title: Simultaneous trial of deep brain and motor cortex stimulation in chronic intractable neuropathic pain.
abstract: OBJECTIVE
  Both motor cortex stimulation (MCS) and deep brain stimulation (DBS) of the ventralis caudalis (Vc) thalamus have been shown to be effective in chronic neuropathic pain, and the modulation of thalamic and thalamocortical activity is regarded as a possible mechanism. Although Vc DBS and MCS have a common analgesic mechanism, the application of MCS and DBS is still considered empirical, and there is no consensus on which method is better.
  
  
  METHODS
  We performed a simultaneous trial of thalamic Vc DBS and MCS in 9 patients with chronic neuropathic pain and investigated the results of the stimulation trial and long-term pain relief.
  
  
  RESULTS
  Of the 9 patients initially implanted with both DBS and MCS electrodes, 8 (89%) had a successful trial; 6 of these 8 patients (75%) responded to MCS, and the remaining 2 responded to Vc DBS. During the long-term follow-up, the mean numeric rating scale score decreased significantly (p < 0.05). The percentages of pain relief in the chronic MCS group and the chronic DBS group were 37.9 ± 16.5 and 37.5%, respectively, and there was no statistically significant difference (p = 0.157).
  
  
  CONCLUSIONS
  Considering the initial success rate and the less invasive nature of epidural MCS compared with DBS, we think that MCS would be a more reasonable initial means of treatment for chronic intractable neuropathic pain.
authors: Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Byung-chul
authors: BC
authors: Son
authors: Deok-ryeong
authors: DR
authors: Kim
authors: Hyung-suk
authors: HS
authors: Kim
authors: Sang-won
authors: SW
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000627:therapeutic use; D003131:Combined Modality Therapy; D046690:Deep Brain Stimulation; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D009437:Neuralgia / Q000188:drug therapy / Q000628:therapy*; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D013787:Thalamic Nuclei / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D000700:Analgesics