Motor cortex stimulation for central pain following a traumatic brain injury.
Central pain can occur in any lesions along the central nervous system affecting the spinothalamocortical pathway. Although diverse etiologies have been reported to cause central pain, there are few reports on the occurrence and surgical treatment of central pain following a traumatic brain injury (TBI). This paper describes the occurrence of central pain following a severe TBI, in which the diagnosis of central pain was typically delayed due to the patient's decreased ability to express his pain for severe aphasia as a neurological sequela. The severe burning pain, deep pressure-like pain, and deep mechanical allodynia, which presented over the contralateral side to the TBI, were successfully relieved with motor cortex stimulation (MCS). The analgesic effect of stimulation was found to be long lasting and was still present at the 12-month follow up. As shown in this patient, the occurrence of central pain syndrome should be considered by physicians caring for TBI patients, and a comprehensive, systematic study will be needed to determine the prevalence of central pain after a TBI.
Son
Byung Chul
BC
Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea. sbc@catholic.ac.kr
Lee
Sang Won
SW
Choi
Eun Seok
ES
Sung
Jae Hoon
JH
Hong
Jae Taek
JT
D000058:Accidental Falls; D000328:Adult; D000588:Amines / Q000627:therapeutic use; D000639:Amitriptyline / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D001039:Aphasia, Broca / Q000209:etiology; D001930:Brain Injuries / Q000150:complications*; D002908:Chronic Disease; D003128:Coma / Q000209:etiology; D003131:Combined Modality Therapy; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D004599:Electric Stimulation Therapy; D000077206:Gabapentin; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D006930:Hyperalgesia / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D008297:Male; D009044:Motor Cortex / Q000503:physiopathology*; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D059408:Pain Management; D011183:Postoperative Complications / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy; D011712:Pyramidal Tracts / Q000503:physiopathology*; D013133:Spinothalamic Tracts / Q000503:physiopathology*; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D000588:Amines; D018712:Analgesics, Non-Narcotic; D003509:Cyclohexanecarboxylic Acids; D000639:Amitriptyline; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin