Pre-motor versus motor cerebral cortex neuromodulation for chronic neuropathic pain

Abstract

Electrical stimulation of the cerebral cortex (ESCC) has been used to treat intractable neuropathic pain for nearly two decades, however, no standardized approach for this technique has been developed. In order to optimize targeting and validate the effect of ESCC before placing the permanent grid, we introduced initial assessment with trial stimulation, using a temporary grid of subdural electrodes. In this retrospective study we evaluate the role of electrode location on cerebral cortex in control of neuropathic pain and the role of trial stimulation in target-optimization for ESCC. Location of the temporary grid electrodes and location of permanent electrodes were evaluated in correlation with the long-term efficacy of ESCC. The results of this study demonstrate that the long-term effect of subdural pre-motor cortex stimulation is at least the same or higher compare to effect of subdural motor or combined pre-motor and motor cortex stimulation. These results also demonstrate that the initial trial stimulation helps to optimize permanent electrode positions in relation to the optimal functional target that is critical in cases when brain shift is expected. Proposed methodology and novel results open a new direction for development of neuromodulation techniques to control chronic neuropathic pain.

Long-Term Results of Cortical Motor Stimulation for Neuropathic Peripheral and Central Pain: Real-World Evidence From Two Independent Centers

“…The suspected loss of CMS efficacy over time could be explained by a tolerance phenomenon. 12,20,21 Some of the strategies proposed to address this effect are cyclization programing, 16,22,23 setting the amplitude at 60% of the motor threshold, 16 and patient hospitalization to perform an intensive reprograming session. 23 Regarding the biological mechanisms of action, cathodal stimulation of the motor cortex could activate cortical interneurons, which indirectly trigger descending pathways to the thalamus and spinal cord.…”

“…29 However, because of its poor negative predictive value, 30,31 after negative response to transcranial magnetic stimulation, CMS trial might still be offered, especially in cases of PTN. Others suggested that functional preservation of motor descending pathways might also predict good responses, 32 whereas Lavrov et al 20 propose that modulation of the premotor cortex could have a strong correlation with a faster and more stable improvement.…”

“…The second one acts directly over the perpendicular pathways (D-wave). 7,20,24,47,48 Which one is the responsible for the analgesic effect is uncertain; however, some authors agree that interneuron activation (I-waves) is key in this process. 44 Low amplitudes are known to generate I-waves, whereas higher amplitudes also trigger D-waves.…”

Does Practice Make Perfect? Functional Connectivity of the Salience Network and Somatosensory Network Predicts Response to Mind-Body Treatments for Fibromyalgia

“…The premotor cortex (together with the insula) processes information regarding perceived unpleasantness of muscle pain [23]. It is also involved in the planning and anticipation of actions and also integration of information incoming from the PFC and somatosensory areas [24]. Importantly its activity has also been shown to be associated with pain catastrophising in FMS [25].…”

Peripheral Nerve Stimulation for Tactile and Proprioceptive Feedback with Phantom Limb Pain Suppression in Amputees

“…With PNS (Chandrasekaran et al 2020;Bensmaia, Tyler, and Micera 2020) and spinal cord stimulation (SCS) (Tan et al 2014;Chandrasekaran et al 2020), a person can experience a wide range of sensory perceptions, so these are efficient approaches to prosthetic feedback, including closed-loop operation of the neural prosthesis of the hand. Combining visuo-motor tasks with PNS-based feedback increases the sense of prosthetic-limb ownership and embodiment in patients (Page et al 2018;Rognini et al 2019) Additionally, good spatial resolution was achieved with cortical stimulation (Lavrov et al 2021) where evoked sensations matched the well-known cortical somatotopic map of the body and these sensations could be modulated by changing stimulation amplitude ( (Chandrasekaran et al 2020;Bensmaia, Tyler, and Micera 2020).…”