Treatment of chronic neuropathic pain by motor cortex stimulation: Results of a bicentric controlled crossover trial

Nǵuyen, Jean-Paul; Velasco, Francisco; Brugières, Pierre; Velasco, Marcos; Kéravel, Y.; Boleaga, Bernardo; Brito, Francisco; Lefaucheur, Jean‐Pascal

doi:10.1016/j.brs.2008.03.007

Cited by 79 publications

(61 citation statements)

References 18 publications

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“…MCS was first proposed by Tsubokawa et al [1,4,5] for the treatment of central poststroke pain. However, in a subsequent series, the efficacy of MCS was witnessed among patients with trigeminal neuropathic pain [6], and MCS has also been reported to be effective in peripheral neuropathic pain [7,8,9,10,11,12,13]. Several groups around the world similarly report mixed results with trends favoring pain of peripheral etiology [14,15,16,17,18], with poor response rates of 40-50% in central pain potentially due to damage to the central pain transmission pathways [16].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Results of Motor Cortex Stimulation in the Treatment of Chronic, Intractable Neuropathic Pain

Im¹,

Ha²,

Kim³

et al. 2015

Stereotact Funct Neurosurg

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Background/Objectives: Although motor cortex stimulation (MCS) has been used for more than 20 years in the treatment of chronic neuropathic pain, there is still a debate about the efficacy of MCS. Methods: To investigate the long-term results and the factors associated with the long-term success of chronic MCS, 21 patients who underwent MCS trial were classified as having central poststroke pain, central pain after spinal cord injury (SCI) and peripheral neuropathic pain, and we investigated the clinical factors associated with long-term success and degree of pain relief. Results: Of the 21 patients, 16 (76.2%) had a successful trial and underwent chronic MCS. In the long-term follow-up (53 ± 39 months), only the diagnosis (central poststroke pain and peripheral neuropathic pain) was associated with long-term success defined as >30% pain relief compared with baseline (p < 0.05, χ² test). The difference in pain relief was not significant in patients having SCI pain (p > 0.05, 1-way ANOVA). The other variables did not show any significant influence in the long-term success and degree of pain relief (p > 0.05, 1-way ANOVA). Conclusions: MCS was more effective in the treatment of chronic neuropathic pain of central poststroke pain and peripheral neuropathic pain types than in the treatment of SCI pain in the long-term follow-up.

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Section: Introductionmentioning

confidence: 99%

Long-Term Results of Motor Cortex Stimulation in the Treatment of Chronic, Intractable Neuropathic Pain

Im¹,

Ha²,

Kim³

et al. 2015

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

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“…However, the reported success rate for MCS is not high (40-50%) in central pain [46]. Among the various indications for MCS, trigeminal neuropathic pain seems to be the one which shows a greater long-term response to MCS than others [1,4,5,44,50,51,58].…”

Section: Discussionmentioning

confidence: 99%

“…MCS was first proposed for the treatment of central pain and shown to be effective in relieving peripheral neuropathic pain including trigeminal neuropathic pain and complex regional pain syndrome type II with hemibody involvement [1,2,3,4,5,6,7,8,9,10,44,45,46,47]. In a subsequent series, however, several groups reported mixed results with trends favoring pain of peripheral etiology [4,9,10,44] with poor response rates of 40-50% in central pain potentially due to damage to the central pain transmission pathways [44,45,46]. …”

Section: Discussionmentioning

confidence: 99%

Simultaneous Trial of Deep Brain and Motor Cortex Stimulation in Chronic Intractable Neuropathic Pain

Son

Kim

et al. 2014

Stereotact Funct Neurosurg

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Background/Objectives: Both motor cortex stimulation (MCS) and deep brain stimulation (DBS) of the ventralis caudalis (Vc) thalamus have been shown to be effective in chronic neuropathic pain, and the modulation of thalamic and thalamocortical activity is regarded as a possible mechanism. Although Vc DBS and MCS have a common analgesic mechanism, the application of MCS and DBS is still considered empirical, and there is no consensus on which method is better. Methods: We performed a simultaneous trial of thalamic Vc DBS and MCS in 9 patients with chronic neuropathic pain and investigated the results of the stimulation trial and long-term pain relief. Results: Of the 9 patients initially implanted with both DBS and MCS electrodes, 8 (89%) had a successful trial; 6 of these 8 patients (75%) responded to MCS, and the remaining 2 responded to Vc DBS. During the long-term follow-up, the mean numeric rating scale score decreased significantly (p < 0.05). The percentages of pain relief in the chronic MCS group and the chronic DBS group were 37.9 ± 16.5 and 37.5%, respectively, and there was no statistically significant difference (p = 0.157). Conclusion: Considering the initial success rate and the less invasive nature of epidural MCS compared with DBS, we think that MCS would be a more reasonable initial means of treatment for chronic intractable neuropathic pain.

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“…However, these results were statistically insignificant after multiple comparison correction [129]. Nguyen et al reported a randomized, blinded crossover trial of MCS in 10 patients with neuropathic pain with significant reduction in pain when the device was switched ‘on’ compared to ‘off’ [130]. Notably, a disappointing response was seen in hemibody post-stroke pain and post-herpetic neuralgia patients.…”

Section: Motor Cortex Stimulation and Its Comparison With Deep Bramentioning

confidence: 99%

The Current State of Deep Brain Stimulation for Chronic Pain and Its Context in Other Forms of Neuromodulation

2018

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Chronic intractable pain is debilitating for those touched, affecting 5% of the population. Deep brain stimulation (DBS) has fallen out of favour as the centrally implantable neurostimulation of choice for chronic pain since the 1970–1980s, with some neurosurgeons favouring motor cortex stimulation as the ‘last chance saloon’. This article reviews the available data and professional opinion of the current state of DBS as a treatment for chronic pain, placing it in the context of other neuromodulation therapies. We suggest DBS, with its newer target, namely anterior cingulate cortex (ACC), should not be blacklisted on the basis of a lack of good quality study data, which often fails to capture the merits of the treatment.

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Treatment of chronic neuropathic pain by motor cortex stimulation: Results of a bicentric controlled crossover trial

Cited by 79 publications

References 18 publications

Long-Term Results of Motor Cortex Stimulation in the Treatment of Chronic, Intractable Neuropathic Pain

Long-Term Results of Motor Cortex Stimulation in the Treatment of Chronic, Intractable Neuropathic Pain

Simultaneous Trial of Deep Brain and Motor Cortex Stimulation in Chronic Intractable Neuropathic Pain

The Current State of Deep Brain Stimulation for Chronic Pain and Its Context in Other Forms of Neuromodulation

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