Vol 46, No 5 (2012)

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Motor cortex stimulation in the treatment of neuropathic pain

Tomasz Mandat1, Henryk Koziara1, Sławomir Barszcz1, Rafał Rola23, Michał Karliński2, Anna Śliwińska2, Stephane Palfi1, Radosław Michalik1, Artur Oziębło1, Jacek Kunicki1, Paweł Nauman1, Wiesław Bonicki1
DOI: 10.5114/ninp.2012.31352
Neurol Neurochir Pol 2012;46(5):428-435.

Abstract

Background and purpose

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.

Material and 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.

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Neurologia i Neurochirurgia Polska