Recent Studies in Motor Cortex Stimulation for Neuropathic Pain

1

I have been wandering through medical literature looking for recent studies pertaining to Trigeminal Neuralgia pain. One of the reports that turned up on Pub Med (via the Medifocus Guide) pertains to Motor Cortex Stimulation as a treatment for neuropathic pain. Some aspects of neuropathy seem to pertain to TN, though it wasn't clear in the abstract if any of the reported work was directed to TN.

Since MCS has come up a few times here during the last few months, I've clipped the following abstract:

J Neurosurg. 2009 Feb;110(2):251-6.

Efficacy and safety of motor cortex stimulation for chronic neuropathic pain: critical review of the literature.

Fontaine D, Hamani C, Lozano A.

Source

Department of Neurosurgery, Centre Hospitalier Universitaire de Nice, Université de Nice-Sophia Antipolis, Nice, France.

Abstract

OBJECT: The authors systematically reviewed the published literature to evaluate the efficacy of and adverse effects after motor cortex stimulation (MCS) for chronic neuropathic pain.

METHODS: A search of the PubMed database (1991-2006) using the key words "motor cortex," "stimulation," and "pain" yielded 244 articles. Only original nonduplicated articles were selected for further analysis; 14 studies were identified for critical review. All were series of cases and none was controlled. The outcomes in 210 patients were assessed and expressed as the percentage of patients that improved with the procedure.

Results

A good response to MCS (pain relief > or = 40-50%) was observed in approximately 55% of patients who underwent surgery and in 45% of the 152 patients with a postoperative follow-up > or = 1 year. Visual analog scale scores were provided in 76 patients, revealing an average 57% improvement in the 41 responders. A good response was achieved in 54% of the 117 patients with central pain and 68% of the 44 patients with trigeminal neuropathic pain. Adverse effects were reported in 10 studies, including 157 patients. Infections (5.7%) and hardware-related problems (5.1%) were relatively common complications. Seizures occurred in 19 patients (12%) in the early postoperative period, but no chronic epilepsy was reported.

Conclusions

The results of the authors' review of the literature suggest that MCS is safe and effective in the treatment of chronic neuropathic pain. Results must be considered with caution, however, as none of the trials were blinded or controlled. Studies with a better design are mandatory to confirm the efficacy of MCS for chronic neuropathic pain.

PMID:
18991496
[PubMed - indexed for MEDLINE]
===============
Regards, Red
2

Wow that looks really interesting. It could perhaps help people where MVD's might not have helped or even ATN patients! That is if they looked into TN and ATN.

3

Haven't been through your web site research materials which are huge; but, I definitely will. Here are my favorites on MCS covering 2006 through 2011 with many from PubMed:

1. http://www.medscape.com/viewarticle/554866_5

Motor Cortex Stimulation and Neuropathic Facial Pain: Efficacy of MCS

2. http://www.medscape.com/viewarticle/554867

Motor Cortex Stimulation for Intractable Pain by Richard K. Osenbach, M.D.

3. http://www.ncbi.nlm.nih.gov/pubmed/18728574

Subdural motor cortex stimulation for central and peripheral neuropathic pain: a long-term follow-up

study in a series of eight patients.

4. http://www.ncbi.nlm.nih.gov/pubmed/18991496

Efficacy and safety of motor cortex stimulation for chronic neuropathic pain: critical review of the literature

5. http://www.ncbi.nlm.nih.gov/pubmed/21273738

Efficacy of motor cortex stimulation for intractable central neuropathic pain: comparison of stimulation

parameters between post-stroke pain and other central pain

6. http://www.ncbi.nlm.nih.gov/pubmed/19336459

Motor cortex stimulation for the treatment of refractory peripheral neuropathic pain Brain. 2009 Jun;132(Pt 6):1463-71. Epub 2009 Mar 31.

7. http://www.ncbi.nlm.nih.gov/pubmed/20633375

Treatment of chronic neuropathic pain by motor cortex stimulation: results of a bicentric controlled

crossover trial Brain Stimul. 2008 Apr;1(2):89-96.

8. http://www.ncbi.nlm.nih.gov/pubmed

Results for Motor Cortex Stimulation: 11 (7 were deleted because they are in a foreign language or prior to 2006). It seems a search using the same search words often yields different results each time.

a. Neurol Med Chir (Tokyo). 2011;51(1):8-14.

Efficacy of motor cortex stimulation for intractable central neuropathic pain: comparison of stimulation

parameters between post-stroke pain and other central pain.

b. Acta Neurochir Suppl. 2007;97(Pt 2):51-6.

Stimulation of primary motor cortex for intractable deafferentation pain.

c. Eur J Neurol. 2007 Sep;14(9):952-70.

EFNS guidelines on neurostimulation therapy for neuropathic pain. Cruccu G, Aziz TZ, Garcia-Larrea L, Hansson P, Jensen TS, Lefaucheur JP, Simpson BA, Taylor RS. 4. Acta Neurochir Suppl. 2007;97(Pt 2):37-44. Motor cortex stimulation for neuropathic pain. Lazorthes Y, Sol JC, Fowo S, Roux FE, Verdié JC 5. Acta Neurochir Suppl. 2006;99:57-9. Stimulation of primary motor cortex for intractable deafferentation pain. Saitoh Y, Hirayama A, Kishima H, Oshino S, Hirata M, Kato A, Yoshimine T.

d. Stereotact Funct Neurosurg. 2001;77(1-4):183-6.

Motor cortex stimulation for post-stroke pain: comparison of spinal cord and thalamic stimulation.

4

Red does exercise help with ATn??? Thank you dean

RonaldS said:

Haven’t been through your web site research materials which are huge; but, I definitely will. Here are my favorites on MCS covering 2006 through 2011 with many from PubMed:

1. http://www.medscape.com/viewarticle/554866_5

Motor Cortex Stimulation and Neuropathic Facial Pain: Efficacy of MCS

2. http://www.medscape.com/viewarticle/554867

Motor Cortex Stimulation for Intractable Pain by Richard K. Osenbach, M.D.

3. http://www.ncbi.nlm.nih.gov/pubmed/18728574

Subdural motor cortex stimulation for central and peripheral neuropathic pain: a long-term follow-up

study in a series of eight patients.

4. http://www.ncbi.nlm.nih.gov/pubmed/18991496

Efficacy and safety of motor cortex stimulation for chronic neuropathic pain: critical review of the literature

5. http://www.ncbi.nlm.nih.gov/pubmed/21273738

Efficacy of motor cortex stimulation for intractable central neuropathic pain: comparison of stimulation

parameters between post-stroke pain and other central pain

6. http://www.ncbi.nlm.nih.gov/pubmed/19336459

Motor cortex stimulation for the treatment of refractory peripheral neuropathic pain Brain. 2009 Jun;132(Pt 6):1463-71. Epub 2009 Mar 31.

7. http://www.ncbi.nlm.nih.gov/pubmed/20633375

Treatment of chronic neuropathic pain by motor cortex stimulation: results of a bicentric controlled

crossover trial Brain Stimul. 2008 Apr;1(2):89-96.

8. http://www.ncbi.nlm.nih.gov/pubmed

Results for Motor Cortex Stimulation: 11 (7 were deleted because they are in a foreign language or prior to 2006). It seems a search using the same search words often yields different results each time.

a. Neurol Med Chir (Tokyo). 2011;51(1):8-14.

Efficacy of motor cortex stimulation for intractable central neuropathic pain: comparison of stimulation

parameters between post-stroke pain and other central pain.

b. Acta Neurochir Suppl. 2007;97(Pt 2):51-6.

Stimulation of primary motor cortex for intractable deafferentation pain.

c. Eur J Neurol. 2007 Sep;14(9):952-70.

EFNS guidelines on neurostimulation therapy for neuropathic pain. Cruccu G, Aziz TZ, Garcia-Larrea L, Hansson P, Jensen TS, Lefaucheur JP, Simpson BA, Taylor RS. 4. Acta Neurochir Suppl. 2007;97(Pt 2):37-44. Motor cortex stimulation for neuropathic pain. Lazorthes Y, Sol JC, Fowo S, Roux FE, Verdié JC 5. Acta Neurochir Suppl. 2006;99:57-9. Stimulation of primary motor cortex for intractable deafferentation pain. Saitoh Y, Hirayama A, Kishima H, Oshino S, Hirata M, Kato A, Yoshimine T.

d. Stereotact Funct Neurosurg. 2001;77(1-4):183-6.

Motor cortex stimulation for post-stroke pain: comparison of spinal cord and thalamic stimulation.

5

See my response to your other posting, Dean... Regards,

6

One footnote, Dean: I am beginning to wade through the references you provided. My instinct is that I may have another section to write in the Face Pain Info article beneath the tab of the same name in our site menus. Thanks for the extensive knowledge base you provided.

Regards, Red

7

When I spoke to the researcher/neurosurgeon, he considered this a Plan B for me. He feels that there is a high rate of success for neuropathic pain.

JanetM

8

Would this help my dad who has Neuropathy in his legs??????????

THANKS!

9

Dancer, you'd have to determine first what is causing the peripheral neuropathy. If it's secondary to diabetes, then I doubt that motor cortex stimulation will do much to help him.You'd have to consult with a neurosurgeon to get an authoritative answer.

Regards, Red