Motor cortex stimulation for long-term relief of chronic neuropathic pain: a 10 year experience.
Chronic subthreshold stimulation of the contralateral precentral gyrus is used in patients with intractable neuropathic pain for more than 15 years. The aim of this study was to analyse retrospectively our own patient group with long term follow-up of 10 years. Seventeen patients with chronic neuropathic pain were treated with contralateral epidural stimulation electrodes. In 10 cases, trigeminal neuropathic pain (TNP) and in seven cases post-stroke pain (PSP) were diagnosed. The placement of the electrodes was performed in local anaesthesia using neuronavigation and intraoperative neuromonitoring. A test trial of minimum one week including double-blind testing was conducted and pain intensity was measured using a visual analogue scale (VAS). Correct placement of the electrode was achieved in all patients using intraoperative neurophysiological monitoring. Double-blind testing was able to identify 6 (35%) non-responders. In 5 of 10 (50%) with TNP and 3 of 7 (43%) with PSP a positive effect with pain reduction > or = 50% was observed. The mean follow-up period was 3.6 years (range 1-10 years) and includes a patient with 10 years of positive stimulation effect. Stimulation of the motor cortex is a treatment option for patients with chronic neuropathic pain localized in the face or upper extremity. Double-blind testing can identify non-responders. Patients with TNP profit more than patients with PSP. The positive effect can last for ten years in long-term follow-up.
Department of Neurosurgery, Medical Faculty Heidelberg, University Hospital Heidelberg, Heidelberg, Germany. rasche@neurochirurgie.uni-luebeck.de
Dirk
D
Rasche
Marc
M
Ruppolt
Christoph
C
Stippich
Andreas
A
Unterberg
Volker M
VM
Tronnier
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004566:Electrodes; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000098:blood supply / Q000503:physiopathology / Q000528:radiation effects*; D009437:Neuralgia / Q000209:etiology / Q000628:therapy*; D010147:Pain Measurement / Q000379:methods; D012189:Retrospective Studies; D012196:Review Literature as Topic; D020521:Stroke / Q000150:complications; D013997:Time Factors; D014277:Trigeminal Neuralgia / Q000150:complications