title: Motor cortex stimulation in the treatment of neuropathic pain.
abstract: OBJECTIVE
  Despite the rapid development of neuropharmacotherapy, medical treatment of neuropathic pain (NP) still constitutes a significant socioeconomic problem. The authors herein present a group of patients treated with motor cortex stimulation (MCS) for NP of various types and aetiologies.
  
  
  METHODS
  Our cohort included 12 female and 11 male NP patients aged 53 ± 16 treated with MCS. Eleven patients were diagnosed with neuropathic facial pain (NFP), 8 with hemi-body neuropathic pain (HNP), and 4 with deafferentation pain (DP). Prior to surgery, 16 out of 23 patients were treated with repetitive transcranial magnetic stimulation (rTMS), with a positive response in 10 cases. Pain intensity in our group was evaluated with the visual analogue scale (VAS) one month before and three months after MCS implantation.
  
  
  RESULTS
  Improvement on the VAS was reported in the whole group of patients (p < 0.001). The best results were reported in the NFP group (p < 0.001) while the worst ones were noted in the DP group (p = 0.04). Anamnesis duration positively correlated with outcome. Infection forced the authors to permanently remove the system in one case. There were no other complications in the group.
  
  
  CONCLUSIONS
  Minimally invasive, safe neuromodulative treatment with MCS permits neuropathic pain control with good efficacy. The type of neuropathic pain might be a prognostic factor.
authors.affiliation: Klinika Nowotworów Ukladu Nerwowego, Centrum Onkologii - Instytut, ul. Roentgena 5, 02-781 Warszawa, Polska. tomaszmandat@yahoo.com
authors.forename: Tomasz
authors.initials: T
authors.lastname: Mandat
authors.forename: Henryk
authors.initials: H
authors.lastname: Koziara
authors.forename: Sławomir
authors.initials: S
authors.lastname: Barszcz
authors.forename: Rafał
authors.initials: R
authors.lastname: Rola
authors.forename: Michał
authors.initials: M
authors.lastname: Karliński
authors.forename: Anna
authors.initials: A
authors.lastname: Sliwińska
authors.forename: Stephane
authors.initials: S
authors.lastname: Palfi
authors.forename: Radosław
authors.initials: R
authors.lastname: Michalik
authors.forename: Artur
authors.initials: A
authors.lastname: Oziębło
authors.forename: Jacek
authors.initials: J
authors.lastname: Kunicki
authors.forename: Paweł
authors.initials: P
authors.lastname: Nauman
authors.forename: Wiesław
authors.initials: W
authors.lastname: Bonicki
mesh_terms: D015331:Cohort Studies; D046690:Deep Brain Stimulation; D020878:Device Removal; D004567:Electrodes, Implanted / Q000009:adverse effects; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009044:Motor Cortex / Q000503:physiopathology*; D009437:Neuralgia / Q000145:classification / Q000503:physiopathology / Q000628:therapy*; D010147:Pain Measurement; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome