title: Chronic motor cortex stimulation in the treatment of central and neuropathic pain. Correlations between clinical, electrophysiological and anatomical data.
abstract: Thirty-two patients with refractory central and neuropathic pain of peripheral origin were treated by chronic stimulation of the motor cortex between May 1993 and January 1997. The mean follow-up was 27.3 months. The first 24 patients were operated according to the technique described by Tsubokawa. The last 13 cases (eight new patients and five reinterventions) were operated by a technique including localisation by superficial CT reconstruction of the central region and neuronavigator guidance. The position of the central sulcus was confirmed by the use of intraoperative somatosensory evoked potentials. The somatotopic organisation of the motor cortex was established peroperatively by studying the motor responses at stimulation of the motor cortex through the dura. Ten of the 13 patients with central pain (77%) and ten of the 12 patients with neuropathic facial pain had experienced substantial pain relief (75%). One of the three patients with post-paraplegia pain was clearly improved. A satisfactory result was obtained in one patient with pain related to plexus avulsion and in one patient with pain related to intercostal herpes zooster. None of the patients developed epileptic seizures. The position of the stimulating poles effective on pain corresponded to the somatotopic representation of the motor cortex. The neuronavigator localisation and guidance technique proved to be most useful identifying the appropriate portion of the motor gyrus. It also allowed the establishment of reliable correlations between electrophysiological-clinical and anatomical data which may be used to improve the clinical results and possibly to extend the indications of this technique.
authors.affiliation: Département des Neurosciences, CHU Henri Mondor, Créteil, France Service des Explorations Fonctionnelles, CHU Henri Mondor, Créteil, France Département D'anesthésie-Réanimation, CHU Henri Mondor, Créteil, France INSERM U421, Faculté de Médecine, Créteil, France Laboratoire de Physiologie de la Manducation, Université Denis Diderot, Paris, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Nguyen
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Lefaucheur
authors.forename: Philippe
authors.initials: P
authors.lastname: Decq
authors.forename: Takuya
authors.initials: T
authors.lastname: Uchiyama
authors.forename: Alexandre
authors.initials: A
authors.lastname: Carpentier
authors.forename: Denis
authors.initials: D
authors.lastname: Fontaine
authors.forename: Pierre
authors.initials: P
authors.lastname: Brugières
authors.forename: Bernard
authors.initials: B
authors.lastname: Pollin
authors.forename: Annaick
authors.initials: A
authors.lastname: Fève
authors.forename: Sylvie
authors.initials: S
authors.lastname: Rostaing
authors.forename: Pierre
authors.initials: P
authors.lastname: Cesaro
authors.forename: Yves
authors.initials: Y
authors.lastname: Keravel
mesh_terms: D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D009437:Neuralgia / Q000503:physiopathology*; D010146:Pain / Q000503:physiopathology*; D013997:Time Factors; D016896:Treatment Outcome