title: Differential efficacy of electric motor cortex stimulation and lesioning of the dorsal root entry zone for continuous vs paroxysmal pain after brachial plexus avulsion.
abstract: BACKGROUND
  Pain after traumatic brachial plexus avulsion (BPA) has 2 distinct patterns: continuous burning pain and paroxysmal shooting pain. Lesioning of the dorsal root entry zone (DREZotomy) is more effective for paroxysmal than continuous pain. It is unknown, however, whether electric motor cortex stimulation (EMCS) has a differential effect on continuous vs paroxysmal BPA pain.
  
  
  OBJECTIVE
  To analyze the differential effect of EMCS and DREZotomy on continuous vs paroxysmal BPA pain in a series of 15 patients.
  
  
  METHODS
  Fifteen patients with intractable BPA pain underwent DREZotomy alone (n = 7), EMCS alone (n = 4), or both procedures (n = 4). Pain intensity was evaluated with the Visual Analog Scale, and separate ratings were recorded for paroxysmal and continuous pain. Pain relief was categorized as excellent (> 75% pain relief), good (50%-75%), or poor (< 50%). Favorable outcome was defined as good or better pain relief.
  
  
  RESULTS
  Eight patients had EMCS; 7 were followed up for an average of 47 months. Of those 7 patients, 3 (42%) with continuous pain had favorable outcomes compared with no patients with paroxysmal pain. Eleven patients had DREZotomy; 10 were followed up for an average of 31 months. Of those 10 patients, 7 (70%) with paroxysmal pain had favorable outcomes compared with 2 (20%) with continuous pain.
  
  
  CONCLUSIONS
  EMCS was ineffective for paroxysmal pain but moderately effective for continuous pain. DREZotomy was highly effective for paroxysmal pain but moderately effective for continuous pain. It may be prudent to use EMCS for residual continuous pain after DREZotomy.
authors.affiliation: Neurosurgery Department, Mansoura University, Mansoura, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ali
authors.forename: Youichi
authors.initials: Y
authors.lastname: Saitoh
authors.forename: Satoru
authors.initials: S
authors.lastname: Oshino
authors.forename: Koichi
authors.initials: K
authors.lastname: Hosomi
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kishima
authors.forename: Shayne
authors.initials: S
authors.lastname: Morris
authors.forename: Masahiko
authors.initials: M
authors.lastname: Shibata
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yoshimine
mesh_terms: D000328:Adult; D000368:Aged; D020516:Brachial Plexus Neuropathies / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D046690:Deep Brain Stimulation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology; D009437:Neuralgia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D013126:Spinal Nerve Roots / Q000502:physiology; D016896:Treatment Outcome