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J Neurol Surg A Cent Eur Neurosurg 2016; 77(01): 052-058
DOI: 10.1055/s-0035-1558419
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Treatment of Central Deafferentation and Trigeminal Neuropathic Pain by Motor Cortex Stimulation: Report of a Series of 20 Patients

Malgorzata Anna Kolodziej
1   Department of Neurosurgery, UKGM, Giessen, Germany
,
Dieter Hellwig
2   Department of Neurosurgery, INI, Hannover, Germany
*   Dr. Hellwig passed away in 2014.
,
Christopher Nimsky
3   Department of Neurosurgery, University Hospital Marburg, Marburg, Germany
,
Ludwig Benes
3   Department of Neurosurgery, University Hospital Marburg, Marburg, Germany
› Author Affiliations
Further Information

Publication History

20 January 2014

24 April 2015

Publication Date:
09 September 2015 (online)

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Abstract

Objective Motor cortex stimulation (MCS) is an alternative treatment modality for central neuropathic pain, if conservative treatment failed. Study aim was outcome assessment after MCS.

Material and Methods This study is a retrospective case series review of patients who had undergone MCS for central pain (n = 8), deafferentation pain (n = 3) and neuropathic trigeminal pain (n = 9) between April 2001 and May 2011. In all patients, four contact-paddle electrodes were placed in the epidural space overlying the motor cortex via burr hole trepanation under local anesthesia. The follow-up period was 6 months to 6 years. Pain control was assessed by the visual analog scale (VAS).

Results A total of 22 patients (11 men, 11 women) were treated; after trial stimulation two male patients were excluded for incompliance reasons. The mean patient age was 59.8 years (range: 31–79 years). In the central pain group, three patients reported complete, and four patients satisfactory pain control. In the trigeminal neuropathic pain group, seven patients reported complete, and two patients satisfactory pain control. In the deafferentation pain group, one patient reported complete, and two patients satisfactory pain control. None of the patients showed new neurologic deficits after the MCS.

Conclusions MCS is an effective treatment modality for central neuropathic pain and trigeminal pain with low morbidity and mortality. Future studies are necessary to evaluate and optimize this treatment option in more detail.

Keywords

deafferentation pain - neuropathic pain - trigeminal pain - motor cortex stimulation - pain treatment
 

  • References

  • 1 Lenz FA. Neurosurgical treatment of pain. In: Cervero F, Jensen TS, , eds. Handbook of Clinical Neurology. Philadelphia, PA: Elsevier; 2006: 867-885
    Google Scholar
  • 2 Peyron R, Faillenot I, Mertens P, Laurent B, Garcia-Larrea L. Motor cortex stimulation in neuropathic pain. Correlations between analgesic effect and hemodynamic changes in the brain. A PET study. Neuroimage 2007; 34 (1) 310-321
    CrossrefPubMedGoogle Scholar
  • 3 Franzini A, Ferroli P, Dones I, Marras C, Broggi G. Chronic motor cortex stimulation for movement disorders: a promising perspective. Neurol Res 2003; 25 (2) 123-126
    CrossrefPubMedGoogle Scholar
  • 4 Lefaucheur JP, Holsheimer J, Goujon C, Keravel Y, Nguyen JP. Descending volleys generated by efficacious epidural motor cortex stimulation in patients with chronic neuropathic pain. Exp Neurol 2010; 223 (2) 609-614
    CrossrefPubMedGoogle Scholar
  • 5 Meyerson BA, Lindblom U, Linderoth B, Lind G, Herregodts P. Motor cortex stimulation as treatment of trigeminal neuropathic pain. Acta Neurochir Suppl (Wien) 1993; 58: 150-153
    PubMedGoogle Scholar
  • 6 Nguyen JP, Keravel Y, Feve A , et al. Treatment of deafferentation pain by chronic stimulation of the motor cortex: report of a series of 20 cases. Acta Neurochir Suppl (Wien) 1997; 68: 54-60
    PubMedGoogle Scholar
  • 7 Peyron R, Garcia-Larrea L, Deiber MP , et al. Electrical stimulation of precentral cortical area in the treatment of central pain: electrophysiological and PET study. Pain 1995; 62 (3) 275-286
    CrossrefPubMedGoogle Scholar
  • 8 Saitoh Y, Hirano S, Kato A , et al. Motor cortex stimulation for deafferentation pain. Neurosurg Focus 2001; 11 (3) E1
    PubMedGoogle Scholar
  • 9 Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Chronic motor cortex stimulation in patients with thalamic pain. J Neurosurg 1993; 78 (3) 393-401
    CrossrefPubMedGoogle Scholar
  • 10 Yamamoto T, Katayama Y, Hirayama T, Tsubokawa T. Pharmacological classification of central post-stroke pain: comparison with the results of chronic motor cortex stimulation therapy. Pain 1997; 72 (1–2) 5-12
    CrossrefPubMedGoogle Scholar
  • 11 García-Larrea L, Peyron R, Mertens P , et al. Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study. Pain 1999; 83 (2) 259-273
    CrossrefPubMedGoogle Scholar
  • 12 Garcia-Larrea L, Peyron R. Motor cortex stimulation for neuropathic pain: from phenomenology to mechanisms. Neuroimage 2007; 37 (Suppl. 01) S71-S79
    CrossrefPubMedGoogle Scholar
  • 13 Drouot X, Nguyen JP, Peschanski M, Lefaucheur JP. The antalgic efficacy of chronic motor cortex stimulation is related to sensory changes in the painful zone. Brain 2002; 125 (Pt 7): 1660-1664
    CrossrefPubMedGoogle Scholar
  • 14 Coulter JD, Maunz RA, Willis WD. Effects of stimulation of sensorimotor cortex on primate spinothalamic neurons. Brain Res 1974; 65 (2) 351-356
    CrossrefPubMedGoogle Scholar
  • 15 Saitoh Y, Shibata M, Hirano S, Hirata M, Mashimo T, Yoshimine T. Motor cortex stimulation for central and peripheral deafferentation pain. Report of eight cases. J Neurosurg 2000; 92 (1) 150-155
    CrossrefPubMedGoogle Scholar
  • 16 Brown JA, Barbaro NM. Motor cortex stimulation for central and neuropathic pain: current status. Pain 2003; 104 (3) 431-435
    CrossrefPubMedGoogle Scholar
  • 17 Carroll D, Joint C, Maartens N, Shlugman D, Stein J, Aziz TZ. Motor cortex stimulation for chronic neuropathic pain: a preliminary study of 10 cases. Pain 2000; 84 (2–3) 431-437
    CrossrefPubMedGoogle Scholar
  • 18 Ebel H, Rust D, Tronnier V, Böker D, Kunze S. Chronic precentral stimulation in trigeminal neuropathic pain. Acta Neurochir (Wien) 1996; 138 (11) 1300-1306
    CrossrefPubMedGoogle Scholar
  • 19 Lima MC, Fregni F. Motor cortex stimulation for chronic pain: systematic review and meta-analysis of the literature. Neurology 2008; 70 (24) 2329-2337
    CrossrefPubMedGoogle Scholar
  • 20 Mertens P, Nuti C, Sindou M , et al. Precentral cortex stimulation for the treatment of central neuropathic pain: results of a prospective study in a 20-patient series. Stereotact Funct Neurosurg 1999; 73 (1–4) 122-125
    CrossrefPubMedGoogle Scholar
  • 21 Nguyen JP, Lefaucher JP, Le Guerinel C , et al. Motor cortex stimulation in the treatment of central and neuropathic pain. Arch Med Res 2000; 31 (3) 263-265
    CrossrefPubMedGoogle Scholar
  • 22 Ruohonen J, Karhu J. Navigated transcranial magnetic stimulation. Neurophysiol Clin 2010; 40 (1) 7-17
    CrossrefPubMedGoogle Scholar
  • 23 Lefaucheur JP, Drouot X, Cunin P , et al. Motor cortex stimulation for the treatment of refractory peripheral neuropathic pain. Brain 2009; 132 (Pt 6): 1463-1471
    CrossrefPubMedGoogle Scholar
  • 24 Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Chronic motor cortex stimulation for the treatment of central pain. Acta Neurochir Suppl (Wien) 1991; 52: 137-139
    PubMedGoogle Scholar
  • 25 Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Treatment of thalamic pain by chronic motor cortex stimulation. Pacing Clin Electrophysiol 1991; 14 (1) 131-134
    CrossrefPubMedGoogle Scholar
  • 26 Knotkova H, Cruciani RA, Tronnier VM, Rasche D. Current and future options for the management of phantom-limb pain. J Pain Res 2012; 5: 39-49
    PubMedGoogle Scholar
  • 27 Rasche D, Tronnier VM. Invasive treatment of chronic neuropathic pain syndromes: epidural stimulation of the motor cortex. In: Knotkova H, Cruciani R, Merrick J, , eds. Brain Stimulation in the Treatment of Pain. New York, NY: Nova Science Publishers; 2010: 69-87
    Google Scholar
  • 28 Meyer-Rosberg K, Burckhardt CS, Huizar K, Kvarnström A, Nordfors LO, Kristofferson A. A comparison of the SF-36 and Nottingham Health Profile in patients with chronic neuropathic pain. Eur J Pain 2001; 5 (4) 391-403
    CrossrefPubMedGoogle Scholar
  • 29 Meyer-Rosberg K, Kvarnström A, Kinnman E, Gordh T, Nordfors LO, Kristofferson A. Peripheral neuropathic pain—a multidimensional burden for patients. Eur J Pain 2001; 5 (4) 379-389
    CrossrefPubMedGoogle Scholar
  • 30 Nguyen JP, Lefaucheur JP, Le Guerinel C , et al. Treatment of central and neuropathic facial pain by chronic stimulation of the motor cortex: value of neuronavigation guidance systems for the localization of the motor cortex [in French]. Neurochirurgie 2000; 46 (5) 483-491
    PubMedGoogle Scholar
  • 31 Rao SM, Binder JR, Hammeke TA , et al. Somatotopic mapping of the human primary motor cortex with functional magnetic resonance imaging. Neurology 1995; 45 (5) 919-924
    CrossrefPubMedGoogle Scholar
  • 32 Katayama Y, Fukaya C, Yamamoto T. Poststroke pain control by chronic motor cortex stimulation: neurological characteristics predicting a favorable response. J Neurosurg 1998; 89 (4) 585-591
    CrossrefPubMedGoogle Scholar
  • 33 Calautti C, Jones PS, Naccarato M , et al. The relationship between motor deficit and primary motor cortex hemispheric activation balance after stroke: longitudinal fMRI study. J Neurol Neurosurg Psychiatry 2010; 81 (7) 788-792
    CrossrefPubMedGoogle Scholar
  • 34 Gharabaghi A, Hellwig D, Rosahl SK , et al. Volumetric image guidance for motor cortex stimulation: integration of three-dimensional cortical anatomy and functional imaging. Neurosurgery 2005; 57 (1, Suppl): 114-120 ; discussion 114–120
    CrossrefPubMedGoogle Scholar
  • 35 Lefaucheur JP, Ménard-Lefaucheur I, Goujon C, Keravel Y, Nguyen JP. Predictive value of rTMS in the identification of responders to epidural motor cortex stimulation therapy for pain. J Pain 2011; 12 (10) 1102-1111
    CrossrefPubMedGoogle Scholar
  • 36 Nguyen JP, Lefaucheur JP, Decq P , et al. Chronic motor cortex stimulation in the treatment of central and neuropathic pain. Correlations between clinical, electrophysiological and anatomical data. Pain 1999; 82 (3) 245-251
    CrossrefPubMedGoogle Scholar
  • 37 Rasche D, Ruppolt M, Stippich C, Unterberg A, Tronnier VM. Motor cortex stimulation for long-term relief of chronic neuropathic pain: a 10 year experience. Pain 2006; 121 (1–2) 43-52
    CrossrefPubMedGoogle Scholar
  • 38 Raslan AM, Nasseri M, Bahgat D, Abdu E, Burchiel KJ. Motor cortex stimulation for trigeminal neuropathic or deafferentation pain: an institutional case series experience. Stereotact Funct Neurosurg 2011; 89 (2) 83-88
    CrossrefPubMedGoogle Scholar
  • 39 Taylor RS. Epidemiology of refractory neuropathic pain. Pain Pract 2006; 6 (1) 22-26
    CrossrefPubMedGoogle Scholar
  • 40 Tirakotai W, Hellwig D, Bertalanffy H, Riegel T. Localization of precentral gyrus in image-guided surgery for motor cortex stimulation. Acta Neurochir Suppl (Wien) 2007; 97 (Pt 2): 75-79
    PubMedGoogle Scholar
  • 41 Tirakotai W, Riegel T, Sure U , et al. Image-guided motor cortex stimulation in patients with central pain. Minim Invasive Neurosurg 2004; 47 (5) 273-277
    Article in Thieme ConnectPubMedGoogle Scholar
  • 42 Yamamoto T, Katayama Y, Obuchi T , et al. Recording of corticospinal evoked potential for optimum placement of motor cortex stimulation electrodes in the treatment of post-stroke pain. Neurol Med Chir (Tokyo) 2007; 47 (9) 409-414
    CrossrefPubMedGoogle Scholar
  • 43 Mogilner AY, Rezai AR. Epidural motor cortex stimulation with functional imaging guidance. Neurosurg Focus 2001; 11 (3) E4
    PubMedGoogle Scholar
  • 44 Nguyen JP. Motor cortex stimulation. . Paper presented at: 10th World Congress on Pain; 2002; San Diego, CA
    PubMedGoogle Scholar
  • 45 Katayama Y, Yamamoto T, Kobayashi K, Kasai M, Oshima H, Fukaya C. Motor cortex stimulation for phantom limb pain: comprehensive therapy with spinal cord and thalamic stimulation. Stereotact Funct Neurosurg 2001; 77 (1-4) 159-162
    CrossrefPubMedGoogle Scholar
  • 46 Nguyen JP, Pollin B, Fève A, Geny C, Cesaro P. Improvement of action tremor by chronic cortical stimulation. Mov Disord 1998; 13 (1) 84-88
    CrossrefPubMedGoogle Scholar
  • 47 Tani N, Saitoh Y, Hirata M, Kato A, Yoshimine T. Bilateral cortical stimulation for deafferentation pain after spinal cord injury. Case report. J Neurosurg 2004; 101 (4) 687-689
    CrossrefPubMedGoogle Scholar
  • 48 Levy R, Deer TR, Henderson J. Intracranial neurostimulation for pain control: a review. Pain Physician 2010; 13 (2) 157-165
    PubMedGoogle Scholar
  • 49 Nguyen JP, Nizard J, Keravel Y, Lefaucheur JP. Invasive brain stimulation for the treatment of neuropathic pain. Nat Rev Neurol 2011; 7 (12) 699-709
    CrossrefPubMedGoogle Scholar
  • 50 Bezard E, Boraud T, Nguyen JP, Velasco F, Keravel Y, Gross C. Cortical stimulation and epileptic seizure: a study of the potential risk in primates. Neurosurgery 1999; 45 (2) 346-350
    CrossrefPubMedGoogle Scholar
  • 51 Nuti C, Peyron R, Garcia-Larrea L , et al. Motor cortex stimulation for refractory neuropathic pain: four year outcome and predictors of efficacy. Pain 2005; 118 (1–2) 43-52
    CrossrefPubMedGoogle Scholar
  • 52 Smith H, Joint C, Schlugman D, Nandi D, Stein JF, Aziz TZ. Motor cortex stimulation for neuropathic pain. Neurosurg Focus 2001; 11 (3) E2
    PubMedGoogle Scholar
  • 53 Sachs AJ, Babu H, Su YF, Miller KJ, Henderson JM. Lack of efficacy of motor cortex stimulation for the treatment of neuropathic pain in 14 patients. Neuromodulation 2014; 17 (4) 303-310 ; discussion 310–311
    CrossrefPubMedGoogle Scholar
  • 54 Krieg SM, Shiban E, Buchmann N, Meyer B, Ringel F. Presurgical navigated transcranial magnetic brain stimulation for recurrent gliomas in motor eloquent areas. Clin Neurophysiol 2013; 124 (3) 522-527
    CrossrefPubMedGoogle Scholar
  • 55 Picht T, Krieg SM, Sollmann N , et al. A comparison of language mapping by preoperative navigated transcranial magnetic stimulation and direct cortical stimulation during awake surgery. Neurosurgery 2013; 72 (5) 808-819
    CrossrefPubMedGoogle Scholar
  • 56 Fontaine D, Hamani C, Lozano A. Efficacy and safety of motor cortex stimulation for chronic neuropathic pain: critical review of the literature. J Neurosurg 2009; 110 (2) 251-256
    CrossrefPubMedGoogle Scholar