficacy across its spectrum of applications.

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Motor Cortex Stimulation for Phantom Limb Pain: Comprehensive Therapy with Spinal Cord and Thalamic Stimulation

Cited by 96 publications

References 6 publications

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

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

Motor Cortex Stimulation for Pain and Movement Disorders

Advances in Spinal Cord Stimulation for Treatment of Chronic Pain

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