Deep brain and motor cortex stimulation for post-stroke movement disorders and post-stroke pain

Area of Science:

• Neurosurgery
• Neurology
• Rehabilitation Medicine

Background:

• Post-stroke movement disorders and pain significantly impact patient quality of life.
• Existing treatments for these conditions have limitations.

Purpose of the Study:

• To review the efficacy of deep brain stimulation (DBS) and motor cortex stimulation (MCS) for post-stroke movement disorders and pain.
• To compare the effectiveness of DBS and MCS in specific patient populations.

Main Methods:

• Review of clinical experience with DBS targeting thalamic nuclei (ventralis oralis posterior et intermedius) for movement disorders.
• Review of clinical experience with DBS targeting thalamic nucleus ventralis caudalis or internal capsule for pain.
• Review of clinical trials involving MCS for post-stroke pain and associated movement disorders.

Main Results:

• DBS of thalamic nuclei was effective in over 70% of patients with post-stroke involuntary movements.
• DBS of the thalamic nucleus ventralis caudalis or internal capsule showed disappointing results for post-stroke pain.
• MCS achieved excellent pain control in approximately 50% of patients and also managed co-existent movement disorders.

Conclusions:

• DBS is a valuable option for post-stroke movement disorders.
• MCS is a promising therapy for post-stroke pain, with potential benefits for associated movement issues.
• MCS may be preferred when involuntary movements and pain coexist, especially if DBS exacerbates pain.