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Motor cortex stimulation in patients with chronic central pain
Paweł Sokal1, Marek Harat1, Piotr Zieliński1
1Department of Neurosurgery, Military Research Hospital, Bydgoszcz, Poland.
Summary
Motor cortex stimulation (MCS) effectively reduces refractory neurogenic pain. This neuromodulation technique showed significant pain reduction, particularly for thalamic pain syndrome, with long-term benefits observed in a majority of patients.
Area of Science:
- Neurosurgery
- Neuromodulation
- Pain Management
Background:
- Refractory central neurogenic pain poses a significant clinical challenge.
- Motor cortex stimulation (MCS) is an established neuromodulation therapy for such conditions.
Purpose of the Study:
- To retrospectively evaluate the efficacy of motor cortex stimulation (MCS) in patients with various types of refractory neurogenic pain.
- To identify factors influencing treatment outcomes.
Main Methods:
- Retrospective analysis of 14 patients treated with MCS between 2005 and 2013.
- Procedures utilized neurosurgical navigation and intraoperative neurophysiological monitoring.
- Outcomes assessed using Visual Analog Scale (VAS) scores with 1-6 year follow-up.
Main Results:
- MCS demonstrated a statistically significant reduction in pain intensity (p<0.0036).
- Long-term excellent ( >80% pain reduction) and satisfactory (50-80% pain reduction) outcomes were achieved in 31% and 23% of patients, respectively.
- Highest efficacy was observed in post-stroke/hemorrhagic thalamic pain (71%), while outcomes were independent of patient demographics or electrode parameters.
Conclusions:
- Motor cortex stimulation (MCS) is effective in significantly reducing neurogenic pain intensity.
- Thalamic syndrome patients exhibited the best long-term outcomes.
- While no predictors for success were identified, careful patient selection, electrode placement, and parameter adjustment are crucial for optimizing MCS efficacy.
