title: Bilateral motor cortex stimulation for the relief of central dysesthetic pain and intentional tremor secondary to spinal cord surgery: a case report.
abstract: Objectives. Our objective was to describe and analyze through a third party disinterested observer the results obtained by using motor cortex stimulation (MCS) for the treatment of central dysesthetic diffuse-distal type of paraplegic pain and intentional tremor secondary to the total removal of a cervical ependymoma. Design. Retrospective case report with discussion. Methods. A 69-year-old female, who after satisfactory removal of a cervical ependymoma, developed a central dysesthetic diffuse-distal type of paraplegic pain and intentional tremor associated with mild cerebellar deficit. Neurologic compromise became so intense that it prevented the patient from leading an independent lifestyle. Conservative treatments failed and a unilateral trial of MCS was performed. After a four-day satisfactory unilateral trial, a bilateral electrode, Resume II (Medtronic, Inc., Minneapolis, MN), was inserted through a small craniotomy and a dual-channel RF activated receiver was implanted. During the second month of follow-up an independent observer personally interviewed the patient and assessed results through a multimodal approach, encompassing several analog scales used to measure the different components of the painful experience; a daily life activities scale and drug intake. Results. Evoked painful phenomena were dramatically improved, but the steady component of pain was only moderately relieved. The patient's tremor improved to allow for the performance of simple movements such as independent eating. Conclusion. In this single case report MCS was extremely useful in eliminating almost all of the patient's pain-evoked phenomena. Both steady burning pain and tremor were also improved. This is only one case report and MCS warrants further investigation as to its utility in controlling central dysesthetic pain in paraplegia and postchordotomy dysesthesias.
authors.affiliation: Unit of Neurosurgery, Tornú Hospital, University of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Roberto Fabian
authors.initials: RF
authors.lastname: Rodríguez
authors.forename: Norberto
authors.initials: N
authors.lastname: Contreras